Office – Based Facial Cosmetic Procedures

Abstract

2.1. Background Various materials for facial rejuvenation, such as wax, silicone and animal products have been used. In 1893, Neuber used autologous fat transfer for soft tissue augmentation [1]. Paraffin and vaseline were injected for soft tissue augmentation, just a few years later [2]. In 1940 liquid silicone was injected for cosmesis [3,4]. Bovine collagen injection became popular in 1980 [1]. 2.2. Anatomy of the skin Human skin has several layers. The most superficial layer which acts as a barrier is the epidermis. The deeper layer to epidermis is the dermis and it consists of the papillary dermis and the reticular dermis. The papillary dermis contains a web of primarily type 3 collagen that reaches the epidermis. The reticular dermis is primarily made of type 1 collagen fibers [5]. Elastic fibers are very low and they are responsible for skin resiliency. Ground substance is also a part of dermis and is composed of hyaluronic acids, glycosaminoglycans and proteins and it fills the spaces between other components of dermis [6]. Sub cutis which is seen under the dermis, consists of fat which is responsible for skin volume.The amount of skin collagen decreases with aging, which affects primarily type 1 collagen fibers [5]. In addition to aging, exposure to tobacco smoke and excessive sun can cause a decrease in collagen fiber contents by increasing collagenase levels responsible for wrinkle formation by loss of skin elasticity and turgor [7]. 2.3. Filler types Injectable filler products are syringes containing filler agents. Their needle size is proportional to the filler viscosity; the higher the viscosity, the larger the needle lumen. The smallest appropriate needle size is used to minimize injection pain [8].High viscous agents are generally used for deeper defects and lower viscous fillers are ideal for superficial defects [1]. The depth of the injection is also important. For superficial defects, the needle tip enters the skin very superficially, but for moderate defects, the level of entrance is mid to deep dermis, and for deeper defects, the needle tip enters at the level of dermal-sub cutis junction. After injection, gentle massage is required for evenness of the injected material.An ideal filler agent must meet criteria such as biocompatibity, and be non-antigenic, non-toxic, easy to handle, long-lasting, inexpensive and reversible [8,9].Generally filler agents are categorized into three groups, according to their duration: first, non-permanent fillers, which are shortlasting fillers and they need repeated injections after their resorption. Second, semi-permanent fillers, which last longer but they will undergo some resorption as well. Third, the permanent fillers which may be long lasting with only a single injection. 2.3.1. Non-permanent fillers 2.3.1.1. Collagen replacements These agents are purified bovine or human collagen and before the advent of Hyaluronic acid filler, was the 'gold standard' filler agents for many years. Bovine collagen was the first Office-Based Facial Cosmetic Procedures