Introduction:
Soft tissue augmentation is a procedure to soften and enhance the features of the face. The procedure involves non-surgical build of the tissues of the face and has been in medical cosmetic practice for centuries. Materials like paraffin and beeswax were effectively used in the past. However, it often leads to devastating complications that lead to death. Further studies introduced safer and compatible materials for augmenting and softening facial features, but no perfect material has yet been discovered.
What Is Soft Tissue Augmentation?
Aging is a natural process accompanied by the atrophy of the facial soft tissues. Several materials and techniques are available that will help in facial rejuvenation. The procedure is known as soft tissue augmentation, and the materials or techniques used can be classified into three types.
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Skeletal-onlay grafts.
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Subcutaneous volumizers.
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Dermal fillers.
Skeletal-onlay grafts and subcutaneous volumizers show the most persistent results. However, dermal fillers are gaining wide popularity after their introduction over the past five years. The dermal fillers have a long-lasting effect, whereas an overlay implant exactly mimics the viscoelastic properties of the facial soft tissue. An accurate diagnosis is the foremost thing to determine the procedure and the outcomes. A proper evaluation will let the physician use a combination of the three techniques to produce optimal outcomes.
What Are Skeletal-Onlay Grafts?
It is the safest and most reliable option for soft-tissue buildup and facial rejuvenation. Preformed grafts are available for implanting. The grafts are synthesized from silastic, porex, and expanded polytetrafluoroethylene.
Placing the implant in the deeper tissues after the incision will push the overlying skin and tissues outward, providing a strong filler effect. It is commonly used for adipose layer volume loss and maintaining the convexity of the midface.
What Are Subcutaneous Volumizers?
Extracting subcutaneous fat from an individual and injecting it into the area of facial soft tissue loss is considered the cornerstone of volume filling. Autologous fat does not create immune reactions and is preferred in an immunocompromised patient. The most common areas where autologous fat is used are nasolabial grooves, lips, and midface.
What Are Dermal Fillers?
Dermal fillers are injectable implants approved by the FDA (Food and Drug Administration) for facial soft tissue augmentation. They are injectables used for a smoother appearance of the face, cheeks, chin, and lips. Diminishes the appearance of wrinkles and can be used for the back of hands as well.
What Are the Ideal Properties of the Material for Augmentation?
A wide range of materials is used for soft tissue augmentation. It should have some specific features to prevent complications. The perfect material for soft tissue buildup would have certain ideal characteristics like:
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It should not induce any allergy, infection, or disease.
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Non-carcinogenic.
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It should feel and appear like natural tissues.
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The time required to work with the material should be very little and not affect the work and social activities of the patient.
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Inexpensive.
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Over time, the augmenting material should be replaced by the host tissues.
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It should be readily available.
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It should be easy to administer.
However, there is only one material that can satisfy all these criteria.
How Is Soft Tissue Augmentation Procedure Performed?
Soft tissue augmentation is performed in the clinical setup by the doctor after consultation, which involves discussing and addressing the patient's concerns. After the consultation, the doctor begins the procedure by cleansing and sterilizing the skin area thoroughly and prepping the area with topical numbing cream or an agent before injecting the derma fillers with a fine needle.
A patient usually returns to their normal routine immediately after the procedure; however, they may experience some swelling, tenderness, and bruising at the injection site after the augmentation procedure.
What Kind of Materials Are Used for Soft Tissue Augmentation?
The biocompatible materials that are human skin friendly are
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Bovine injectable collagen (collagen obtained from cows).
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Hyaluronic acid (a natural substance found in the extracellular matrix of connective tissues).
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Fibrel (a gelatin matrix implant with absorbable gelatin powder).
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Atelocollagen (an animal protein).
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Bioplastics (plastics produced from renewable biomass).
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Autologous fat (transferring fat from one part of the body to the intended area of the same individual).
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Autologous Collagen (taking collagen of the same individual for augmentation).
Bovine collagen sets a standard with which other products are compared in terms of efficacy and safety.
Is It Necessary to Perform Skin Testing Before the Soft Tissue Augmentation Procedure?
Approximately three percent of the population shows an allergic reaction to certain materials used for soft tissue augmentation, observed through dietary exposure. People who are allergic cannot undergo augmentation using the material. A skin test will help identify the best suitable material for an individual. According to current recommendations, an allergy patch test should be done by injecting 0.1 cubic centimeters of material into the skin of the volar surface of the forearm. The test should be read in 48 to 72 hours and then again at four weeks. It usually lasts for more than six hours. The appearance of erythema at the injection site followed by tenderness, swelling, and induration with or without pruritis indicates a positive allergy test.
Adverse reactions can be defined as sensitization of the immune system by an agent that will bring about immunologic reactions at the treatment site in patients who were negative on skin testing. In the case of patients injected with allergic materials, adverse reactions will develop 24 hours after injection. This method can help determine most of the patients allergic to the material but cannot determine all of them.
What Is the Incidence of Adverse Reactions in Soft Tissue Augmentation?
The incidence of adverse reactions is minor, one to six percent. It may occur in less than three percent of the population undergoing soft tissue augmentation. Of the cases of adverse reaction majority (89.6 %) of them occur during the first treatment procedure. As a result, it is strongly recommended that the physicians actively involved in facial augmentation perform double skin testing before the procedure.
Conclusion:
With several studies and research, the current options of soft tissue augmentation techniques have increased widely. A wide spectrum of products and techniques are available that are biocompatible and causes fewer adverse reactions. The skeletal overlay grafts and the subcutaneous volumizers have provided surgeons with options to address soft-tissue deficiencies; these materials have viscoelastic properties similar to human soft tissues. However, the introduction of dermal fillers has given patients non-surgical options for achieving excellent results similar to surgical interventions. The lesser invasive nature of dermal fillers and no downtime for the results have increased the demand for dermal fillers among patients and medical practitioners.
