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Filler Materials Medical Aspects. Prof. Dr. med. P. Graf Munich. Aesthetic Operations/Treatments. Operations versus Minimal invasive Treatments. Filler-Material (Selection). Silicon Polytetrafluoräthylen (PTFE) Collagen Hyaluronic Acid Acryl (Plexiglas) Polyacrylamid - PowerPoint PPT Presentation
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Filler MaterialsMedical Aspects
Prof. Dr. med. P. GrafMunich
Aesthetic Operations/Treatments
Aesthetic Operations/Treatments in the USA 2000-2012 (Source: ASPS)
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Breast Augmentation
Blepharoplasty
Liposuction
Rhinoplasty
Abdominoplasty
Botulinumtoxin
Operations versus Minimal invasive Treatments
Aesthetic/Reconstructice Operations/Treatments 2000-2012 in the USA (Source: ASPS)
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total, operative cosmetic
total minimal nivasive cosmetic
total cosmetic
total operative reconstructive
Filler-Material (Selection)
Silicon Polytetrafluoräthylen (PTFE) Collagen Hyaluronic Acid
Acryl (Plexiglas)
Polyacrylamid
Poly-L-lactic acid
Calcium-Hydroxylapatit
Autologous Tissue (Fat)
Filler Material (Composition)
Plastic Material Silikon PTFE PMMA
Organic Material Collagen Hyaluronic Acid Autologous Fat
Filler Material (Consistency)
hard Silicon PTFE Goldthreads
„ liquid“ Collagen Hyaluronic Acid Acryl Microspheres Autologous Fat
Silicon (Hard Consistency)
inert Material Nonresorbable No indication as filler material for wrinkles Deep positioning Indication for contour improvement (Breast, chin,
etc.)
Silicon (Chinaugmentation)
Die Darstellung präoperativer Fotos in ärztlichen Internetseiten ist in Deutschland leider nicht erlaubt
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Collagen
Low Immunogenicity (3%) Resorbable Superficial and deep Positioning Bovine spongiform encephalopathy (BSE)
Hyaluronic Acid I
No Immunogenicity Resorbable (6 Months) Superficial and deep positioning
Hyaluronic Acid IIPattern of Intercellular Space
The intercellular space of the skin is filled by collagen fibers which are located in a matrix of polysaccharides (=hyaluronic acid).
Hyaluronic Acid IIIMicrostructure, Properties
An important function of hyaluronic acid is its property of water retention.
Hyaluronic Acid IVIntradermal/Subdermal Positioning of Filler
Hyaluronic Acid VInjection Technique
Linear Injection technique
Serial step-by-stepInjection technique
Hyaluronic Acid VILip Augmentation
Nonresorbable Filler MaterialAcryl-derivates, Calcium-Hydroxylapatit, Poly-L-Lactic Acid, etc.
Non- / Low-Resorbable Deep Positioning Immunogenicity ? -Foreign Body reaction
-Inflammation-Infection-Fistula
Complications I Transdermal Migration of Acryl Microspheres (PMMA), (=Plexiglas)
Complications IIintravascular Injection
Skin necrosis after accidental intravascular injection of PMMA
Complications IIIBlindness
from:Complications of Injectable Fillers, Part 2: Vascular Complications Aesthetic Surgery Journal Claudio DeLorenziy 2014 34: 584-600
Bacterial Biofilm I
A biofilm is any group of microorganisms in which cells stick to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance (EPS). Biofilm extracellular polymeric substance, which is also referred to as slime (from: https://en.wikipedia.org/wiki/Biofilm)
from:https://en.wikipedia.org/wiki/BiofilmResp.from: Looking for Chinks in the Armor of Bacterial Biofilms Monroe D PLoS Biology Vol. 5, No. 11, e307 http://biology.plosjournals.org/perlserv/?request=slideshow&type=figure&doi=10.1371/journal.pbio.0050307&id=89595
Bacterial Biofilm II
“Biofilms are ubiquitous. Nearly every species of microorganism, not only bacteria have mechanisms by which they can adhere to surfaces and to each other. Biofilms will form on virtually every non-shedding surface in a non-sterile aqueous (or very humid) environment.”
“Biofilms can grow in showers, pipes, on teeths, catheters, contact lenses, heart valves, etc.”
https://en.wikipedia.org/wiki/Biofilm
Bacterial Biofilm IIIin Soft Tissue Fillers
Bacterial biofilm formation and treatment in soft tissue fillersMorten Alhede et al. April 2014Pathogens and Diseasedoi: 10.1111/2049-632X.12139
„…Evaluation of treatment strategies showed that once the bacteria had settled (into biofilms) within the gels, even successive treatments with high concentrations of relevant antibiotics were not effective. Our data substantiate bacteria as a cause of adverse reactions reported when using tissue fillers, and the sustainability of these infections appears to depend on longevity of the gel. Most importantly, the infections are resistant to antibiotics once established but can be prevented using prophylactic antibiotics. …“
ComplicationsInflammation, Foreign Body Reaction, Fistulas
Consequences
Think!
Would you like to have a permanent filler?
Do you inform your patients who ask for permanent fillers about foreign body reactions, inflammations, infections, fistulas?
Do you inform about alternatives (hyaluronic acid, fat transfer)? Antibiotic prophylaxis?
Fat Transplantation by E. Lexer in Munich
Autologous Fat TransplantationApplication
Neurosurgery Ophthalmology Urology Aesthetic Surgery etc.
Autologous Fat TransplantationLipofilling
No immunogenicity Resorption Deep positioning (subcutaneous) Operation
Autologous Fat TransplantationHealing Process
Autologous Fat TransferResorption
Causes of trauma to transplanted fat grafts By suction of fat (mechanical, high vacuum) By preparation of graft (mechanical, drying) By injection of fat graft (high pressure) By late ischemia within the body (high tissue pressure)
Rates of Resorption in Literatur 20 - 100%Own Investigations: 55,6% (47 - 68%)
Autologous Fat TransferMinimization of Resorption
Avoid potentially damaging substances (Adrenalin?) Gentle suction (diameter of canula, size of vacuum) Atraumatic preparation of fat graft Careful preparation („ Cleaning“) of aspirated fat Careful Injection (short, thick canula) Good dissemination of graft Avoid high tissue pressure
Atraumatic treatment is critical forRates of resorption (=success) of fat transfer
Autologous Fat Transfer Operative Technique
Autologue Fat Transfer “Cleaning“
Autologous Fat Transfer Injection
Autologous Fat Transfer nasolabial
Die Darstellung präoperativer Fotos in ärztlichen Internetseiten ist in Deutschland leider nicht erlaubt
Die Darstellung präoperativer Fotos in ärztlichen Internetseiten ist in Deutschland leider nicht erlaubt