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Vol. 101. Issue 5.
Pages 381-393 (June - July 2010)
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Vol. 101. Issue 5.
Pages 381-393 (June - July 2010)
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Dermal Fillers: Types, Indications, and Complications
Materiales de relleno: tipos, indicaciones y complicaciones
I. Sánchez-Carpintero
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Corresponding author.
, D. Candelas, R. Ruiz-Rodríguez
Unidad de Dermatología, Clínica Rúber, Madrid, Spain
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There are many types of dermal fillers currently used for cosmetic and medical indications in routine clinical practice. Fillers can be classified as temporary, semipermanent, or permanent depending on the length of time the substance remains in tissue. They can also be classified by the composition of the product. Materials can be based on collagen (bovine, porcine, and human), hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, polymethyl methacrylates, and polyacrylamide gels, among others. Temporary fillers are the products most often used for cosmetic purposes, in particular hyaluronic acid. This is due to the ease of application of fillers based on this substance, the good results obtained, and their safety profile. This review presents an overview of the techniques used for the correct placement of dermal fillers and the most common clinical indications for these procedures. It also covers the nature, properties, and mechanisms of action of the principal temporary, semipermanent, and permanent dermal fillers as well as the indications for each type of material. Finally, we describe the most common complications encountered and their treatment.

Dermal fillers
Hyaluronic acid
Poly-L-lactic acid
Calcium hydroxylapatite

Existen numerosos materiales de relleno utilizados en la práctica clínica diaria con fines cosméticos y médicos. Se pueden clasificar, en función de su duración en el tejido, en temporales, semipermanentes y permanentes. También pueden clasificarse de acuerdo con la composición del relleno: colágeno (bovino, porcino y humano), ácido hialurónico, ácido poliláctico, hidroxiapatita de calcio, polimetilmetacrilatos y geles de poliacrilamida, entre otros. Los rellenos temporales son los más empleados con fines estéticos, especialmente el ácido hialurónico. Este hecho se debe al perfil de seguridad que tienen, a la facilidad en su aplicación y a los buenos resultados encontrados. En esta revisión se exponen las diferentes técnicas descritas para su colocación correcta y las indicaciones clínicas más frecuentes. También se describe la naturaleza, las propiedades, los mecanismos de acción y las indicaciones de los principales materiales de relleno, tanto temporales como semipermanentes o permanentes. Finalmente se describen las complicaciones más comunes y su tratamiento.

Palabras clave:
Material de relleno
Ácido hialurónico
Ácido poliláctico
Hidroxiapatita de calcio
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A. Ogden, T.W. Griffiths.
A review of minimally invasive cosmetic procedures.
Br J Dermatol, 159 (2008), pp. 1036-1050
D.W. Buck, M. Alam, J.Y.S. Kim.
Injectable fillers for facial rejuvenation: a review.
J Plast Reconstr Aesthet Surg, 62 (2009), pp. 11-18
J.D.A. Carruthers, R.G. Glogau, A. Blitzer, R.L. Anderson, J.L. Cohen, S.E. Cox, Facial Aesthetics Consensus Group Faculty, et al.
Advances in facial rejuvenation: toxin botulinum type a, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations.
Plast Reconstr Surg, 121 (2008), pp. 5-30
K.L. Beasley, M.A. Weiss, R.A. Weiss.
Hyaluronic acid fillers: a comprehensive review.
Facial Plastic Surg, 25 (2009), pp. 86-94
V. Descamps, J. Landry, C. Francès, E. Marinho, V. Ratziu, O. Chosidow.
Facial cosmetic filler injections as possible target for systemic sarcoidosis in patients treated with interferon for chronic hepatitis C: two cases.
Dermatology, 217 (2008), pp. 81-84
J.L. Cohen.
Understanding, avoiding, and managing dermal filler complications.
Dermatol Surg, 34 (2008), pp. S92-S99
J.P. Arlette, M.J. Trotter.
Anatomic location of hyaluronic acid filler material injected into nasolabial fold: a histologic study.
Dermatol Surg, 34 (2008), pp. S56-S63
J.M. Hilinski, S.R. Cohen.
Volumetric use of injectable fillers in the face.
Facial rejuvenation with fillers, pp. 77-92
A.W. Klein, S. Fagien.
Hyaluronic acid fillers and botulinum toxin type A: a rationale for their individual and combined use for injectable facial rejuvenation.
Plast Reconstr Surg, 120 (2007), pp. 81-88
M.G. Rubin.
Treatment of nasolabial folds with fillers.
Aesthet Surg J, 24 (2004), pp. 489-493
V.S. Lambros.
Hyaluronic acid injections for correction of tear trough deformity.
Plast Reconstr Surg, 120 (2007), pp. 74-80
H.B. Gladstone, J.L. Cohen.
Adverse effects when injecting facial fillers.
Sem Cutan Med Surg, 26 (2007), pp. 34-39
W.T.L. Wu.
Periorbital rejuvenation with injectable fillers.
Facial rejuvenation with fillers, pp. 93-105
S.R. Colleman.
Avoidance of arterial occlusion from injection of soft tissue fillers.
Aesthetic Surg J, 22 (2002), pp. 555-557
R. Sadove.
Injectable poly-L-lactic acid: a novel sculpting agent for the treatment of dermal fat atrophy after severe acne.
Aesthetic Plast Surg, 33 (2009), pp. 113-116
K.C. Smith.
Repair of acne scars with Dermicol-P35.
Aesthet Surg J, 29 (2009), pp. S16-S18
S. Williams, S. Tamburic, H. Stensvick, M. Weber.
Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands.
J Cosmet Dermatol, 8 (2009), pp. 216-225
E.S. Marmur, H. Al Quran, A.P. De Sa Earp, J.Y. Yoo.
A five-patient satisfaction pilot study of calcium hydroxylapatite injection for treatment of aging hands.
Dermatol Surg, 35 (2009), pp. 1978-1984
C. Inglefield.
Nonsurgical hand rejuvenation with Dermicol-P35 30G.
Aesthet Surg J, 29 (2009), pp. S19-S21
M. Glasgold, S.M. Lam, R. Glasgold.
Autologous fat grafting for cosmetic enhancement of the perioral region.
Facial Plastic Surg Clin North Am, 15 (2007), pp. 461-470
L.P. Bucky, A.K. Kanchwala.
The role of autologous fat and alternative fillers in the aging face.
Plast Reconstr Surg, 120 (2007), pp. 89-96
J. Kablik, G.D. Monheit, L. Yu, G. Chang, J. Gershkovich.
Comparative physical properties of hyaluronic acid dermal fillers.
Dermatol Surg, 35 (2009), pp. 302-312
F. Wang, L.A. Garza, S. Kang, J. Varani, J.S. Orringer, G.J. Fisher, et al.
In vivo stimulation of de novo collagen production cause by cross-linked hyaluronic acid dermal filler injection in photodamaged human skin.
Arch Dermal, 143 (2007), pp. 155-163
C.P. Clark.
Animal-based hyaluronic acid fillers: scientific and technical considerations.
Plastic Reconstr Surg, 120 (2007), pp. 27S-32S
P.E. Grimes, J.A. Thomas, D.K. Murphy.
Safety and effectiveness of hyaluronic acid fillers in skin of color.
J Cosmet Dermatol, 8 (2009), pp. 162-168
A.W. Klein.
Techniques for soft tissue augmentation: an “A” to “Z”.
Am J Clin Dermatol, 7 (2006), pp. 107-120
S.L. Matarasso.
Injectable collagens: lost but not forgotten—a review of products, indications, and injection techniques.
Plast Reconstr Surg, 120 (2007), pp. 17-26
L.S. Baumann, A.T. Shamban, M.P. Lupo, G.D. Monheit, J.A. Thomas, D.K. Murphy, JUVEDERM vs ZYPLAST Nasolabial Fold Study Group, et al.
Comparison of smooth gel hyaluronic acid dermal fillers with cross-linked bovine collagen: a multicenter, doublemasked, randomized, within-subject study.
Dermatol Surg, 33 (2007), pp. S128-S135
L. Bauman.
Cosmoderm/Cosmoplast (human bioengineered collagen) for the aging face.
Facial Plast Surg, 20 (2004), pp. 125-128
U.U.I. Bauer, T.M. Born.
Shaping the future: new outcomes in Europe.
Facial rejuvenation with fillers, pp. 121-134
J. Carruthers, A. Carruthers.
Two-center Canadian report on the safety and effectiveness of Evolence Breeze.
J Drugs Dermatol, 8 (2009), pp. 830-834
S.J. Monstrey, S. Pitaru, M. Hamdi, K. Van Landuyt, P. Blondeel, J. Shiri, et al.
A two-stage phase I trial of Evolence 30 collagen for soft tissue contour correction.
Plast Reconstr Surg, 120 (2007), pp. 303-311
S. Gogolewski, M. Jovanovic, S.M. Perren, J.G. Dillon, M.K. Hughes.
Tissue response and in vivo degradation of selected polyhydroxy acids: polylactides (PLA), poly(3-hydroxybutyrate) (PHB), and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB/VA).
J Biomed Mater Res, 27 (1993), pp. 1135-1148
D. Vleggaar.
Soft tissue augmentation and the role of Poly-L-lactic acid.
Plast Reconstr Surg, 118 (2006), pp. 46S-54S
U. Bauer.
Improvement of facial aesthetics at 40 months with injectable poly-L-lactic acid (PLLA).
International Society of Aesthetic Plastic Surgery, (2004),
G.J. Moyle, S. Brown, L. Lysakova, S.E. Barton.
Long term safety and efficacy of poly-L-lactic acid in the treatment of HIVrelated facial lipoatrophy.
A.G. Salles, P.H. Lotierzo, R. Giménez, C.P. Camargo, M.C. Ferreira.
Evaluation of the Poly-L-lactic acid implant for the treatment of the nasolabial fold: 3 year follow-up evaluation.
Aesthetic Plastic Surg, 108 (2008), pp. 496-504
E.S. Marmur, R. Phelps, D.J. Goldberg.
Clinical, histologic and electron microscopic findings after injections of a calcium hydroxylapatite filler.
J Cosmet Laser Ther, 6 (2004), pp. 223-226
M. Busso, P.L. Karlsberg.
Cheek augmentation and rejuvenation using injectable calcium hydroxylapatite (Radiesse).
Cosmetic Dermatol, 19 (2006), pp. 583-588
D.J. Golberg.
Calcium hydroxylapatite.
Fillers in cosmetic dermatology, Informa UK Ltd, (2006),
D. Piacquadio, S. Smith, R. Anderson.
A comparison of commercially available polymethylmethacrylate-based soft tissue fillers.
Dermatol Surg, 34 (2008), pp. S48-S52
M. Alam, J.S. Dover.
Management of complications and sequelae with temporary injectable fillers.
Plast Reconstr Surg, 120 (2007), pp. 98S-105S
S. Fagien.
Facial soft tissue augmentation with hyaluronic acid fillers: Juvederm and Restylane: practical considerations for their use.
Facial rejuvenation with fillers, pp. 11-21
R.J. Hirsch, V. Narurkar, J. Carruthers.
Management of injected hyaluronic acid. Induced Tyndall effects.
Lasers Surg Med, 38 (2006), pp. 202-204
R.S. Narins.
Minimizing adverse events associated with poly-L-lactic acid injection.
Dermatol Surg, 34 (2008), pp. S100-S104
K. Butterwick, N.J. Lowe.
Injectable poly-L-lactic acid for cosmetic enhancement: learning from the European experience.
J Am Acad Dermatol, 61 (2009), pp. 281-293
D.A. Jansen, M.H. Graivier.
Evaluation of a calcium hydroxylapatitebased implant (Radiesse) for facial soft tissue augmentation.
Plast Reconstr Surg, 118 (2006), pp. S22-S30
A. Berlin, J.L. Cohen, D.J. Goldberg.
Calcium hydroxylapatite for facial rejuvenation.
Sem Cutan Med Surg, 25 (2006), pp. 132-137
E.M. Reisberger, M. Landthaler, L. Wiest, J. Schröder, W. Stolz.
Foreign body granulomas caused by polymethylmethacrylate microspheres: successful treatment with allopurinol.
Arch Dermatol, 139 (2003), pp. 17-20
H.J. Brody.
Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement.
Dermatol Surg, 31 (2005), pp. 893-897
J. Alijotas-Reig, V. García-Giménez.
Delayed immune-mediated adverse effects related to hyaluronic acid and acryl hydrogel dermal fillers: clinical findings, long-term follow-up and review of the literature.
J Eur Acad Dermatol, 22 (2008), pp. 150-161
P. Micheels.
Human anti-hyaluronic acid antibodies. Is it possible?.
Dermatol Surg, 27 (2001), pp. 185-191
N.J. Loewe, A. Maxwell, P. Loewe, M.G. Duick, K. Shan.
Hyaluronic acid skin fillers: adverse reactions and skin testing.
J Am Acad Dermatol, 45 (2001), pp. 930-933
A.S. Glaich, J.L. Cohen, L.H. Goldberg.
Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers.
Dermatol Surg, 32 (2006), pp. 276-281
S. Schanz, W. Schippert, A. Ulmer, G. Rassner, G. Fierlbeck.
Arterial embolization caused by injection of hyaluronic acid (Restylane).
Br J Dermatol, 146 (2002), pp. 928-929
R.J. Hirsch, J.L. Cohen, J.D. Carruthers.
Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection. Embolus and a proposed algorithm for management with hyaluronidase.
Dermatol Surg, 33 (2007), pp. 357-360
F. Rongioleti, F. Cattarini, E. Sottofattori, A. Rebora.
Granulomatous reaction after intradermal injection of hyaluronic acid gel.
Arch Dermatol, 139 (2003), pp. 815-816
J. Alcalay, R. Alcalay, A. Gat, S. Yorav.
Late-onset granulomatous reaction to Artecoll.
Dermatol Surg, 29 (2003), pp. 859-862
G. Lemperle, J.J. Romano, M. Busso.
Soft tissue augmentation with Artecoll: 10 year history, indications, techniques and complications.
Dermatol Surg, 29 (2003), pp. 573-587
J.E. Angus, A.G. Affleck, I.H. Leach, L.G. Millard.
Two cases of delayed granulomatous reactions to the cosmetic filler Dermalive, a hyaluronic acid and acrylic hydrogel.
Br J Dermatol, 155 (2006), pp. 1077-1078
M. Rossner, F. Rossner, F. Bachmann, L. Wiest, B. Rzany.
Risk of severe adverse reactions to an injectable filler based on a fixed combination of hydroxyethylmethacrylate and ethylmethacrylate with hyaluronic acid.
Derm Surg, 35 (2009), pp. 367-374
G. Lemperle, N. Gauthier-Hazan, M. Wolters, M. Eisemann-Klein, U. Zimmermann, D.M. Duffy.
Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.
Plast Reconstr Surg, 123 (2009), pp. 1842-1863
O.E. Dadzie, M. Mahalingam, M. Parada, T. El Helou, T. Philips, J. Bhawan.
Adverse cutaneous reactions to soft tissue fillers—a review of the histological features.
J Cut Pathol, 35 (2008), pp. 536-548
V.B. Morhen, G. Lemperle, R.L. Gallo.
Phagocytosis of different particulate dermal filler substances by human macrophages and skin cells.
Dermatol Surg, 28 (2002), pp. 484-490
G. Lemperle, N. Gauthier-Hazan.
Foreign body granulomas after all injectable dermal fillers: part II. Treatment options.
Plast Reconstr Surg, 123 (2009), pp. 1864-1873
J.S. Conejo-Mir, S.S. Guirado, M.A. Muñoz.
Adverse granulomatous reaction to Artecoll treated by intralesional 5-fluorouracil and triamcinolone injections.
Dermatol Surg, 32 (2006), pp. 1079
V. Sánchez García, A. Sanz Trelles.
Superficial granulomatous pyoderma: successful treatment with minocycline.
J Eur Acad Dermatol Venereol, 20 (2006), pp. 1134-1135
M. Aivaliotis, G. Kontochristopoulos, E. Hatziolou, K. Aroni, N. Zakopoulo.
Successful colchicine administration in facial granulomas caused by cosmetic implants: report of a case.
J Dermatol Treatment, 18 (2007), pp. 112-114
P. Lloret, A. España, A. Leache, A. Bauza, M. Fernández Galar, M.A. Idoate, et al.
Successful treatment of granulomatous reactions secondary to injection of esthetic implants.
Dermatol Surg, 31 (2005), pp. 486-490
R.S. Narins, K. Beer.
Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential.
Plast Reconstr Surg, 118 (2006), pp. S77-S84
D.H. Jones, A. Carruthers, D. Orentreich, H.J. Brody, M.Y. Lai, S. Azen, et al.
Highly purified 1000-cSt silicone oil for treatment of human immunodeficiency virus associated facial lipoatrophy: an open pilot trial.
Dermatol Surg, 30 (2004), pp. 1279-1286
M. Alam, R. Levy, U. Pavjani, J.A. Ramierez, J. Guitart, H. Veen, et al.
Safety of radiofrequency treatment over human skin previously injected with medium-term injectable soft-tissue augmentation materials: a controlled pilot trial.
Lasers Surg Med, 38 (2006), pp. 205-210
M.P. Goldman, T.S. Alster, R. Weiss.
A randomized trial to determine the influence of laser therapy, monopolar radiofrequency treatment, and intense pulsed light therapy administered immediately after hyaluronic acid gel implantation.
Dermatol Surg, 33 (2007), pp. 535-542
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