from the Fall 2007 issue
Dermal fillers are not new. However, never since the introduction of injectable bovine collagen in 1981 has there been more buzz and new offerings in this growing area of facial rejuvenation. We’ve been so excited about all the new products that we dubbed 2007 the year of the dermal filler. Here is our rundown of what’s available and what we recommend to our patients seeking treatment to fill various wrinkles, hollow cheeks and acne scars.
We begin with the observation that, like many other cosmetic procedures, consumer preference plays a definite role in what dermal filler we use. Our preliminary consultation on fillers is a dialog with our patient about the condition he/she wants to correct and the results he/she wishes to achieve. Certain fillers yield better results for nasolabial folds versus lips, lip lines versus sunken cheeks, and areas around the eyes. Also, the depth of the fold can argue for the use of a thicker filler. Another distinction is that certain injectables provide instantaneous results, which may fit the particular need of our client because of an upcoming event, like a wedding or reunion, for which he/she is preparing. Longer-lasting fillers tend to yield results over time rather than immediately after injection by encouraging and stimulating the growth of the patient’s own collagen.
Collagen – The first FDA-approved dermal filler was collagen. Although available in its original bovine-derivative form, the vast majority of the collagen we inject is human, thus avoiding the need for skin testing for allergic reaction to the bovine formulation. Collagen is a great first-time filler – it goes in smoothly with little discomfort and produces an immediate plumping of the skin. We use CosmoDerm® to fill in fine lines, especially vertical lip lines, and wrinkles. We inject thicker CosmoPlast® to treat deeper wrinkles, define the lip border and fill in acne scars. The main disadvantage is that it lasts only three to six months, but for first timers concerned about how the treatment will look, this short duration serves to reduce risk.
Hyaluronic Acid (HA) Dermal Fillers – HA dermal fillers are by far our most popular plumping agents. We treat approximately five times as many patients with this filler type as all our other fillers combined. HA is a crystal-clear, non-animal, biodegradable gel based on a natural substance. The most commonly-treated areas are the nasolabial folds (from the nose to the corners of the mouth), the glabellar lines (between the eyebrows), the marionette lines (from the corners of the mouth to the jaw line), and the lips. HA can also improve acne and chicken pox scars. There is no testing required, and results are instantaneous. We carry two families of hyaluronic acid fillers – Restylane®/Perlane® and Juvéderm™ Ultra/Ultra Plus. Restylane and Juvéderm Plus are less concentrated gels used to fill most superficial lines, wrinkles and lips, while Perlane and Juvéderm Ultra Plus are thicker formulations for deeper wrinkle filling. So which is better? And why do we carry both? We think this answer lies more in the eyes of our patients, just like preferring Coke over Pepsi, so we offer both. Both offer longer correction periods than collagen. Restylane/Perlane, the more established brand (FDA-approved 2003), is indicated to last for about six months, while the Juvéderm family (FDA-approved 2006) can last up to six months or longer. To date, there have been no head-to-head clinical trials between these competing formulations.
ArteFill® – ArteFill is the first and only FDA-approved, non-resorbable (often referred to as permanent) wrinkle filler for the correction of smile lines (nasolabial folds). ArteFill contains 20 percent polymethylmethacrylate PMMA microspheres and 80 percent bovine-collagen gel with 0.3 percent lidocaine, an anesthetic. The bovine collagen plumps the skin immediately, but is reabsorbed by the body in about a month. However, the microspheres remain behind and the patient’s own collagen builds up around the microspheres. Most people need a second treatment three months after the initial injection to obtain optimal correction of the wrinkle. Current clinical results indicate that ArteFill will last up to five years. Because of the bovine collagen component, a simple skin test is performed. If the test is negative, you may undergo your initial facial treatment a month later. Although the typical two treatments cost more initially, ArteFill is cheaper in the long-run when compared to the recurring cost of non-permanent dermal fillers.
Sculptra™ – Although often categorized as a filler, Sculptra, like ArteFill, is a tissue augmenter. Sculptra is FDA-approved for the restoration and/or correction of the signs of facial fat loss (lipotrophy) in people with human immunodeficiency virus and is pending approval for cosmetic use. We have been using it “off label” to treat wrinkles and facial contour irregularities (particularly hollowness in cheeks) since 2004. Sculptra contains an injectable material known as poly-L-lactic acid (pLa), a biocompatible, biodegradable material used in dissolvable sutures. Injected below the area of fat loss, the pLa stimulates the body to produce new collagen resulting in a gradual increase in skin thickness. We usually perform a second treatment to achieve the desired results. Because it stimulates actual collagen production, Sculptra’s major advantage is that it can last two years. For those wanting longer-lasting results but who are not ready for a permanent filler, Sculptra is the answer.
What are the risks? Side effects are infrequent and temporary. With dermal fillers, you can expect mild swelling and redness, and occasional bruising at the injection site. Although uncommon, lumps and bumps are possible, but can be treated if they occur.
If you’d like to personally discuss the treatment that is right for you, call today to set up a consultation with one of our experienced providers at 713.850.0240.
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