Ahn Christine S, Rao Babar K
Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
J Cosmet Dermatol. 2014 Sep;13(3):212-23. doi: 10.1111/jocd.12100.
There is an increased demand for soft tissue augmentation procedures. A wide range of products can provide correction through different mechanisms and it is important for clinicians to understand the biological pathways of each material. This study presents a systematic review of the pathways of commonly used fillers, with consideration of the complications associated with each.
The PubMed (National Library of Medicine) database was searched for MeSH headings for different types of fillers, including trade names, between January 1, 2000, and January 1, 2013. Article titles were screened, and only studies designed to determine the mechanism of action and histopathology of complications were included.
When restricted to studies on biological mechanisms, 109 manuscripts were identified and the mechanisms of action of short-term and long-term degradable as well as permanent fillers were reviewed. Hyaluronic acid fillers, which are the most commonly used, form a fibrous capsule and induce limited de novo collagen. Poly-l-lactic acid and calcium hydroxylapatite are semipermanent fillers that provide long-term restoration of tissue volume by stimulating fibroblasts to lay down a matrix of collagen and elastic fibers. Polymethyl methacrylate is the only FDA-approved permanent implant that is held in place by encapsulation, providing a scaffold upon which the dermis can recover to its original thickness.
Soft tissue augmentation products are variable, and no single product can be considered the most effective or ideal. An understanding of biological mechanisms may help guide physicians choose the best suited product among the various options available while minimizing the occurrence of complications.
软组织填充手术的需求日益增加。多种产品可通过不同机制实现矫正，临床医生了解每种材料的生物学途径很重要。本研究对常用填充剂的作用途径进行了系统综述，并考虑了与之相关的并发症。
检索美国国立医学图书馆的PubMed数据库，查找2000年1月1日至2013年1月1日期间不同类型填充剂的医学主题词，包括商品名。对文章标题进行筛选，仅纳入旨在确定并发症作用机制和组织病理学的研究。
在仅限于生物学机制的研究中，共识别出109篇手稿，并对短期和长期可降解以及永久性填充剂的作用机制进行了综述。最常用的透明质酸填充剂会形成纤维包膜，并诱导有限的新生胶原蛋白生成。聚左旋乳酸和羟基磷灰石是半永久性填充剂，通过刺激成纤维细胞形成胶原蛋白和弹性纤维基质来长期恢复组织体积。聚甲基丙烯酸甲酯是唯一经美国食品药品监督管理局批准的永久性植入物，通过包囊固定在位，提供一个支架，使真皮能够恢复到原来的厚度。
软组织填充产品各不相同，没有一种产品可被认为是最有效或理想的。了解生物学机制可能有助于指导医生在各种可用选项中选择最适合的产品，同时尽量减少并发症的发生。
