DermaLive is a long-term wrinkle reduction product including two types of components: pure hyaluronic acid, produced in cell culture, and an acrylic hydrogel. The product was first marketed in France and the rest of Europe in 1998. We have over three years of experience with this product. Several studies have been conducted simultaneously, mainly in Germany and in France. At present, DermaLive is used in the long-term correction of natural or acquired skin depressions (caused by aging, trauma) or the creation of volume (lips, sunken cheekbones). It provides a worthwhile alternative to good-quality bioresorbable materials (pure hyaluronic acid or collagen)--materials that are so resorbable, in fact, that most patients are ultimately dissatisfied with the results--and to other so-called permanent materials that patients do not tolerate well. Filling involving the use of autologous fat transplantations, which yields satisfactory results, is not appropriate for ambulatory injection and, therefore, will not be examined in detail. The tolerance experienced with DermaLive three years on is, at present, considered highly satisfactory. The wrinkle reduction effect obtained after the first injection is long-lasting with 60% resorption of the initial material. Two or three injections, with an interval of at least three months between each, may be required to bring about the reduction of some wrinkles or the correction of post-scar depressions. Side effects occurring long after the injection are rare (1.2 for 1,000). They appear mainly as palpable nodules occurring about six months after injection. They are treated by intralesional injection of corticoids. DermaLive and DermaDeep are both filler implants with a long-lasting effect designed for corrective and aesthetic surgery. Instruction of use and intervals between injection sessions must be respected. After DermaLive or DermaDeep injection, injections of pure hyaluronic acid (Juvederm or Restylane) for treatment of fine lines and superficial defects yield safe and excellent aesthetic results.

Soft tissue fillers for wrinkle treatment and facial reshaping offer numerous advantages for both doctors and patients. They are extremely well tolerated and efficacious and can produce long-lasting improvement with regular use. In this article a detailed, thorough review of the resorbable injectable filler implants available on the international market is offered and the most suitable for various treatment areas are identified. The chemical nature, formulation, indications, recommendations for technique, and possible side effects of each family of fillers are described.

There are now many injectable implants for face remodeling since the first product appeared in Europe in 1984. The treatment regions most in demand are the cheeks, jaws, lips, and the oval of the face. The aging process is due to fat resorption over the upper two thirds of the face, in addition to the loss of elasticity. Weakness in the skin and subcutaneous fascia becomes more apparent over the lower third of the face. The fat loss together with the slack skin gives the impression of gauntness and loss of volume under the eyes (i.e., the zygomatic and palpebral areas). Treating the zygomatic bone area and subcutaneous tissue by injecting filler products will increase volume around the zygomatic malar bone and subcutaneous area. To choose an implant, we must take into account the patient's wishes, hopes (whether temporary or long-lasting effects are required), age, skin type (dry, moist, greasy, thick, or thin), and the patient's medical history to prevent obvious contraindications in the choice of implant due to type of product, especially in the case of allergies, inflamed areas, or any suspicion of autoimmune disease or recent infection.

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