Dermal fillers are made of various kinds of natural and man-made or synthetic materials that have been developed over the years for injection into the skin.

This is not a new treatment. As early as the 1890s, doctors could take fat from patients' arms and inject it into their faces. In the mid 1900s, doctors were using paraffin and then silicone as a filler in the skin, with some reported problems regarding safety that prevented them being used widely.
In the U.S.A. in the 1980s, scientists discovered a type of collagen (a filler material) which occurs naturally in cows' skin that proved to be safe in humans. At this point, the use of fat as a filler material was overtaken by this new collagen.
According to Statistics from the American Society for Aesthetic Plastic Surgery, (ASAPS) collagen injections were the 11th commonest aesthetic procedure in the U.S. with more than 220,000 treatments in 2005 alone. This is in fact a 72% decrease compared to 2004 figures. 
Although similar statistics are not yet available in South Africa. , there has been tremendous growth in the use of collagen and other dermal fillers in this country. More people than ever are having this treatment because it works, it is not as expensive as a face lift and it doesn't involve any surgery.

Along with a trend toward living a longer, healthier life, more and more patients are looking to physicians to help them achieve a more youthful appearance. The skin's natural aging process manifests as contour changes and rhytids secondary to the depletion of subcutaneous fat and the loss of dermal collagen.

Traditionally, rejuvenation has been achieved with a face-lift by surgically tightening the skin. Today, a multitude of minimally invasive procedures are aimed at rejuvenation without the risk, recovery time, and expense of major surgery. The development and popularity of BOTOX® has opened the door for equally noninvasive, adjunctive treatment of dynamic rhytids.

Soft tissue augmentation has become a popular means of addressing contour defects that result from aging, photodamage, trauma and/or scarification, or disease. Dozens of filling agents exist in the armamentarium; therefore, the physician is responsible for knowing which substance is best suited to address a particular defect and the patient.

Background And History

Although humans have been practicing the art of tissue augmentation since ancient times and despite a renaissance in implant technology in the last several decades, to date no perfect substance for soft tissue augmentation exists. A consensus exists on the properties of the ideal dermal filler; these properties include the following:

Modern soft tissue augmentation dates back to the late 19th century when Neuber first used autologous fat to correct depressed facial defects. Shortly thereafter, in the early 1900s, injectable paraffin gained popularity until a high incidence of foreign body granuloma formation was discovered. In the 1940s, the use of highly refined injectable silicone emerged as a dermal implant, with excellent cosmetic results and high use potential. However, because of the high abuse potential and untoward adverse effects from adulterated compounds, its use as a cosmetic agent has been banned.

The last several decades have seen an explosion in technologic advances contributing to a cascade of new dermal implants. Injectable bovine collagen was developed in the 1970s. Approved by the FDA in 1981, it has remained the industry criterion standard. In the 1980s, Fibrel was introduced and then approved by the FDA for dermal augmentation. Fibrel works by forming a clot, which, in turn, stimulates collagen synthesis. In the face of the AIDS epidemic and a concern for blood-borne diseases, the company later pulled Fibrel off the market, reconsidering the use of human serum for product reconstitution. With the emergence of liposuction in the late 1970s, fat once again became a convenient source for tissue augmentation. In the late 1980s, autologous collagen processed from harvested fat was first used for dermal augmentation.

The most recent advances in dermal filling technology are in the form of hyaluronic acid derivatives, harvested and cultured autologous dermal implants, allogeneic products, and synthetically derived products. Continuing research promises that advances, such as recombinant human collagen, are on the horizon.

Summary

The keys to a successful outcome in soft tissue augmentation are in knowing which implant best corrects a particular defect and in knowing how and when to intervene if adverse or unsatisfactory reactions occur. Of equal importance is the selection of a patient with reasonable expectations, with full disclosure of the risks. Consulting with the patient preoperatively is important to conduct a thorough history and physical examination, to discuss risks and benefits, to identify contraindications, and to review expectations and limitations.