© Thieme Medical Publishers
Contemporary Neurotoxins and Injectable Fillers
28 December 2011 (online)
The last decade or so has brought a remarkable evolution in nonsurgical facial treatments. This is especially true in the area of injectable treatments for facial rhytids, volume restoration and augmentation, and muscular hyperactivity. The facial plastic surgeon now has a wide array of injectable products available for the management of everything from facial spasm to fine rhytids to extensive soft tissue atrophy and volume loss. New technologies that have evolved have reduced potential complications from more traditional fillers such as bovine collagen, while at the same time a variety of products have been optimized for specific esthetic or anatomic problems.
This edition of Facial Plastic Surgery is devoted to this ever-expanding array of injectable fillers and neuromodulators. Although still available, collagen-based fillers have not been included in this edition as their clinical use has dwindled and in fact they will soon no longer be available in the United States. Newer filler materials—most notably hyaluronic acid products—have emerged and replaced collagen fillers for most clinicians. These newer fillers have a better safety profile with minimal allergic potential and also tend to have longer and more predictable clinical results. The various hyaluronic acid fillers will be covered extensively in this issue.
Articles are dedicated to discussions of longer-lasting fillers such as calcium hydroxyapatite and permanent fillers based on polymethyl methacrylate. These articles address appropriate applications, techniques, and potential hazards of these long-term fillers. Another article is also devoted to injectable poly-l-lactic acid fillers, which recently received Food and Drug Administration (FDA) approval for esthetic facial augmentation purposes.
Recently, new options for facial neuromodulator treatments became available and FDA-approved applications were expanded. In addition to onabotulinum toxin A, another related neuromodulator, abobotulinum toxin A, became available. The differences between these products are discussed as well as appropriate clinical uses and indications. Recently, FDA approval was granted for the use of these products in the treatment of migraine headaches, and it is expected that additional applications will become recognized in the future.
As injectable filler and neuromodulator treatments have become widespread and are being performed by increasingly diverse practitioners, concerns for patient safety have grown. In response to this, the Physicians Coalition for Injectable Safety (PCIS) was established. The PCIS is a true multispecialty consortium that was founded by the leading organizations of board-certified physicians involved in facial plastic and esthetic surgery. The goal of this organization is to educate the public about approved injectable fillers and to eliminate the practice of unqualified persons performing facial injections. The reader is encouraged to support the PCIS (visit their website at http://www.injectablesafety.org) and to refer patients to this website for up-to-date and factual information about fillers and injectables. The site has many patient-oriented materials including videos and planning information.