LAUSR

To remedy the inevitable changes that accompany the aging body, fillers have been used since the early 19th century in efforts to enhance appearance. With goals of rejuvenating and restructuring both real and perceived bodily imperfections, the development of fillers was not without its share of blunders. The story of fillers begins with the discovery of paraffin in 1830 by a German chemist named Baron Karl Ludwig von Reichenbach. Hewasabletocreatethematerialthroughthedrydistillationofbeechwood tar. Noting that the substance was extremely unreactive, he thought paraffin could be used as a lubricant or perhaps as a replacement for beeswax in candles. The name paraffin comes from the Latin words parum and affinis, meaning barely and affinity, respectively. In the years to follow, paraffin would take the medical community by storm. Using paraffin as a vehicle, dermatologists injected heavy metal salts into their patients for the treatment of syphilis. At the University of Vienna, Theodor Billroth, a founding father of modern abdominal surgery, used paraffin to lubricate resected joints. However, it wasn’t until 1899 that Robert Gersuny, a student of Billroth’s, used the material for cosmetic purposes. Gersuny injected liquid paraffin, also known as mineral oil, to create a testicular prosthesis for a patient who was castrated for tuberculous epididymitis. Gersuny thereafter experimented with the process by combining petrolatum, a combination of solid and liquid paraffin that was also known commonly as Vaseline, and olive oil. The key to his custom “filler” was its high melting temperature of 40°C. The substance could be heated into its liquid form, and then injected into the body where it would cool and solidify. The medical community took notice of the utility of paraffin, and it was quickly used for other applications, including nasal augmentation, breast augmentation, eliminating wrinkles, and even treating urinary incontinence. Things took a turn for the worse in the early 20th century, when reports surfaced about infections, embolization, migration, granuloma formation, and scarring. The term paraffinoma was used to describe the granulomatous foreign-body reaction that occurred at injection sites. An unfortunate case was that of Gladys Spencer-Churchill, the second wife of the Ninth Duke of Marlborough, who underwent injections to her nasal dorsum. The paraffin migrated into her chin and produced paraffinomas along the way, resulting in severe disfigurement. The use of paraffin inevitably ceased owing to associated complications, but it paved the way for the use of otherfillers, includingsilicone,autologousfat,andcollagen.Fromitshumble beginnings as a testicular prosthesis, paraffin will be remembered for spearheading the development of more efficacious fillers.