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GoreTex is a synthetic material composed of interconnected fibrils of expanded polytetrafluoroethylene (PTFE). You may recognize Gore- Tex as the lightweight fabric used to make insulating ski jackets, but GoreTex fibers are even more interesting as surgical implants. They have been used for almost 30 years as surgical vascular grafts and more recently for implants in the skin.

GoreTex patches can be placed just under the skin of the nose to give a smooth profile to previously unaesthetic indentations, and can be threaded under the deep folds between the nose and the mouth to smooth the grooves.

GoreTex is good for enhancing thinned, aging lips, which are often surrounded by wrinkles into which lipstick runs. The procedure is simple and takes only minutes under local anesthetic.

The advantage is that correction is longer-lasting than with collagen. GoreTex is biologically inert and never causes an allergic reaction. If infection occurs or if the correction is not quite what the patient wants, the implant can easily be removed with no long-term consequences.

Skin Implants Fibril

Fibril is another alternative soft tissue material to collagen. It is similar to collagen in the way it is injected, but its composition is quite different. Fibril contains an absorbable sponge of gelatin powder along with a substance called epsilonaminocaproic acid. When mixed with the patient’s own blood plasma and injected immediately into the skin, it causes the fibrinogen protein to form a matrix which fills in the surface indentation of a wrinkle or scar.

Fibril has several limitations: the Fibril procedure is longer and therefore more expensive than bovine collagen implantation because each patient’s blood must be drawn to prepare the mixture. Furthermore, the areas treated remain red and swollen for days to weeks after the treatment. And finally, the correction is less long-lasting than in the case of collagen treatment. Fibril, however, remains a possible alternative for people allergic to collagen.

Skin Implants Silicone

Silicone is a synthetic polymer of polydimethylsiloxane which, like GoreTex, has the least physiologic reactivity of any foreign substance ever used for soft tissue implantation. When properly implanted, silicone can be highly effective. Because of complications when it was first used, however, silicone acquired a bad reputation and was eventually prohibited for soft tissue implantation in the United States. Its improved form is effectively used in many other countries.

Skin Implants getting it right

In the early 60s, injectable silicone contained a one percent additive of either oleic acid or sesame oil, purposefully included to enhance the body’s reaction to the silicone to delay its absorption and thereby prolong its effectiveness. In some six percent of patients, these additives caused unattractive, red nodules over the site of the implant. These additives were therefore later abandoned.

When silicone was first used, it also had a lighter viscosity, i.e. it was more fluid, with the disadvantage of sometimes migrating between the planes of facial muscles, causing unattractive sagging. Subsequently, silicone of a heavier viscosity was made and found to lock into the tissues much better, with far less possibility of the fluid migrating to other areas. This higher viscosity silicone is now the form that is always used.

A delicate manoeuvre

For a successful cosmetic silicone implantation, the doctor’s technique is very important. Silicone must be injected in minute micro-droplets through a tiny syringe (similar to that used for collagen implantation). After injection, the skin is massaged and the patient must not move his or her face for at least 20 minutes. Because silicone is a polymer, which is not absorbed but which remains for ever in the skin, when small wrinkles or scars are treated the indentation is only minimally filled with silicone at each treatment.

The body reacts by creating a capsule of collagen around the implanted silicone with the effect that the tiny particles injected are eventually enlarged by the body’s natural reaction. It usually takes two to three silicone treatments spaced at least one month apart to successfully correct deep wrinkles and indented scars.

Silicone is most effective for the correction of the deep furrows around the mouth, the creases between the eyebrows, and for small wrinkles at the border of the lips as well as for shallow, indented scars. Silicone is also the optimal soft tissue implantation material for correction of indentations of the bridge of the nose, particularly after nasal surgery. Silicone cannot be used under the eyes or in deep creases under the mouth or for chin augmentation. It is used only sparingly for treating forehead wrinkles.

Does it work? Silicone, when properly handled, can give permanent correction of scars or indented wrinkles. This advantage is tempered by the possibility that with aging some beading can occur where the skin was injected. The second advantage of silicone is that it is completely inert. There can be no allergic reaction to silicone. In fact, you are already likely to have some silicone in your body! As every syringe needle is coated with silicone, a minute quantity of the substance exists within every person who has ever had a blood test or medical injection.

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