FACIAL FILLERS

Collagen

The ability to inject materials into facial wrinkles and scars as filling agents has been around for along time. Collagen is available as Zyderm and Zyplast which are manufactured from Bovine skin. Patient's who wish to try collagen must receive a small test dose of the collagen to check for an allergy to this product. Only a few individuals will be allergic to the product and therefore can not receive it. There is an interval of one month to see if the skin will react before we can inject collagen into the face or lips. Collagen is a natural protein and therefore will be metabolized. The effects of the collagen may last for 2-3 months. The injections can be repeated as often as necessary to maintain the desired effects. The most common areas to inject the collagen are: Lips, nasal-labial lines and fine lines and wrinkles around the mouth. The injections are done using a topical anesthetic agent or pre-injection ice. Minor swelling and infrequent bruising are sometimes seen. Read more about this product.

Improved collagen products are also now available. CosmoDerm and Cosmoplast are human engineered collagen fillers. They are clearly less immunogenic than bovine collagen. Theoretically, they may degrade more slowly and last longer. No test dose is required and the product is now currently available.

In February, an FDA advisory panel recommended approval of the filler Artecoll, which will be sold under the brand name Artefill. This is a permanent collagen implant product. It combines polymethylmethacrylate (PMMA) microspheres and bovine collagen as a permanent treatment for wrinkles and soft tissue defects. The manufacturer says that when bovine collagen is reabsorbed into the body, the presence of the PMMA microspheres generates new collagen production in that same spot. It has been used in Europe for close to a decade and is available in other countries. Artefill is supposed to last forever, but we will have to see what happens with it.


FAT

Another alternative to collagen is your own fat. A surgical procedure that can be performed under local anesthesia or a mild sedation is offered to help correct lines and wrinkles of the face, fill hollow areas of the face, add to the hand to give a more youthful appearance and anywhere else that is deficient. The procedure involves harvesting fat from the patient, usually from the inner thigh or abdomen. The fat is processed and re-injected into the area using a fine needle and syringe. The most common areas of fat graft placement are the lips and the nasal-labial fold lines of the face. The procedure can take anywhere from one to a few hours. There is usually swelling and mild bruising noted which resolve over the first week after the injection of the fat. Keep in mind this is your own tissue and therefore no test dose is required. The fat tissue is a graft and therefore must acquire a blood supply to survive. If this occurs and usually is does, the fat is permanent. This means that the fat injected into your lips will stay forever. Usually half of the fat graft will survive. A second procedure may become necessary or desired to further augment the area if some of the fat graft goes away. Some patients do require 2-3 sessions to achieve the desired look they are after. Keep in mind that the fat is a living cellular structure and will change with you. If you gain weight over the years, the fat graft may also enlarge and if you loose weight, the fat graft may decrease in size. There is nothing like your own tissue--a truly natural product!

Artificial Materials-- Radiance®

New and different materials are always being tested for use as facial fillers. You may have heard about a material called Radiance®. This material is FDA approved for use in the human body. It has been used in the vocal cords as a filler and as a marking material. It is made from HydroxyApatite which is the building block of bone. Since it does not contain calcium the product is soft and moldable. It is available to us only for off-label use. We think this product will be useful as a filling material in the nasal-labial folds of the cheeks and in the lips. It may also prove to be useful as a filler for the cheeks and for facial scars. This product does not need a test dose as no allergic reactions have been found in patients. The exciting thing about this product is the duration of its effects. Reports by physicians show it may last for 5-7 years. Read more about this product.

Artificial Materials-- Restylane®

Another product, Restylane®, now available in the United States has been used in Europe, Canada and Australia as a filling agent. Restylane is made from Hyaluronic acid. Hyaluronic acid is a polysaccharide (sugar) that is found in all living structures. Hyaluronic acid may offer advantages to patients who are intolerant of proteins (and collagen). In gel form, it binds to water and provides volume for filling in areas of tissue loss, such as the nasalabial folds. Read more about this product.


We are entering an era of much competition with these new products. Time will tell if they offer improvements over currently available products. None of the products will be perfect and they all have slightly different uses, different adverse event profiles, and different aesthetic utility in that one may work better in one location than another. Please join us for a consultation and learn more about this unbelievable new product. You can have it injected on the same day as your consultation and there is no down time. You will see the results immediately.

Artificial Materials-- Hylaform®

And yet another product containing hyaluronan. Hyaluronan is a naturally occurring polysaccharide of the extra-cellular matrix in human tissue, including the skin. Manufactured by genzyme and distributed by INAMED aesthetics. We also have this new product available for immediate use.

If you have any questions about facial fillers please feel free to schedule a consultation with Board Certified Dermatologist, Board Certified Dermatopathologist, Babar K. Rao, MD, FAAD at his Manhattan, New York or Fresno, California office.
 

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Board Certified Dermatologist, Board Certified Dermatopathologist, Manhattan, New York

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