What We Have Learned About Soft-Tissue Augmentation Over the Past 10 Years

In 2002,my coauthors and I published the results of a clinical trial ofmicronizedacellulardermalgraft (mADG) (Cymetra;LifecellCorp) for rejuvenationof theaging lip.1 A lookbackat this article is instructive as to where we were, as a field, at the beginning of the millennium and allows reflection on where we are headed. In this study,weevaluatedmADGfor use as an injectable agent to augment lips. At the timeof the study, the criterion standardmaterialwasZyplast (glutaraldehydecross-linkedporcine collagen;Allergan Inc),which, on average, required retreatment on a quarterly basis. Furthermore, there were no accepted, validated instruments toassess lip appearance. Inour study,patientswere randomized to receive injectionsof eitherZyplastormADGevery3months, and clinical results were assessed with digital photographs by determining various physical parameters of lip appearance. By 1 year, mADG-treated patients were more likely than Zyplast-treated patients toshowan increasedupper lipvermilionheightandvisiblesurface, an increasednasolabial angle, and anterior projection and visible vermilion of the lower lip. We postulated that a dynamic process of ACG dispersion and resorption vs invasion and stabilization by recipient tissue accounted for these changes. At that time, therewere some patients who were clinically noted to have persistent effect up to 1 year after the last treatment. Over the past decade, many of these patients have returned for continued care, andmost of thosewho initially noted clinically significant effect have not noted substantial regressionof these changes; otherswhohadmoremoderately successful results have sought additional volumization, owing toeither continued facial aging or loss of effect of mADG. Inmany ways, our field has changed greatly since 2002. Hyaluronic acid derivatives were approved for use in the United States in 2003, and Restylane (Medicis Aesthetics) was specifically approved for use in the lips in 2011. Zyplast was last available for purchase in 2010. Autologous fat transfer techniques have been refined, and the procedure is more widely offered because more consistent resultswereachievedasourunderstandingof thephysiologic characteristics of these grafts has become better eluciRejuvenation of the aging lipwith an injectable acellular dermal graft (Cymetra). Sclafani AP, Romo TR III, Jacono AA.