Filler

1
Filler Liquid Injectable Silicone

• Lee Hun Gu
• Kim Byung Gwan

2
Filler

• ? Filler ?
• - Filler materials are consists of
• highly viscous fluid or polymer
• particle suspension that include
• synthetic polymers and
• autologous tissue
• - The demand for safe, effective,
• long-lasting, biocompatible
• dermal filler materials is
• increasing.
• Autologous from self-tissue.

3
An Overview of Filler

• Fillers can be classified into three groups.
• - Permanent Filler include polymer gel
  (Silicon(synthetic) and
• Aquamid(synthetic)), nondegradable polymer
  microspheres
• suspended in resorbable liquid (Artefill)
• - Semipermanent filler include slowly degradable
  polymer
• microspheres suspended in resorbable liquid,
  and autologous fat.
• - Nonpermanent Filler include natural filler such
  as
• Collagen and hyaluronic acids (Lestylane).

4
The ideal soft tissue filler substance

• Safe
• Biocompatible
• Stable after implantation
• Non-migratory
• Resistant to phagocytosis
• Pliable - flexible
• maintain its volume without being absorbed or
  degradaed
• minimal foreign body reaction - 4 characters
• not require pretesting
• painless
• inexpensive

5
What is liquid Injectable Silicone?

• What is liquid Injectable Silicone?
• - Silicone is a artificial substance made from
  silicon, which is used to make polished and also
  used in cosmetic surgery and plastic surgery-
• (The scientific name for liquid silicone is
  dimethylpolysiloxane. Siloxanes are compounds in
  which the elements silicon is conjugated with
  oxgen and methane.

6
What is liquid Injectable Silicone?

• They can exist as solids, gel, and liquids.
• -The Viscosity of silicone fluids-
• (The viscosity of these compounds is a
  function of the polymerization and cross-linking
  of their molecule)

7
What is liquid Injectable Silicone?

• The viscosity of silicone is measured in
  centistokes.

8
Pros and Cons of using silicone

• Pros
• 1) Permanent, noncarcinogenic,Minimally
  antigenic and not support bacterial growth
• 2) Different forms of silicone implanted into
  different anatomical sites have differing
  potential for benefits and complications.
• Cons
• 1) Misuse, Adulteration, Substitution.
• 2) No standard.

9
Pros and Cons of using silicone

• Cons
• 1) Misuse, Adulteration, Substitution.
• 2) No standard.

10
History of Silicone

• In the Past
• - Many misuse case
• ( Large amount of silicone 1960s U.S
• ?Contamination )
• ( Adulteration by various formula
• Sakarai Formula ?mixed with olive oil
• to increase inflammation and prevent
• migration)

11
Formal Ongoing Study

• Test small volume of silicone with normal people?
  No side effects
• Test large volume of Silicone (21CC)with
  lipodystrophy ? Severe side effects (facial
  necrosis,panniulitis)

• The test is getting sophisticated and rigorous
  designed.
• Use 1000-cS fluid

12
Complications and Immune response

• Very low frequency (12)of Complications Bad
  immune response (Edema, Cellulitis, etc)
• If the Silicone is injected properly.
• Fatal results (Death, Siliconoma, etc )can be
  occurred,
• If the silicone is injected improperly
• (Large volume, Industrial Silicone,
  Unpurified Silicone )

13
Technical Consideration

• Injection Technique
• (1) Must be small amount approximately 0.01 ml
• (2) Overcorrection should be avoided
• (3) Material should be placed in the deep
  dermal or subdermal plane
• Microdroplet Method
• Using tiny droplets of silicone(0.01 to
  0,03cc)that are deposited into the subcutis by a
  series of injection spaced approximately 2 to 10
  mm apart.

14
Consideration

• ? Silicone
• Silicone has relatively stable, safe,
  biocompatible properties
• in itself as a filler.
• If the liquid silicone injected improperly (
  misuse, Adulteration,
• Substitution ), the side effects would be
  occurred.

15
Consideration

• ? Other Fillers
• Host defense mechanisms react
  differently to the various filler materials, but
  all substance appeared to be safe .
• Because the use of a regulated U.S FDA
  approved product have been shown to cause early
  side or adverse effects in a very small
  percentage of patients.
• But the mechanism of late inflammation or
  granuloma formation is still unknown. So the
  chance of its late side effect problems exists.

16
Conclusion

• 1. Proper filler injection and Development of
  surgery techniques.
• - Usage of Nonpermanent filler
• (Temporary fillers)
• - the development of medical appliances.

17
Conclusion

• 2. Material technique development of Fillers.
• 1) Interaction with an energy source and
  Immunological progression of Filler substances.
• - Silicone embedded with a chromophore.
• 2) Adipose derived stem cells as a Filler.

18
Conclusion

• 3. The late reactions to filler substances can be
  verified in exact clinical long term studies.

19
Reference

• 1. An Overview of Permanent and Semipermanent
  Fillers. 2006
• 2. Liquid Injectable Silicone A Review of Its
  History, Immunology,
• technical Consideration, Complications, and
  Potential. 2006
• 3. Adipose-Derived stem and Progenitor Cells as
  Fillers in Plastic
• and Reconstructive Surgery. 2006
• 4. Liquid injectable silicone for soft tissue
  augmentation. 2006