Abstract
There has been an increasing role in the use of injectable fillers for rejuvenation
of the aging face. In this systematic review, we aim to evaluate the existing literature
related to soft tissue fillers of the midface. Specifically, we focus on the non-hyaluronic
acid fillers including polymethylmethacrylate (PMMA), poly-L-lactic acid (PLLA), calcium
hydroxyapatite (CaHA), and autologous fat. A systematic review was conducted in November
2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines with PubMed and Embase databases. Medical Subject Headings terms
used were “cheek” OR “midface” OR “malar” and “filler” OR “poly-L-lactic acid” OR
“calcium hydroxyapatite,” “autologous fat” OR “polymethylmethacrylate” OR “Artefill”
OR “Bellafill” OR “Radiesse” OR “Sculptra.” The initial search identified 271 articles.
After 145 duplicates were removed, 126 studies were screened for relevance by title
and abstract. A total of 114 studies were eliminated based on inclusion and exclusion
criteria. Twelve articles underwent full-text review. Seven articles were included
in the final analysis consisting of four non-hyaluronic filler products: PMMA, PLLA,
CaHA, autologous fat. Most patients were highly satisfied with their results. Due
to the gradual volumizing effects of PMMA, PLLA, and CaHA, patient satisfaction generally
improved over time. Minor adverse reactions related to treatment included bruising,
swelling, and pain. Nodule formation was reported in PLLA and CaHA studies. For autologous
fat, 32% of the original injection volume remained at 16 months post-treatment, which
still provided clinically improved malar enhancement. Dermal fillers are an attractive
treatment option for the aging face due to their high patient satisfaction, long-lasting
effects, and low side-effect profile. Patients should be appropriately counseled on
the delayed effects of non-HA fillers. Autologous fat is a good option in many patients
with the major drawback of unpredictable longevity, which may require a secondary
procedure. Future studies should examine the longevity and long-term side effects
of these fillers.
Keywords
facial filler - autologous fat - midface augmentation - cheek - rejuvenation
