ABSTRACT
We have seen that there are constant physiologic reactions with fillers, but some of them induce specific local modifications: they have a biostimulation effect. Collagen or hyaluronic acid based fillers are used for
their filling effect by the volume injected, but they also play an important role in cutaneous metabolism, by stimulating neocollagen formation, by enhancing dermal cohesion, fibrocyte and keratinocyte metabolism,1
or water retention. They cannot be considered only as volume enhancers, but also as true biostimulators, even if their duration within the tissues is short. This biostimulation effect is sought and is part of the
desired characteristics of some of the implants: Artecoll® and Artefill® have smooth microspheres whose characteristics will stimulate a strong fibrous encapsulation, isolating completely the beads from the host tissues and assuring long-lasting tolerability in most cases. It is partially the same with New-Fill®, Sculptra®, Radiesse® and Atlean® which induce a resorption/ replacement of their microspheres by fibrous/osseous tissue, albeit after a strong secondary inflammatory phase.2 It is also the case with the dextran microbeads of Reviderm® and BeautySphere®, attracting water then strongly stimulating collagen formation. Some implants are described as inducing at first lit-
tle or no inflammatory reaction, but clinical experience has shown that they are responsible for delayed major reactions. In that respect, their biostimulation effect can be considered an unfavorable reaction leading to complications. This is the case with Dermalive® and Bioplastique®. The only strictly volumetric implants are the fluid
ones: silicone or acrylic gels, which do not first induce a foreign body reaction. Nevertheless, like the others, they have some side-effects, and complications.
