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Systematic Review of “Filling” Procedures for Lip Augmentation Regarding Types of Material, Outcomes and Complications

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Systematic Review of “Filling” Procedures for Lip Augmentation Regarding Types of Material, Outcomes and Complications See discussions, stats, and author profiles for this publication at: http://www.researchgate.net/publication/275366004 Systematic review of “filling” procedures for lip augmentation regarding types of material, outcomes and complications ARTICLE in JOURNAL OF CRANIO-MAXILLOFACIAL SURGERY · APRIL 2015 Impact Factor: 2.6 · DOI: 10.1016/j.jcms.2015.03.032 DOWNLOADS VIEWS 18 39 4 AUTHORS: Joan San Miguel Rajgopal R Reddy Clínica birbe, Barcelona, Spain GSR Institute of Craniofacial Surgery 5 PUBLICATIONS 1 CITATION 13 PUBLICATIONS 71 CITATIONS SEE PROFILE SEE PROFILE Federico Hernández-Alfaro Maurice Mommaerts Universitat Internacional de Catalunya University Hospital Brussels 64 PUBLICATIONS 326 CITATIONS 61 PUBLICATIONS 170 CITATIONS SEE PROFILE SEE PROFILE Available from: Maurice Mommaerts Retrieved on: 24 July 2015 Journal of Cranio-Maxillo-Facial Surgery xxx (2015) 1e24 Contents lists available at ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com Systematic review of “filling” procedures for lip augmentation regarding types of material, outcomes and complications Joan San Miguel Moragas a, Rajgopal R. Reddy b, Federico Hernandez Alfaro c, * Maurice Y. Mommaerts a, a European Face Centre, University Hospital Brussels, Belgium b GSR Institute of Craniofacial Surgery, Saidabad, Hyderabad, India c Clínica Teknon, Barcelona, Spain article info abstract Article history: Background: The ideal lip augmentation technique provides the longest period of efficacy, lowest Paper received 14 January 2015 complication rate, and best aesthetic results. A myriad of techniques have been described for lip Accepted 26 March 2015 augmentation, but the optimal approach has not yet been established. This systematic review with meta- Available online xxx regression will focus on the various filling procedures for lip augmentation (FPLA), with the goal of determining the optimal approach. Keywords: Methods: A systematic search for all English, French, Spanish, German, Italian, Portuguese and Dutch Augmentation language studies involving FPLA was performed using these databases: Elsevier Science Direct, PubMed, Enhancement Filler Highwire Press, Springer Standard Collection, SAGE, DOAJ, Sweetswise, Free E-Journals, Ovid Lippincott & Lip Williams Wilkins, Willey Online Library Journals, and Cochrane Plus. The reference section of every study selected through this database search was subsequently examined to identify additional relevant studies. Results: The database search yielded 29 studies. Nine more studies were retrieved from the reference sections of these 29 studies. The level of evidence ratings of these 38 studies were as follows: level Ib, four studies; level IIb, four studies; level IIIb, one study; and level IV, 29 studies. Ten studies were prospective. Conclusions: This systematic review sought to highlight all the quality data currently available regarding FPLA. Because of the considerable diversity of procedures, no definitive comparisons or conclusions were possible. Additional prospective studies and clinical trials are required to more conclusively determine the most appropriate approach for this procedure. Level of evidence: IV. © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. 1. Introduction been established, the best aesthetic result has also not been agreed upon. The words ‘youthful’, ‘pouty’, and ‘voluptuous’ are commonly The best filler material for facial soft tissue augmentation re- used to define the ideal result of a lip augmentation procedure. mains to be determined. A myriad of natural and synthetic com- Essentially, this is accomplished by enlarging the lip, but it is not a pounds have been used, but none is clearly superior to the rest. The simple matter. Reports of unnatural (and sometimes disastrous) ideal filler material achieves the best aesthetic long-term results appearances caused by lip augmentation frequently appear in the and has the lowest complication rate and lowest cost. media (Browning, 2012; Parsons, 2012; 20minutes.es 2012). Volu- Determining the optimal filler material is especially difficult for minous lips are not appealing if the upper incisors are camouflaged lip augmentation surgery. Not only has the best filler material not behind the lips while speaking or laughing, or if the lip movements are affected, or there are noticeable nodules, or the natural vermilion grooves are obliterated. The attractiveness of the lip generally parallels the attractive- * Corresponding author. European Face Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. Tel.: þ32 02 477 60 12. ness of the teeth visible while speaking or smiling, and studies E-mail address: [email protected] (M.Y. Mommaerts). typically correlate the smile line with the position of the upper lip http://dx.doi.org/10.1016/j.jcms.2015.03.032 1010-5182/© 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Please cite this article in press as: San Miguel Moragas J, et al., Systematic review of “filling” procedures for lip augmentation regarding types of material, outcomes and complications, Journal of Cranio-Maxillo-Facial Surgery (2015), http://dx.doi.org/10.1016/j.jcms.2015.03.032 2 J. San Miguel Moragas et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2015) 1e24 during a smile. A smile makes a face appear more attractive studies regarding filling procedures for lip augmentation (FPLA). (Doherty et al., 2003), and approximately 75%e100% of the maxil- The review included studies evaluating fillers or grafts. The goal lary anterior teeth should be exposed for the smile to be most was to evaluate good quality data regarding the various FPLA appealing (Passia et al., 2011). The human brain has specific areas techniques to determine the optimal approach. and circuits (afferent fibers from the fusiform area [Brodmann Area (BA)37] to the medial orbitofrontal cortex BA14, BA32) to perceive 2. Materials and methods smiles and feel pleasure (Shahin and Tootell, 2012; Tsukiura and Cabeza, 2008). Furthermore, an enlarged lip is not beautiful if its 2.1. Literature search shape is not attractive; however, the ideal shape has not been established. Although general rules have been established, the A systematic literature search shown as a QUOROM-flow dia- attractiveness of specific shapes has not yet been investigated. gram in Fig. 1 (Moher et al., 1999) was conducted with the assis- Thus, even though lip augmentation techniques using fillers are tance of the Unika Library Service from the University of Navarre being analyzed in this systematic review, the results will be taken (Clínica Universitaria de Navarra, Pamplona, Spain) and the assis- very cautiously, since in virtually no study are the results analyzed tance of LIMO Library Service from the Catholic University of when smiling or speaking, and the change in the shape is not Leuven (Leuven, Belgium). These services allowed us to access the analyzed in any of them. Elsevier Science Direct Complete, PubMed Central, Highwire Press, Nevertheless, dermal fillers are a thriving business, and the Springer Standard Collection, SAGE Premier 2011, DOAJ Directory of overall dermal filler market in the United States (US) has expanded Open Access Journals, Sweetswise, Free E-Journals, Ovid Lippincott at a compound annual rate of 20.2%, reaching $782,645,560 in total Williams & Wilkins total Access Collection, Willey Online Library sales (Surgery.org, 2012). The market in the rest of the world has Journals, and Cochrane Plus databases. The following heading similarly increased by 20%, reaching $1.5 billion in global sales sequence was used: {‘Lip’ OR ‘Mouth’ OR ‘Perioral’ or ‘Nasolabial} (Miinews.com, 2010). Factors contributing to this expanding mar- AND {[‘filler’]OR[(‘graft’ AND (‘dermal’ OR ‘fat’ OR ‘adipose’ OR ket demand likely include the aging population, expanding media ‘tendon’ OR ‘muscular’)] OR [(‘hyaluronan’ OR ‘hyaluronic acid’ OR exposure and consumer awareness, new and improved filler tech- ‘Hylan’ OR ‘Hylaform’ OR ‘Revanesse’ OR ‘Hyaluderm’ OR ‘Juvederm’ nologies, and expanding social acceptance. Injection of hyaluronate OR ‘Teosyal’ OR ‘Esthelis’ OR ‘Captique’ OR ‘Belotero’ OR0 Restylane’ fillers is the second most common nonsurgical procedure in the OR ‘Perlane’ or ‘Puragen’ OR ‘Emervel’)OR(‘elastin’ OR ‘Endoplast- USA with a total of 1.5 million injections performed annually 50’)OR(‘Collagen’ OR ‘Zyplast’ OR ‘Zyderm’ OR ‘Cosmoplast’ OR (Surgery.org, 2012). ‘Cosmoderm’ OR ‘Autologen’ OR ‘Dermalogen’ OR ‘Evolence’ OR With the above considerations in mind, we designed the current ‘Dermicol’ OR ‘Permacol’)OR(‘Alloderm’ OR ‘Surgisis’ OR ‘Cymetra’ study to systematically review all the heretofore-published quality or ‘Matrix’)OR(‘Fibroblasts’ OR ‘Isolagen’)OR(‘Agarose’ OR ‘Easy Fig. 1. QUOROM-flow diagram. Flow diagram according to QUOROM statement (Moher et al., 1999) providing information about the number of articles identified, included, and excluded and the reasons for excluding them. Abbreviations: n ¼ number of studies. Please cite this article in press as: San Miguel Moragas J, et al., Systematic review of “filling” procedures for lip augmentation regarding types of material, outcomes and complications, Journal of Cranio-Maxillo-Facial Surgery (2015), http://dx.doi.org/10.1016/j.jcms.2015.03.032 J. San Miguel Moragas et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2015) 1e24 3 Filler’ OR ‘Easy Agarose’ OR ‘Dextran’
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