The aim of this systematic review was to determine the safety and efficacy of permanent and semi-permanent dermal fillers for age related lines and wrinkles and for the visible effects of HIV-associated facial lipoatrophy. The small number of well-designed studies limited the ability to draw firm conclusions. The products included for review appeared to increase skin thickness as measured by skin callipers, ultrasound or subjective ratings of appearance, but long term efficacy has not been established. Patient satisfaction was high in all of the studies, reflecting the desire for people to feel better about their appearance. Despite the substantial increase in products available for soft-tissue augmentation,
well-performed clinical studies are scarce, and long-term clinical safety data are lacking. The results of the review indicate that semi-permanent and permanent fillers offer a comparable safety profile compared with temporary products in those studies that compared them, and that aesthetic improvements are maintained over time. Case series evidence suggests that permanent and semi-permanent dermal fillers achieve their objective, which is to decrease the visible (objective or subjective) effects of age related changes or HIV-associated facial lipoatrophy with high patient satisfaction.
Although the most common adverse events were mild and appeared to be related to the act of injection, palpable lumps were present in many patients. Biopsy of these lumps rarely occurred, leaving their exact nature largely unknown. Although permanent products offer longevity and potentially lower treatment costs, adverse events, should they occur, may be difficult to manage and of long duration. Long term studies investigating the safety and efficacy of dermal filling products may be problematic as patients continue to undergo subsequent cosmetic interventions.