We have never seen such a period of growth in cosmetic medicine. We live in an age where hair transplants; fat removal and breast augmentation have all progressed to the stage that they can be done without requiring hospital admission or even a general anaesthetic. It is a brave new world and one that will continue to progress into the emergent era of stem cell technology with new hair growth and breast tissue being prime examples of where this period will lead us. But at the moment we have Direct Hair Implants(TM) and Macrolane(TM).
Macrolane is a type of natural filler similar to some that we have been injecting into faces since 1996. It is made from hyaluronic acid, a compound that occurs naturally in the skin and connective tissue and is known to be present in every tissue of the body. Hyaluronic acid is an important cell constituent that retains water and also provides nutrients and removes waste from cells that do not have a direct blood supply, such as cartilage cells. Hyaluronic acid is found in the synovial joint fluid, the vitreous humour of the eye, the cartilage, blood vessels, extracellular matrix, skin and the umbilical cord.
It is extremely popular as an injectable skin filler for correcting the lines and wrinkles associated with aging, as well as acne scars and other skin conditions as its molecules bind to water in the skin, hydrating and firming its structure, and the loss of hyaluronic acid with aging is associated with skin dehydration and wrinkling. Because hyaluronic acid degrades rapidly in the skin, the commercially available version is cross-linked, or bound to itself chemically to increase stabilization.
The safety of hyaluronic acid has been clinically documented and supported by robust clinical studies, spanning over 10 years. The company that makes Macrolane has been making high purity stabilized Hyaluronic Acid gels in the form of an injectable dermal filler called Restylane since 1996. In this twelve year period over 8 million Restylane treatments have been successfully performed worldwide with a problem rate of about 1:20,000. This makes Restylane one of the most tried and tested dermal filler and is recognised in cosmetic dermatology as the benchmark for safety.
Pain, redness, itching, discoloration and tenderness at the point of injection are also common side effects that occur after a Restylane treatment. These effects usually subside within a day or two. Most side effects experienced by Restylane patients are classified as mild. However, roughly one in 2,000 patients suffer more serious reactions, such as tenderness, prolonged redness and acne-like skin formations. These side effects can last for only a few days after injection up to as long as four weeks after treatment. Hypersensitive skin is usually to blame for more serious reactions to Restylane.
There have been two pilot studies of body contouring with Macrolane(TM) to date that I am aware of. The first was done in 2002. It looked at using Macrolane to augment the breast of non-pregnant, non-breast-feeding females. These patients were watched for another 2 years to monitor safety and benefit. No serious adverse events were reported in the study. Treatment-related adverse events such as injection site pain and reaction were mild and transient in nature. The second study involved patients with concave body deformities following liposuction, surgical scars or post-traumatic fat atrophy.
Again no side effect were noted outside minor events noted on the day of injection. A study published in the February 2007 issue of Food and Chemical Toxicology indeed confirmed the safety of oral hyaluronic acid. It is used as a dietary supplement that supports health in joints and skin. Hyaluronic acid provides the matrix for the synovial fluid to retain moisture in the skin and cushioning in the joints. The research showed test subjects exhibited no toxicity, even at 33 times the recommended dose.
In the first breast study patient assessment data showed 95% satisfaction at three months, 79% at six months and 63% at 12 months. In the other one, more than 80% of patients reported improvements at three months and 69% at six months and some improvement was seen at 12 months.
I feel this related to the fact that a volume of 100ml of compound is injected into a protected space created by the doctor in the connective tissue in front of the pectoralis major muscle but behind the mammary gland. In this position Macrolane is intended to last for at least about 18 months. Each individual treatment programme will include a yearly top-up as required to maintain optimal treatment results.
We have already discussed the safety aspects of Hyaluronic Acid compounds but I feel there is more to it than this. We know patient demand for accessible non surgical, less invasive aesthetic treatments, which offer minimal downtime has being growing for some time. Personally, I feel this is the driving force behind this phenomenon. To be honest, cosmetic surgeons of late have not been bathed in glory in the press and patients are largely afraid to take the risk. Take barigastric banding. Obesity surgery not only helps people lose weight but also improves the associated co-morbidities of obesity such as diabetes, hypertension (high blood pressure), arthritis, joint pain, reflux, cardiovascular disease, stroke, various forms of cancer (including prostate, bowel and ovarian), and overall quality of life.
The Ailesbury Clinic opened in Dublin in 2002. It was awarded Best Medical Practice at the 2005 Irish Healthcare Pharmaceutical Awards. It was selected as runner-up in the 2008 and 2009 finals of the Best Aesthetic Medical Clinic in the UK and Ireland.
