Department of Otolaryngology-Head and Surgery, School of Medicine, Tulane University, New Orleans, Louisiana.
Department of Otolaryngology-Head and Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts.
Facial Plast Surg. 2021 Aug;37(4):536-542. doi: 10.1055/s-0041-1725164. Epub 2021 Mar 1.
There has been an increasing role in the use of injectable fillers for rejuvenation of the aging face. In this systematic review, we aim to evaluate the existing literature related to soft tissue fillers of the midface. Specifically, we focus on the non-hyaluronic acid fillers including polymethylmethacrylate (PMMA), poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and autologous fat. A systematic review was conducted in November 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with PubMed and Embase databases. Medical Subject Headings terms used were "cheek" OR "midface" OR "malar" and "filler" OR "poly-L-lactic acid" OR "calcium hydroxyapatite," "autologous fat" OR "polymethylmethacrylate" OR "Artefill" OR "Bellafill" OR "Radiesse" OR "Sculptra." The initial search identified 271 articles. After 145 duplicates were removed, 126 studies were screened for relevance by title and abstract. A total of 114 studies were eliminated based on inclusion and exclusion criteria. Twelve articles underwent full-text review. Seven articles were included in the final analysis consisting of four non-hyaluronic filler products: PMMA, PLLA, CaHA, autologous fat. Most patients were highly satisfied with their results. Due to the gradual volumizing effects of PMMA, PLLA, and CaHA, patient satisfaction generally improved over time. Minor adverse reactions related to treatment included bruising, swelling, and pain. Nodule formation was reported in PLLA and CaHA studies. For autologous fat, 32% of the original injection volume remained at 16 months post-treatment, which still provided clinically improved malar enhancement. Dermal fillers are an attractive treatment option for the aging face due to their high patient satisfaction, long-lasting effects, and low side-effect profile. Patients should be appropriately counseled on the delayed effects of non-HA fillers. Autologous fat is a good option in many patients with the major drawback of unpredictable longevity, which may require a secondary procedure. Future studies should examine the longevity and long-term side effects of these fillers.
在面部年轻化治疗中，注射用填充剂的应用日益广泛。本系统评价旨在评估有关中面部软组织填充剂的现有文献。具体而言，我们专注于非透明质酸填充剂，包括聚甲基丙烯酸甲酯（PMMA）、聚左旋乳酸（PLLA）、羟基磷灰石钙（CaHA）和自体脂肪。本系统评价于 2020 年 11 月按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在 PubMed 和 Embase 数据库中进行。使用的医学主题词是“cheek”或“midface”或“malar”和“filler”或“poly-L-lactic acid”或“calcium hydroxyapatite”，“autologous fat”或“polymethylmethacrylate”或“Artefill”或“Bellafill”或“Radiesse”或“Sculptra”。最初的搜索确定了 271 篇文章。去除 145 篇重复文章后，通过标题和摘要筛选了 126 篇研究的相关性。根据纳入和排除标准，共有 114 项研究被排除。12 篇文章进行了全文审查。最终分析包括 7 篇文章，涉及 4 种非透明质酸填充剂产品：PMMA、PLLA、CaHA、自体脂肪。大多数患者对治疗结果非常满意。由于 PMMA、PLLA 和 CaHA 的逐渐体积填充效果，患者的满意度通常会随着时间的推移而提高。与治疗相关的轻微不良反应包括瘀伤、肿胀和疼痛。在 PLLA 和 CaHA 研究中报告了结节形成。对于自体脂肪，治疗后 16 个月，原始注射量的 32%仍存在，这仍然提供了临床上改善的颊部增强效果。真皮填充剂由于其高患者满意度、持久效果和低副作用谱，是治疗衰老面部的一种有吸引力的治疗选择。应适当向患者告知非 HA 填充剂的延迟效果。自体脂肪是许多患者的良好选择，主要缺点是不可预测的寿命，这可能需要二次手术。未来的研究应检查这些填充物的耐久性和长期副作用。
