Carboxymethyl cellulose – the new filler era Esthetic medicine history

Historia medycyny estetycznej

The activity of  XIX-century volumetric surgeries pioneers constitutes a starting point for scientific achievements utilized in the technology of polysaccharide injection – innovative in comparison to  cross-linked hyaluronic acid.

The history of fixing appearance with the use of such preparations reaches year 1893. Back then praffine products were used, but caused lot of complications (parafinoma). In the 60’s of XX century the use of silicone became popular, but it turned out dangerous, especially after a large dose (sclerodermal development). In 1981 the use of cattle collagen became a practice, but it demonstrated immunogenicity –  since 2003, humane collagen was used, but only until 2004, due to it’s unwanted side effects. Since 2004 it’s become a practice to use the safest, until today widely used hyaluronan (HA).

Requirements

In the year 2000 Italian scientists began to seek a new product, to meet the following requirements more than HA:

• bacterial protein residues purification level,
• a manner and degree of crosslinking
• physico-chemical characteristics (viscoflexibility, stability),
• complete biodegradability,
• esthetic effect in a defined period.

The research was focused on carboxymethyl cellulose. It has already been utilised in pharmaceutical industry for over 50 years as a highly refined aid substance in production of injection preparations (dexamethasone) and a carrier allowing to control the release of active substances in other pharmaceuticals (doclophenac, nifedipine). Due to it’s high quality, the substance is used in modern technologies (Hydrofiber) to treat chronic wounds, and in ophthalmology to produce fake tears in the cornea and conjunctiva inflammation.

Carboxymethyl cellulose

Carboxymethylcelluloce – CMC is a water-soluble substance. Cellulose has a botanical origin, usually wood or cotton. Carboxymethyl cellulose is the most common cellulose ester. Increases the viscosity of liquids, stabilizing the suspension of solid particles. Has hygroscopic properties. Despite wide range of applications in pharmaceutical industry, this polymer is used in manufacture of food products as a number E466 thickener and emulsion stabilizer (i.e. in ice cream). CMC is also a component of many other products: cosmetics, hygienic products (toothpastes), laxatives, detergents, paints, fabrics, paper, and even oil industry products.

Chemically, a cellulose particle is made from glucose particles (glucopyranose), combined by glucosidic bonds. CMC is a cellulose derivative with carboxymethyl groups connected with some of hydroxyl glucopyranose monomer groups,constituing the compound. Is often synthesised as a carboxymethyl cellulose sodium salt, which allows avoiding animal, human or bacterial contamination. Wide applicability proves that the substance does not pose risks of mutagenicity carcinogenicity. The research indicated it’s bactericidal action inside tissues, which proves that it’s safe to use CMC.

Esthetic medicine uses CMC for a long time i.e. in products including calcium hydroxypatite,  polylactic acid, polyethylene glycol, polycaprolactone, where it has a role of a carrier as well as a filler.

Carboxymethyl cellulose clinical research

The dermatological and toxicological research made by independent laboratories on mice, guinea pigs and humans show clearly that carboxymethyl cellulose is not toxic. Food examination proves that in metabolism and topical use, CMC does not give any pharmacological effect. Patch tests of a human skin show that it does not irritate nor is sensitizing. CMC is an FDA confirmed compound.

After years of gaining worldwide experience in use and ten years of experimental research, a preparation of cross-linked CMC was created to meet the demand of esthetic medicine volumetric surgeries. In Italy, where it was first made, it gained an ISS certificate. In 2010 the Clinical Interventions in Aging magazine published first non-commercial results of research on 84 volunteers, which have been injected CMC from 2006 to 2009. The protection period lasted for 12 months after the polymer absorption. None of the patients proved allergic. Optimal tolerance, safety, ease of injection, material elasticity in a tissue, stepwise absorption without migration noticed. Moreover, as a cross-linked biopolymer, it shows bioabsorption, biocompatibility and biodegradability – being a polysaccharide of the same group as hyaluronan. It is innovative in comparison to HA-based fillers, because of complete lack of proteins and bacterial endotoxins (CMC origin is not animal nor bacterial). It is derived in a chemical synthesis, using a natural substance – cellulose.

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The text is a synthesis of mgr Katarzyna Rembelska’s article, cabines.pl