Shadow of a smile: Despite popularity of fillers, implants for nasolabial folds maintain market stanceShadow of a smile: Despite popularity of fillers, implants for nasolabial folds maintain market stance

Key Points

With an ever-increasing array of long-lasting fillers to choose from, permanent implants for the nasolabial folds may be less in demand, but there are still patients who, for various reasons, want their augmentation performed just once and for the long-haul.

Whether patients are needle-phobic or, by logic of simple math, view one-time implantation as being more economical than regular visits for filler refills, cosmetic surgeons can offer longer-term solutions for addressing nasolabial folds. In fact, recent research indicates that the newer generations of implants can indeed offer patient satisfaction — even if results are subtle.

These study results help to give confidence to patients and physicians who opt for the permanent implant route, and despite the improvement of temporary fillers, there are still plenty who fall into that category, says Jim Gilmore, M.D., F.A.C.S., F.I.C.S., a co-author of one of the studies.1

"I think it comes down to some patients simply not wanting to have to keep coming in for treatments," says Dr. Gilmore, an associate professor of facial plastic and cosmetic surgery at UT Southwestern Medical Center in Dallas.

IMPLANT IMPROVEMENTS Some of the most popular permanent implants used in recent years have been expanded polytetrafluoroethylene (ePTFE), or Gore-Tex, but they have had to overcome a rocky history when it comes to the lower face, including problems with extrusion, movement, infection and swelling. However, a newer generation of the ePTFE implants, which was introduced in 2001, features a dual-porosity design that helped to improve the implants. However, a newer generation of the ePTFE implant was introduced by Atrium Medical Corporation in 2001 to address these issues. Originally marketed as Advanta, the new facial implant featured a dual-porosity design to incorporate two pore sizes: a soft, high-porosity center, surrounded by a smooth, medium-porosity outer sheath. The unique design was intended to increase tissue in-growth and decrease inflammatory response. The implant is now marketed by Surgiform Technology, Ltd. of Columiba, SC, as the SurgiSoft Facial Implant.

A recent study evaluated the outcomes of 170 patients who received a total of 612 Advanta implants for midface rejuvenation and found that eight patients had minor complications, three of whom required implant removal.1 Among patients receiving implants for the nasolabial grooves, 15 were rated by a subjective observer as having significant improvement, 79 had minimal improvement and 18 had no improvement. As for treatment in the melolabial grooves, 30 patients showed significant improvement, 50 had minimal improvement and 12 had no improvement. That only nine percent of patients had "significant improvement" with the implants underscores the point that improvement in the lower face with the Advanta implants tends to be subtle.

The study also suggests that reasons for the lack of improvement included the depth of the nasolabial folds or the lack of variety in implant sizes. "Early implants were only available in a 3.0-mm round design, while the selection now comes in round and oval varieties up to 6.0 mm," according to the study. Nevertheless, the researchers say a study comparing the short-term results of ePTFE implants with soft tissue fillers would be interesting, and they argue that the results may even be comparable in a side-by-side comparison.

THE TEST OF TIME When it comes to longer-term results with permanent implants, a second study that included dual-porosity implants concluded that ePTFE implants appear to stand the test of time in the lower face.2 The study looked at long-term results and patient satisfaction in 33 patients who received implants between 2001 and 2002.

In total, patients received 85 implants: 46 percent in the nasolabial folds, 34 percent in the lips, 16.5 percent in the marionette lines, two percent in the oral commissures and one percent in the glabella. At five-years' follow-up, 87 percent of implants had remained in place with excellent correction, and 11 implants in six patients were removed (four of the 11 implants were replaced with larger implants at patient request without subsequent problems). Other reasons for implant removal included malposition, localized swelling and an unnatural feel. In general, however, patient and physician satisfaction was high.