...and facial defects. The authors injected the lips 20 female patients with the Evolence filter for the purposes of lip enhancement and/or augmentation. Sixteen of the 20 patients (80%) experienced multiple lip nodules despite firmly molding the product immediately after injection. Many of these nodules required further treatment. Some nodules regressed over many months, but some nodules were still quite visible in 6 patients over 1 year later. Given this direct clinical experience, it is the authors' conclusion that the Evolence filler should not be injected into the lips due to the high incidence of nodule formation.

Introduction

Bovine collagen (Zyderm[R], Zyplast[R]) was approved by the FDA in 1982 and proved the injection to be one of the most popular and safe fillers for many years. (1) The bovine-derived collagen filler has 2 major drawbacks: patient skin testing is required prior to use and the filler does not provide a lasting correction beyond a few months. Subsequently, human-bioengineered collagen (Cosmoderm[R]) became available, allowing the avoidance of skin testing; however human collagen filler did not provide a longer correction compared to bovine collagen. (2)

Over the past decade numerous hyaluronic acid (HA) fillers have been introduced to the market due to the limitations of both bovine-derived and human-engineered collagen. Many of the HA fillers have been shown to provide more durable results than bovine collagen, (3), (4) and consequently, popularity has soared, replacing bovine collagen as the filler of choice for the lips and face. Hyalurons are now the largest selling fillers in the US aesthetic marketplace, with over 1 000 000...

NOTE: All illustrations and photos have been removed from this article.



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