Facial Volume Restoration with Permanent Dermal Filler (Artecoll-4) in Chinese Women

Review of Plastic Surgery Biomaterials and Current Progress in Their 3D Manufacturing Technology

Plastic surgery is a broad field, including maxillofacial surgery, skin flaps and grafts, liposuction and body contouring, breast surgery, and facial cosmetic procedures. Due to the requirements of plastic surgery for the biological safety of materials, biomaterials are widely used because of its superior biocompatibility and biodegradability. Currently, there are many kinds of biomaterials clinically used in plastic surgery and their applications are diverse. Moreover, with the rise of three-dimensional printing technology in recent years, the macroscopically more precise and personalized bio-scaffolding materials with microporous structure have made good progress, which is thought to bring new development to biomaterials. Therefore, in this paper, we reviewed the plastic surgery biomaterials and current progress in their 3D manufacturing technology.

Risk Comparison of Filler Embolism Between Polymethyl Methacrylate (PMMA) and Hyaluronic Acid (HA)

Background

The incidence of vascular complications varies among different fillers. The main purpose of this study was to compare the risk of embolism between PMMA (Artecoll) and hyaluronic acid (HA, Restylane) after artery injection.

Methods

Rabbit ears were injected via the central artery with 0.1 ml PMMA (group A), 0.1 ml HA (group B), 0.2 ml PMMA (group C), or 0.2 mL HA (group D), respectively. The formation of transparent emboli was monitored right after injection. Tissue necrosis and histopathological changes were analyzed on day 7.

Results

With 0.1 ml injected volume, PMMA was dispersed within a few minutes and only 5% of the injected ears had mild necrosis on day 7, while HA tended to form obvious transparent emboli, an indication of blood vessel clotting, and 60% of injected ears showed necrosis on day 7. With 0.2 ml injected volume, PMMA had a risk of complete blood vessel clotting in between 0.1 ml PMMA group and 0.1 ml HA group, and 30% of injected ears had necrosis; in contrast, 100% of 0.2 ml HA-injected ears showed transparent emboli and necrosis. The necrosis areas were significantly increased in the HA groups compared with PMMA groups at the same injection volumes. HA injection also caused dilation of small blood vessels.

Conclusion

At the same injection volume, PMMA had less risk of embolism compared with HA. With increased injection volume, there were increased risks of embolism and necrosis for both PMMA and HA.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Electronic supplementary material

The online version of this article (10.1007/s00266-019-01320-w) contains supplementary material, which is available to authorized users.

Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics

BACKGROUND

Considering that aesthetic benefits can be obtained with the use of permanent filling materials, this work focuses on the development of a consensus regarding the facial and corporal use of polymethylmethacrylate (PMMA) filler in Brazil.

METHODS

A questionnaire regarding PMMA treatment, which included items on the main indication, application site, volume of product applied, criteria for selection of the material, complications, contraindications, and individual professional experience, was distributed to the Expert Group members. In addition, the responses were summarized, constituting the starting point for the debate regarding the use of PMMA-based fillers on The First Brazilian PMMA Symposium to create a guideline to be followed in PMMA facial and corporal treatments.

RESULTS

This survey involved 87,371 cases. PMMA treatment is recommended for restorative and aesthetic purposes in facial and corporal cases, particularly for facial balance. PMMA 30% filler is recommended in specific facial sites (nose, mentum, mandible angle, zygomatic arc, and malar). PMMA filler is contraindicated in other sites (lips) regardless of concentration. With regard to facial treatment, the juxtaperiostal is the application plane most recommended. For PMMA corporal application, intramuscular is the application plane most indicated, while intradermal and justadermal planes are contraindicated. The submuscular plane application is relative to PMMA filler concentration. The experts also inquired regarding the amount of PMMA recommended in each corporal site (50 mL in the calf, 100-150 mL in the gluteal region).

CONCLUSION

These recommendations provide a guideline for physicians, supporting them to perform safe and efficacious treatment with PMMA fillers.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .