35 years of soft tissue augmentation

In 1981, I was one of the fortunate doctors to study the use of an injectable material for the treatment of lines, wrinkles and acne scars.  Bovine collagen was the first injectable material approved by the FDA for aesthetic purposes.  It was not perfect, but it was what was the best available at the time.  Since in was bovine material a skin test was required prior to injection and I instituted the use of double skin testing to almost eliminate the problem of adverse allergic reactions.  Because it was foreign material, the search was on to find a substance less allergenic or even from human sources.  This led to the development of Dermalogen from Collagenesis that was human cadaveric in origin and therefore did not require a skin test. Unfortunately, it was too expensive to manufacture.  Cosmoderm from culture of human fibroblasts came on to the scene and about the same time a new substance appeared--hyaluronic acid, at first from cock's comb, but eventually from bacterial fermentation.  This led to the use of material that did not require a skin test, looked and felt natural and eliminated allergic reactions.  Still today hyaluronic acid is used in most of the injectable materials around the world and remains very effective in myriads of uses. There are many approved in the US and many more around the world that are also excellent products such as Teosyal from Teoxane in Switzerland and the Revanesse line from Prollenium in Canada, both of which may be available in the US soon.  We now have available injectables that induce collagen formation and are versatile and long lasting, such as Sculptra and Radiesse. Additionally, techniques have evolved to volumize the face rather than filling in scars and wrinkles leading to a more youthful and natural appearance.  Growth factors are being utilized with PRP and the future will most likely involve the use of stem cells.  A skilled aesthetic physician can obtain results we never even dreamed of at the beginning with Zyderm and Zyplast.  Having been medical director of Collagenesis, Inamed and Prollenium over the years, I anxiously await the next phase of development of this group of materials that have benefited thousands of patients all over the world.