Injectable Fillers

Botulinum injections Botox

During the last few years it has become very popular to use a long known nerve poison for medical or for cosmetic medical purposes. The botulin poison is produced by the botulin bacteria which is a septic bacterium often found in canned meat, for instance. The botulin poison is utterly poisonous and in small amounts lethal for humans. The poison blocks the impulses to muscles and paralyzes them. In man this leads to respiratory palsy.
It is this paralytic effect taken advantage of in the medical or medical cosmetic treatment.

Principle: With very minor amounts and very low concentrations of the poison, Botox, injected in a particular muscle, the muscle gets paralyzed and can not contract. The folds of the muscle at contraction cause the visible folds and rhytides in the skin. As the muscles do not contract the mimic disappears as well and the look of the area treated is stiff and without expression. The poison slowly breaks down and with that the effect, mostly within 2 - 3 months. To get a lasting effect repeated injections are necessary.

Side effects: The paralytic effect arises where the poison comes in contact with muscular tissues. Due to gravity the injected Botox may migrate downwards and come to muscles not intended. This can lead to embarrassing diplopia if the muscles of the eyes are affected.

The small amounts used should not cause any general symptoms. The maximal effect is gradually seen after 2 - 3 days. The treatment itself is invisible.

AQUAMID

Recently a new filler for permanent tissue augmentation by injection was introduced in Europe, Aquamid® . The information about this material is put in front of our normal information on lip augmentation, which of course still should be read by anyone seeking information about this type of operation. The clinic expects the treatment with Aquamid® to replace some of the suggested operations.

As general tissue augmentation like breasts, lips, malars, chins and calf for a long time have been and still are demanded corrections, the industry has been seeking a suitable substance for this indication. Through years injectables with time restricted durability like collagen and hyaluronic acids have been used. Due to resorbtion the injections had to be repeated. Allergic reactions have been reported.

Other injectable substances with more or less permanent durability have also been used. These are silicone and polymethylmethacrylate, which can aggregate and cause lumps or disappear depending on the molecular size. Again other materials as a permanent filler is the Gortex® tube. Autologous tissues with a variety of long term results have been used. Fat injections do mostly have a transient filling effect and are no alternatives for permanent augmentation. Fat-dermis or fascia implants do commonly have a permanent filling effect, although they can be absorbed. Acellular implants from corps does also exist for this purpose. Biologic auto transplants need vascular ingrowth to survive and if this does not occur, the material is partially or totally absorbed.

Bigger augmentations like breasts, muscle, buttocks etc. can only be achieved by implants today.

Aquamid® is a neutral hydrogel consisting of a stable chain of polyacrylamide in 90% of water. Polyacrylamide should not be confused with the poisonous acryl amide. The gel can be directly injected into the subcutis where it integrates with the tissues. If injected gel is to be removed, it can at least partially be aspirated or pressed out during the fist 8 months after injection. After this time there is an ingrowth of fibrous tissues into the gel which makes a surgical removal necessary to ablate it. Polyacrylamide gel has been used successfully for over 10 years in Ucraine, mostly for breast augmentation and facial corrections. The cosmetic results have been excellent with a very low frequency of side effects/complications of about 0,02%.

This information is related to facial corrections as the only officially cleared indication.

Method: With a very thin needle, the gel can be introduced into areas to be filled or enlarged.

Typical areas:
Malar region, chin, cheeks, lips and nose.

There will be a short swelling and erythema that will disappear within 12 hours.

There will be no pain.

The injected gel stays soft or hard depending of the injection technique and it does not migrate.

The treatment is done under local or general block anaesthetic. The anaesthesia makes the face feel hard and big, but have no fear, it is invisible! The analgesia disappears within a couple of hours.

No after treatment is needed.

Side effects:

	No reports of any complications so far.
	Irregularities can occur. This can be corrected by massaging or secondary injections. It is important that the physician should be able to see and to manage these side effects.
	Sometimes it is difficult to decide what volume is aesthetically needed. If one is in doubt, it is better to give a secondary treatment later than to inject to much. · Injected Aquamid® can be firm for a month. It softens gradually with time.

Texten är redigerad och kontrollerad av doktor Per Gunnar Opitz hos Opitz plastikkirurgiska klinik i Malmö