WHAT MATERIAL TO CHOOSE?
In general, reabsorbable materials are preferably used in peribucal wrinkles, in the upper third of the face and in people who only want temporary results. These products have a satisfactory duration of about 6 to 9 months in general (except for the product used in cheek or chin augmentation that lasts approximately 18 months). After that time, touch ups with new injection of the material is advisable.
Non-reabsorbable materials are used in subjects who wish longer lasting results.
At Instituto Médico Láser, we use materials that in our experience offer maximum safety and that ensure excellent results. These are the most important:
A) Hyaluronic Acid:
This is the most widely used implant to fill wrinkles. Clinicians have been using it since the 70s.
Its advantages:
High biocompatibility.
No allergy testing required.
It is reabsorbable: metabolism of hyaluronic acid is well known (CO2+H20).
It is a uniform lineal polysaccharide with the same chemical structure in all species and tissues.
Indications:
All types of skin deficits, wrinkles, scars, hypovolumetries.
Lip reshaping.
Modelling of face contour (recontouring).
Facial aging.
A thorough understanding of the different materials of hyaluronic acid that can be used and an adequate management of these materials, ensures immediate and natural looking results.
Secondary effects: As with other implants, oedema or reddening at the injection site might appear for two or three days. Hyaluronic acid is one of the safest products available, although it is not risk-free and it can cause problems such as induration or fibrosis.
Incompatibilities:
Known incompatibility with hyaluronic acid and quaternary ammonia salts such as benzalkonium chloride. Thus it is imperative that the product does not come into contact with such products or with surgicomedical products treated with these products. No interactions between hyaluronic acid and other filling implants have been studied and thus extreme precaution must be exerted in case other filling implant has been or is injected into the dermis.
Contraindications:
Intolerance to hyaluronic acid.
Coagulation/clotting anomalies.
Infections or severe immune disorders.
In case of recurrent herpes, prophylaxis prior to implantation should be carried out.
There is a wide range of products of different particle size to adapt to the tissue to be treated.
B) Polylactic Acid (Sculptra):
A biomaterial belonging to the aliphatic polyesters family that is widely used in medicine: reabsorbable sutures, prosthesis, bone implants, etc…
It is a biodegradable polymer that is excreted from the body without active metabolites or residual products.
This material is used as guide for induction of collagen formation and thus results are not immediate. Several sessions are usually necessary at 4 to 6 weeks intervals for optimal results. Improvement is progressive depending on the number of sessions performed (2 to 3 are usually required).
Indications:
It is not used for individual wrinkles but in larger areas such as puppet lines, cheeks. Polylactic acid is not the best option for craws feet, forehead lines, furrow lines, neck or perioral lines where hyaluronic acid would be better
Side effects:
Allergic reactions are exceptional (so no sensitivity testing is required) and granulomas are very rare.
C) Polyacrylamide (Aquamid):
Characteristics:
This is a permanent filler (non.reabsorbable)
Physically and chemically stable product.
Atoxic.
Stable (does not migrate).
Non-allergenic.
Contains the highest water content of commercialised injectables (97.5%).
Indications:
It is used in different indications but generally it is used the most in lip augmentation.
Side effects:
Local discomfort due to oedema for 2 to 3 days. Low risk of complications at mid term (granulomas or fibrosis)
Contraindications:
It cannot be used near areas with inflammation or skin diseases.
It cannot be used together with other filling materials for soft tissue deficit.
It cannot be injected in cases of active herpes.
It cannot be injected in patients with coagulopathy (clotting anomalies), infectious or severe immune diseases.