Implants are synthetic or natural materials that are implanted into the skin to improve the facial contour or raise depressed or sunken scars and puff up wrinkles. There are two varieties of implants - solid implants and injectable implants:

• Solid implants
  Solid implants are used to enhance the facial contour, for example to strengthen the jawline or augment the cheek (known medically as malar augmentation) or chin (mentoplasty) or reshape the nose (rhinoplasty. Local anaesthesia with or without sedation or general anaesthesia may be used. In chin augmentation for example, an incision is made along the lower lip or under the chin and the implant is inserted into a pocket created in front of the jaw bone. For cheek implants, an incision is made inside the mouth through the lower eyelid or behind the hairline. Recovery may take 5 - 10 days, depending on the procedure. A variety of implants may be used including bone, cartilage or silicone.
  
• Injectable implants (fillers)
  Injectable implants, as the name suggests are injected into the skin to puff out wrinkles and raise depressed or sunken scars with sloping edges (scars with well-defined steep edges do not respond well). The material used for implants include collagen purified from cattle skin, a material known as Fibrel, the patient's own fat or a synthetic material known as Gortex but NEVER liquid silicone.

   

  • Collagen is injected into the dermis and is available as Zyderm I and II and Zyplast. Zyderm collagen is less concentrated and is injected into the upper layers of the dermis. It can be used to correct superficial wrinkles on the forehead, superficial or secondary creases adjacent to nasolabial furrows, forehead creases, vertical creases around the lips which cause lipstick to "bleed" and "crow's feet" on the outside of the eyes. Zyplast collagen is more concentrated and is injected into the mid to lower layers of the dermis. It is used to correct deep wrinkles, nasolabial furrows which run from the corners of the nose to the chin and deep distensible scars (scars that are effaced when stretched) and for lip augmentation (puffing the lips that are thinned and have lost their fullness or pout). Zyplast cannot be used for treating deep forehead wrinkles because there have been reports of it causing skin necrosis there. How long the benefits of an implant lasts depends on the mobility of the region. When used on a relatively immobile areas such as acne scars, the benefits of an implant can last about 6 - 18 months. If the area is very mobile for example deep forehead wrinkles and deep nasolabial furrows, the effect may last only 3 - 12 months. Crows feet can last up to 1 year. Lip augmentation may only last 6 weeks. A skin test has to be performed by injecting a small amount of collagen into the patient's forearm and checking the site at 48 - 72 hours and then at 4 weeks. This helps to detect allergy which occurs in about 3% of individuals. Very occasionally, allergy may still develop in those whose skin tests are negative. There is also concern that collagen might increase the risk of autoimmune disorders (self-allergies) such as lupus erythematosus, polymyositis/dermatomyositis developing. Collagen implants cannot be used in pregnant women, people allergic to lignocaine (the anaesthetic agent that is mixed in with the collagen implant) or beef and in those with a history of autoimmune disorders (self-allergies) such as lupus erythematosus and rheumatoid arthritis.
    
  • Hyaluronic acid is injected in the same way as collagen and lasts just as long. It has not been reported to cause allergies so a skin test is not necessary.

   

  • Fibrel contains three components - a powdered gelatin made from porcine (pig) collagen, aminocaproic acid and the patient's own plasma. Plasma is prepared from the patient's own blood which means the doctor will have to draw blood from the patient's arm. This is then centrifuged to separate out the plasma which is then mixed with the gelatin and aminocaproic acid. The mixture is then injected into the dermis. Fibrel is useful for treating deep wrinkles and distensible scars, not the more superficial facial lines. A skin test is still needed to detect allergy even though this is less common than with collagen implants. Fibrel injections tend to be more painful and the procedure takes more time to perform and causes more bruising than collagen implants. It is therefore, not as popular.

   

  • Fat liposuctioned from the abdomen, buttocks or thighs can be injected into the skin to replace fat lost through ageing, puff up wrinkles and scars and to restore fullness to thin lips. There is no risk of allergy since the fat comes from the same person. The technique is known as autologous fat transplantation. Fat cells are washed and decanted. 20 - 30% of cells will take, the others cells are absorbed. In a modification of this procedure, called autologous collagen transplant, collagen is extracted from the liposuction fat and this is then injected. A US based company performs the extraction of collagen so this technique is not available elsewhere. The benefits are similar to those of cattle collagen except that there is no risk of allergy since the collagen comes from the same person.

   

  • Gortex is not truly an "injected" implant but is included here for convenience. It is a synthetic implant which has been used for many years in cardiovascular and renal transplant surgery to serve as a channel between the organ and the arterial supply and in surgery to repair hernias. Recently, it has been used as a facial implant to augment or plump up lips and to correct nasolabial furrows which run from the corners of the nose to the chin and forehead furrows. In nasolabial augmentation, for example, the strip of Gortex is introduced with a needle and threaded underneath the skin. The entry and exit points are then closed with absorbable sutures. The implant does not dissolve and stimulates the production of fibrous tissue which further augments the implant. The procedure is usually done under local anaesthesia. It is generally safe. Complications are uncommon and include infection, irritation and rejection. Another similar but newer technique employs SoftForm which comes as a round, spongy tube with a hollow core. It is used in much the same way as Gortex and is quite good for softening the laugh lines around the mouth and the from the corner of the mouth to the chin.

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