title: Use of cross-linked carboxymethyl cellulose for soft-tissue augmentation: preliminary clinical studies.
abstract: OBJECTIVE
  The continual search for new products for soft-tissue augmentation has in recent years led to the introduction of long lasting alternatives to hyaluronic acids and collagen that are composed of other polymers able to improve clinical persistence over time. This is the first report in which sodium carboxymethyl cellulose (CMC) has been chemically treated by the cross-linking process and thus used as a hydrogel for soft-tissue augmentation through injection with thin needles. The study evaluates, from a clinical point of view, the behavior of cross-linked carboxymethyl cellulose hydrogel used in the aesthetic field and its side effects so as to check the safety and performance of the polymer following intradermal injections.
  
  
  METHODS
  This work shows the preliminary results of an ongoing clinical study conducted between 2006 and 2009, performed on 84 healthy volunteers (62 females, 22 males) aged between 18 and 72 years, for the treatment of 168 nasolabial folds, 45 perioral wrinkles, and 39 lip volume.
  
  
  RESULTS
  Study results show an excellent correction of facial defects. Tolerance and aesthetic quality of the correction obtained indicate considerable safety features and absence of side effects. From a clinical point of view, hydrogel is gradually absorbed into the injection site without migration issues.
  
  
  CONCLUSIONS
  Cross-linked CMC hydrogel proves to be an ideal agent for soft tissue augmentation with regard to safety and ease of application. It did not cause infection, extrusion, migration, or adverse reactions in the patients who have been followed for two years. Delayed aesthetic results on facial wrinkles were very satisfactory.
authors.affiliation: Department of Plastic Surgery, Salvator Mundi International Hospital, Roma, Italy. mleonardis@virgilio.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Leonardis
authors.forename: Andrea
authors.initials: A
authors.lastname: Palange
authors.forename: Rodrigo F V
authors.initials: RF
authors.lastname: Dornelles
authors.forename: Felipe
authors.initials: F
authors.lastname: Hund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use; D002266:Carboxymethylcellulose Sodium / Q000009:adverse effects / Q000138:chemical synthesis / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D020100:Hydrogels / Q000627:therapeutic use; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D015595:Skin Aging / Q000187:drug effects* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D020100:Hydrogels; D006820:Hyaluronic Acid; D003094:Collagen; D002266:Carboxymethylcellulose Sodium