The common organic implants have proven to be relatively safe non-surgical options for the treatment of many skin contour problems, such as wrinkles and furrows.

Hylaform viscoelastic gel is a relatively new implant material so it does not have the track record of such products as Zyderm and Zyplast. However, two decades of investigation would suggest that it will be safe and effective for soft tissue augmentation as it is implants require a stitch at either biologically compatible and stable end of the implant site. Once these are removed there is no in dermal tissue. Of interest it also promises to be of importance in other areas of medicine including orthopaedics, ophthalmology, and urology.

The types of problems which may arise from organic implants include:

Allergic reactions:

In I to 2% of cases organic implants, with the exception of Hylaform viscoelastic gel implants and microlipid transfers, are regarded by the body as foreign and rejected in an allergic reaction. If there is a history of allergies to the ingredients within the implant solution, or if an allergic reaction occurs at a test site on the arm, implant therapy should not be undertaken. Allergic reactions are characterized by prolonged redness, swelling, itching, and firmness. A reaction usually persists for 3 to 4 months, lasting perhaps a year or longer in more severe cases. On very rare occasions, a scab may form with the subsequent sloughing or shedding of the skin at the treatment site. This may result in a shallow scar.

Delayed allergic reactions may occur even though the test site was found to be normal and one or more implants were successfully injected. For this reason, some physicians repeat the test within a month. If no allergic reaction occurs after the second test, the implants are then injected into the areas requiring treatment.

If a reaction is caused by one type of implant, it is possible another could be used once all signs indicate the previous implant has been absorbed. For example, Zyderm and Zyplast contains a local anesthetic, whereas matrix implants do not, Although a local anesthetic is in most cases beneficial, those allergic to it may wish to try the Koken or Fibrel implants.

Other types of problems:

There is the unlikely chance (less than I%) that a blood vessel may be hit or blocked during an injection. If this occurs a bruise may form at the site or a scab may occur with subsequent sloughing or shedding of the skin. This could result in a shallow scar. Because this is more likely to occur when treating the vertical creases between the eyebrows some dermatologists are now opting to use localized muscle relaxants (Botox botulinum exotoxin). The relaxants, when injected into the muscles above the eyebrow cause a temporary paralysis so an individual can no longer frown. The temporary muscle inactivity reduces the wrinkles.

If collagen is injected into a vein near the eye, visual loss could occur. Only one incident of this happening out of millions of injections has been reported so the risk is extremely low. At the time of implant therapy it is wise to avoid the use of aspirin or other types of nonsteroidal anti inflammatory drugs that reduce the clotting of the blood. This will help control bleeding and bruising at the treatment site.

If there is a history of herpes simplex, the trauma caused by the injection of the collagen may stimulate the eruption of a herpes cold sore at the site of the injection.

Relation to connective tissue disease:

There have been some reports that connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis and polymyositis may be caused by collagen implants because they have occurred in patients who have no history of these diseases but have received collagen injections. After an intense investigation, the Food and Drug Administration in the United States found that "...there is insufficient statistical or biological evidence to support a conclusion that collagen injections cause autoimmune or connective tissue diseases in persons without a history of these diseases." Yet it would seem prudent that patients with collagen related diseases such as rheumatoid arthritis should not be injected with collagen implants until new data is available to clarify this issue. An alternative is the use of microlipid (or fat) transfers or the new Hylaform viscoelastic gel.

Safety with pregnancy:

Whether or not implants can be safely injected during pregnancy or breast feeding has not been established, so it is better to wait until after the postnatal period before embarking on an implant therapy program.