It is human nature to pursue beauty. According to statistics, the percentage of modern woman once wanted to accept cosmetic plastic surgery to change her appearance reached over 70%. No matter how pretty a woman is, she would never be satisfied with herself at present. However, cosmetic surgery is a traditional artificial operation; there are some unavoidable risks that still exist, such as surgery scars, post-surgery recovery, natural look, satisfaction and so on. The most concerned about those unexpected risks is the scare resulted from the surgery; after all, it takes courage for those women who leaving an incision scar on their originally flawless face or inserting materials that they do not even know. For fears of the uncertainty, many women do not dare to try cosmetic surgery and idle away their youth.

The cosmetic surgery industry surely has noticed the existence of these issues, which led biotechnological companies around the world invested fully in research and developing non-surgical plastic methods. As the result, to perform a cosmetic surgery by only injecting different kinds of fillers gradually emerged in the market a decade ago and the so-called micro cosmetic surgery also started be well known, even becoming a popular trend in recent years. However, the effect of the majority of injectable products such as Hyaluronic Acid (HA) and collagen are for short-term effect, which last only around 6 to 9 months and will be even completely dissolved by the human body after one year. Therefore, the requirement of repeated injections causes a long-term burden for the customers as well as inconvenience. Furthermore, the volume of molecules of these types of material are too small, which is very suitable in filling creases and hollow areas, but it is expensive and ineffective if it is used for nose job, cheek implant, chin augmentation, 夫妻宮 or any other parts of the body. Therefore, it can be said that injectable fillers with short-term effects that are similar to HA can be used to complement the deficiencies of surgery. However, it cannot substitute the effect of traditional surgery as its effects are only temporary and the effect is lost when time pasts. |

Everybody would probably ask if there are any injectable filler with long term effect that will not be absorbed by our body. Of course, the answer is yes. It is injection of free silicone called “Liquid Silicon.” This is something we are all familiar with and we had it in the past. The reason why silicone is widely used in the cosmetic surgery industry is due its low activity, low rejection, and the advantage of easiness in filling as it has large amount molecules. Therefore, artificial nose bone, artificial chin, and etc gradually become the major raw materials for plastic cosmetic surgery. After liquid silicone is injected into the body, as it will not combine with body’s tissues, eventually this material will react our body’s immune system and be covered and formed into lumps called silicon tumor. Although this reaction is not harmful, it can be felt when touched. In addition, weight is the other disadvantage of silicon. Its excessively high density generally does not allow body tissues to sustain its weight. This resulted in causing the part where injection was applied to become floppy and out of shape, thus, silicone injections already have been officially forbidden domestically and internationally. Recently, as the knowledge of plastic surgery is widely spread, general public are more aware of the side effects of this kind of cosmetic therapy. Once silicon, injected into the body it will spread, consequently it cannot be take out completely. Therefore, in the earlier period, many patients who have accepted silicone injections, they are still suffering and till now a perfect solution cannot be found.

Side effects of silicone injections not only exist in Taiwan, but also around the world. For this reason, companies developing new alternatives which have long term (permanent) effect are slowly in progress. Large improvements in biotechnology, several of the developed countries already have alternative injectable fillers with long term effect in the market. Among which and also well known by most people is Aquamid produced by Denmark. This product has been used by European people almost a decade ago and receives high opinions from doctors and consumers. Aquamid consists of 97.5% distilled water, only 2.5% of polyacrylamid gel (PAAG). PAAG is a non-toxic material, which is water loveable and mainly converts water into a thick paste that makes it hard for body to absorb, thus it is preserved in the body. This is also why it can maintain the effect for a long time. Since human body cannot metabolize polyacrylamid, its permanent existence inside human body may release some free radicals, which could be harmful to human body. Therefore, it is not suitable to inject large quantities. Generally suggested the maximum limit quantity that the human body can safely accept is 15cc. Also, USA FDA has not permitted its use yet. On the other hand, Europe, Australia, Central / South America and Japan have authorized Aquamid to be used legally. Doctors mainly use it for cheek implant, nose job, nasolabial fold correction, chin augmentation, or injecting small amount into areas of cheekbone and etc. Hence, its safety is carefree.

Another star product of injectable filler with long term effects also comes from Europe; it is Bio-Alcamid which has been out in the market for 8 years. Not only the name of this Italian made filling is similar to Aquamid , but also the molecule content, polyalkylimide (PAIG) ,is a derivative of polyacrylamid. However, the major difference between Bio-alcamid and Aquamid is that after it is injected into the body, it forms a very thin water-preventing layer which obstructs body tissues contacting with Bio-alcamid which further forms sections of small rooms filled with polylkylimide content. As it does not get in contact with body tissues, thus the problem of oxidation of free radicals will not occur. For this reason, large amount of Bio-Alcamid can be injected into parts of the body that requires fillings, for example, funnel shape breasts, fat atrophy due to aging, body part deformation due to external injuries and on construction therapies. It also can be used for cheek augmentation, Rhinoplasty, buttock augmentation, chin augmentation and etc. The use of Bio-Alcamid in the beauty cosmetic industry is much broader than Aquamid. Besides Europe, Japan, North America for example Canada also use it on filling patient’s faces that is caved into and have atrophy. Under specific conditions, US government permits the use Bio-Alcamid. It can be said that it is a very good new to patients who really requires non-surgical method of cosmetic surgery.

I, the author, had the honor of having opportunity to use the products mentioned above in Japan and Korea, even invited by the Manufacturer of Bio-Alcamid to Milan in Italy to carry out education training and also exchanged valuable opinions with local cosmetic plastic surgeons. Although the ingredient and usage are basically the same, but there are still many differences that is worth paying attention to. Therefore, doctors must be extremely cautious when using these. Firstly, there is no difference between injection method of Aquamid and is the general HA injections. You can apply the injection underneath skin in different directions several times until it is inflated. However, Bio-Alcamid requires injection of at least 0.2~0.5cc in one area then change the place of injection. In another word, it needs several injections with certain quantities instead of several injections from different directions, otherwise the formation of a thin layer is a disadvantage and alternatively, it can be absorbed by human body. Clinical technique of Bio-Alcamid is much harder, it is hard to inject evenly for untrained doctors. Secondly, the ingredients of Bio-Alcamid are thicker; therefore, after injected into human body, it is still able to feel its existence when touched carefully. If it is injected too close to the skin’s surfaces, then skin show unevenness easily. Yet, after Aquamid is injected, there is no difference in the skin tissues and even forgot its existence. Thirdly, these two products are used in different applications. As Bio-Alcamid is a thicker paste, it is easier to prop up the soft tissues or skin. Therefore, it is often used to pad the desired shape, for example, cheekbone lift, nose jobs, chin lift or to rectify bone deformation which is similar to the implantation of a fake object in plastic surgeries. However, the touch of Aquamid is softer. Thus, it is more suitable to uses it in filling parts that is soft in the first place, for example, cheeks implants, sex organs implants, forehead lifting or nasolabial fold correction and so on. Fourthly, the procedures of injecting Aquamid and general HA injections are the same. In the clinic, after anesthesia is injected into the skin, Aquamid can be injected directly and patient will not feel too much pain. On the other hand, Bio-Alcamid requires sterilization procedures that are as conscientious as for any surgery procedures and also it is best to give small amount of intravenous anesthesia in order to prevent the pain Fifthly, these two types of injectable fillers can be removed after injected, but it is best for Aquamid to be removed within one month of the actual injection, otherwise, it is hard to locate it when it had reacted with tissues. However, Bio-Alcamid does not have this concern. If you do not like the effects, simply ask the doctor to remove it for you at anytime. Lastly, under all safety precautions, Bio-Alcamid can be injected in large dosage whereas it is not possible for Aquamid.

Besides the two types of injectable fillers with permanent effect described by me, the author, there is another type of injectable fillers with permanent effect which contains polimethylmethacrylate(PMMA) as the ingredient. Examples of these are Artecoll from German, and other products from Chinese. However, as all of these products contain animal collagen, swollenness, tissue incompatibility and other complications may occur depending on each individual’s body conditions. An example of this type of case recently happened in China where injectable filler was used for breast augmentation. For this reason, I personally do not recommend consumers to accept these types of injectable filler. In the same regards, what are the side effects for Aquamid and Bio-Alcamid? The simplest way to explain the condition that could most possibly happen is that patient may still be able to feel some lumps. This situation is most likely to occur with Bio-Alcamid, especially when aging skin has atrophied and become thinner, patient must pay attention to changes after injection was applied. Thus, we often do not recommend applying excessive amount on the face area. If visible limps are discovered, it must be extracted in order for the lump to disappear. Floppiness or dislocation of other types similar to liquid silicone would not happen, as either PAAG or PAIG will strongly attach to body tissue. Another situation, which must be prevented when injecting is occurrence of infections, otherwise wide spread of infectious reaction under the skin can occur due to the depth injected under the skin and spread of the body tissues. In some severe cases, patient must go through surgery, which may leave scar and cavities, in order to clean up the infection. In addition, this type of material is prohibited for use in breast augmentation, as it has not been clinically proven whether it will affect lactiferous tissues or breastfeeding in this short period of time. Above are different factors consumers should consider prior to enjoy this very convenient way of cosmetic surgery.

The progress in medical science and technology always benefits people, no doubt the introduction of Aquamid and Bio-Alcamid satisfy women’s desire of the aesthetic appearance of their nose without having to go through a painful surgery. However, I must remind the applications of these kinds of material are less than a decade; even though the ingredient are determined safe from theory, clinical reports are not able to verify the scientific data and animal experimental results, which provided by the manufactures, not mentioned the change after 30years. Therefore, it is premature to say this revolutionary product can replace cosmetic plastic surgery; in addition the government doesn’t approve the new product yet. I believe our friends who like to be beautiful will have to wait patiently.