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capsule of mainly type I, or non-scar tissue collagen, around each of the particles. This process of encapsulation will last as long as the foreign body or biomaterial remains within the tissues of the body.1,8,9 Multiple factors affect this process of encapsulation of the implanted material, including the site of implantation and the host response, which is dependent on the health status and age of the patient. Equally as important is the physical properties of the Dr Ian Strawford details the use of collagenbiomaterial implanted, notably the size and stimulating fillers and shares a successful case study shape of the particles. Simply put, the effect of a biomaterial on the host is to stimulate In my practice, collagen-stimulating fillers have become an an inflammatory/immune response and the response of the host on increasingly popular treatment choice among patients in the 40-60 the biomaterial is to attempt to eliminate or encapsulate the foreign age group as they offer age appropriate, natural and long-lasting material.1,10 Biomaterial particle size and shape is a significant factor on 1 results with very low risks of complications. predicting the response to the implanted material. Particles less than In this article I will discuss how a collagen-stimulator treatment differs 20mm in size are phagocytosed by macrophages and eliminated from traditional hyaluronic acid-based fillers and how they can be from the body.11 Particle sizes of between 25mm and 50mm and used for facial contouring, volume restoration and skin rejuvenation spherical in shape produce the most fibrosis or new collagen when through bio-stimulation of the tissues. implanted, due to the higher surface area per mass of any biomaterial used.12 Particle sizes greater than 50mm in size are more likely to A rise in popularity produce a prolonged inflammatory reaction, producing only type In recent years the recognition and importance that facial volume loss III collagen.1,11 In essence, a perfect bio-stimulatory material needs plays in the ageing process has shifted the focus of treatment from a to produce a predictable host response when implanted, which in concentration on isolated problem areas, such as the nasolabial folds, the case of collagen-stimulating dermal fillers, is to produce type I to targeting the entire face to restore shape for a more harmonious collagen in response to the biomaterial for as long as it is present and natural effect.2 in the body. Thus, in my professional opinion, the ideal collagenDermal fillers have become a popular means of addressing volume stimulating product used in medical aesthetics should consist of loss and contour defects resulting from ageing, disease or trauma, smooth microspheres no larger than 50mm in size, stable in both size and the most widely used are the ones based on hyaluronic acid and shape, as well as being long lasting, before degradation and full gels.3,4 However, non-permanent collagen-stimulating dermal fillers elimination from the body.1 have become an increasingly important and popular treatment in medical aesthetics.5 Since the introduction of calcium hydroxyapatite Treatment technique and poly-L-lactic acid collagen-stimulating dermal fillers in 2006 Prior to treatment, an aseptic technique should be adopted to and 2004, respectively, the role of collagen stimulation in facial prepare the face. Depending on where you are treating will aesthetics has been extensively studied.5,6 Interestingly, the initial use determine the depth of injection; however, for temple hollowing, of poly-L-lactic acid, was in patients with severe facial lipoatrophy malar volume correction, cheek augmentation and jawline contouring, associated with HIV infection, which was explored in a 2006 literature I would recommend a supraperiosteal injection, placing the product review conducted by El-Beyrouty et al., where results showed that on the bone. More superficial placement can be used to address cutaneous thickness improved in these patients.7 subdermal volume loss and for bio-stimulation, in order to increase collagen and elastin within the dermis. I would recommend that What is the mechanism of action? placement of the product can either be by 27 gauge needle or On injecting any dermal filler or bio-stimulatory agent/biomaterial such 25 gauge cannula. Caution should be taken with older patients who as polycaprolactone into human tissue, there will always be an initial are less likely to respond well. This is because, with age, the number foreign body response in the host’s tissues to the injected product.1 Before After It is important to understand the mechanism of this foreign body response to understand why collagen stimulation occurs and how it is part of the normal healing response of the body. Normal healing starts within two hours of a wound, through an initial inflammatory phase, with the production of macrophage cells, which in turn stimulate fibroblast cells, to produce initially type III collagen or scar tissue.1 This rapid production of type III collagen allows a quick initial healing phase. With an implanted material such as polycaprolactone, following the initial inflammatory phase and within two weeks, the micro-particles within the tissues will become encapsulated by fibroblasts leading to fibroplasia. This is a natural Figure 1: Patient before and 12 weeks after treatment. The result of bioprotective mechanism of the body to isolate the ‘harmful’ foreign stimulation will be gradual over the next six months but long lasting, up to particles. This gradual process of encapsulation produces a stable two years.16
Understanding Collagen-stimulating Dermal Fillers
Reproduced from Aesthetics | Volume 7/Issue 2 - January 2020
