[Life Plastic Surgery] Dr. Sewhan Rhee's Column

Complications of Injectable Fillers, Part I 

Dr. Sewhan Rhee’s Column

Hello, this is LIFE Plastic Surgery.The journal article by Dr. Sewhan Rhee has been released in the Magazine Plastic Surgery Korea. Plastic Surgery Korea is a beauty and cosmetic surgery related magazine to share the information and trend regarding medical experts and cosmetic surgery. On this month’s issue, Dr. Sewhan Rhee wrote an article regarding Complications of Injectable Fillers. Here is the summary of the articles. Complications of Injectable Fillers, Part IStarting with Zyderm Collagen (Allegan Inc, Irvine, California) in 1981, bovine Collagen has been widely used. After that numerous different variations have been released. Among that the most popular kinds are HA kinds. HA products are made of linear, unbranched, highmolecular weight glycosaminoglycan complex sugar which are composed of the alternation of d-glucuronic acid and N-acetyl-d-glucosamine. In 1934, As Meyer and Palmer first published while analyzing bovine vitreous, HA is found on the skin and has the following functions. From physical functions such as working as lubricant and to biological functions such as fertility, embryogenesis, morphogenesis, cell movement, reaction to immflamation, would healing, HA is an essential substance and has chemical functions.
 In a natural state, HA is a very ideal filler substance. However, it has extremely short half life. Producing companies sought to modify the chemical composition of HA to prolong the natural turnover and increase the half-life by using various substance such as butanediol diglycidyl ether(BDDE). So far through minimal ingredient change, producing companies have been producing HA products that can maintain the immune system and has long half-life and does not change easily. The initial HA production used the biological substance extracted from animal, but it was blamed for protein contamination. As a result the base material for hyaluronates has been drawn and developed from Lancefield group A and C Streptococcus equi zooepi-demicus. These bacteria then produced pure hyaluro-nate mucoid capsule.
 Rather than contaminated complex protrein of birds or mammals, more distilled and large amount of hyaluronate can be obtained in this bacterial broth by distilling/refining primitive bacterial protein contaminant. Between the chains there are more cross-linking. Due to efforts to prolong the shelve-life there is inevitable decrease in the saturation. This is caused by immunity-mediated side-effects. Therefore, to minimize the susceptibility to breakdown, there needs to be balance between maintaining natural HA’s chemical structural change and not changing natural structure too much so that it is recognized as foreign substance by immune system.

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