Soft Tissue Augmentation

Another fascinating perspective that illustrates some of the history of ophthalmic surgery in facial rejuvenation relates to facial soft tissue augmentation by injection. In 1990, Charles Kelman, the famous ophthalmologist/pioneer and inventor of phaco-emulsification, personally witnessed some concerns over the use of bovine collagen (mostly relating to severe allergic reactions) while appreciating the benefits of collagen as a soft tissue augmentation agent for the improvement of facial wrinkles. As the agents Zyderm and Zyplast were the only agents available in the US at that time, Kelman and biochemist Dale P. DeVore began their quest to produce a safe, injectable autologous collagen that evolved into the current products such as Dermalogen.
Besides collagen, hyaluronic acid (Restylane, Juvederm, etc.) also has its origins in ophthalmology. As a routine component of successful intra-ocular surgery, hyaluronic acid proved its safety, efficacy, and biocompatibility. Modifications of the molecule (such as cross-linking) has aided in persistence and residence time. Intra-ocular surgery, performed on millions of patients, has also broadened the experience of biocompatible implants with an unprecedented safety profile. Intra-ocular lenses use a polymethylmethacrylate (PMMA) component as the optical haptic, and polypropylene for fixation and stabilizing. After many implantations, these substances have proved to have no inflammatory response. Permanent fillers such as Artefill (polymethylmethacrylate beads in a collagen dispersion) have been developed as a result of years of experience. Other materials such as polypropylene sutures that are now used commonly for both canthal suspension procedures as well as barbed suture technology, have also been ratified by years of in-vivo compatibility testing.