|
Restylane, Hylaform, Perlane, Captique, Sculptra and Radiesse are some of the products available for filling creases and wrinkles not associated with facial animation. The products are injected after topical or regional anesthetic and gradually resorb over the course of four to six months and may last up to nine months. Compared to the collagen products of the past, the currently used dermal fillers do not require pretesting. Radiesse lasts for approximately 12 to 18 months and Sculptra may last 2½ years, but it is only FDA approved in the U.S. for treatment of facial fat atrophy in HIV positive patients. It can be used “off label” in other areas and has great promise for achieving a “lifting” effect in mild cases of skin laxity. New dermal fillers continue to be under clinical investigation all the time. The duration of dermal fillers is very variable and depends on the formulation of the material, how deeply it is injected, and how much is used. Most dermal fillers are only temporarily effective so that repeat treatments will be needed every three to six months on average but may last up to nine months.
Read the product literature in advance or check out the company’s website for details about any filler you are considering. It is also a good idea to keep your own records of what type of treatment you had, when you had it, and how much was used. Most doctors routinely record this information in your medical chart. When you return for a touch up, the doctor can better judge how long the material lasted and can make an informed decision as to whether more filler is needed to maximize the correction. Many doctors request that you return to the office in two to three weeks after a treatment, whether or not a touch-up is required, in order to document the success of the procedure.
In some cases, laser skin resurfacing, microdermabrasion, or chemical peels which help to soften wrinkles by removing and smoothing the outer layers of the skin, may be more effective than adding volume to the face with dermal fillers. Each patient needs to be evaluated individually, and the appropriate treatment is based on assessment of the skin tone, the location, depth and extent of the creases, and the degree of skin laxity.
"There is no filler substance that is right for every face, and most doctors like to use a wide variety that are suitable for different purposes."
Resorbable Fillers – Resorbable fillers are made from natural or synthetic materials that are broken down and resorbed by the body over time. They are temporary and will need to be repeated, typically in three to nine months. The good news is that if you are not happy with the results, the material will eventually disappear. Of these, hyaluronic acid based fillers are the safest and most predictable, and the one that we use most often in our practice. Other commonly used resorbable fillers include human and bovine or cow collagen.
Nonresorbable Fillers – The nonresorbable class of fillers has synthetic components that do not get broken down by the body. They are considered permanent because the particles cannot be removed, or ‘semi permanent’ because the particles are suspended in a substance that gets absorbed in three to six months. They are considered permanent because some of the material cannot be removed after it has been injected. Examples of nonresorbable fillers include silicone and polyacrylamide gels.
There are over 70 commercially available fillers reportedly on the market around the world, most of which will never enter into widespread use and will not enter the FDA approval process for various reasons including safety record and lack of funding.
Contact us for more information on Dermal Fillers
Bovine Collagen
Zyderm® and Zyplast® (Inamed Corp) are composed of highly purified bovine dermal collagen that has been used to correct facial imperfections since the 1980’s. The bovine collagen is processed to create a product that is similar to human collagen. There are three forms: Zyderm 1®, Zyderm 2®, and Zyplast®. Four weeks prior to the procedure, a test dose is administered in the forearm to determine if you have a sensitivity to the implant material. Three percent of people tested may have sensitivities. Frequently a second test dose is administered. Collagen is most commonly used to fill out superficial wrinkles, skin depressions and some scars. It has been largely replaced by newer substances including human collagen and hyaluronic acid gel.
Contact us for more information on Collagen
Hyaluroinc Acid Gel
Hyaluronic acid is a natural polysaccharide (sugar like substance) that is commonly found in the connective tissues of the body. The source of the material can be from animals (avian protein; i.e., roosters or poultry), or bacterial fermentation which is non-animal. Its normal function in the body is to bind water and to lubricate moving parts like joints. The most common areas for treatment are the nasolabial folds (creases from the nose to mouth), the nasomental creases (corners of the mouth) and around the lips, as well as cheek and chin contours. Since there is no anesthetic supplied in the syringe, a topical anesthetic or local block may be needed to maximize comfort. Aside from expected temporary redness/puffiness for the first day or two, there are few complications to report and we are seeing longevity of four to six months and even longer in some patients. As the substance naturally occurs in humans, allergic reactions are rare.
Contact us for more information on Hyaluronic Acid Gel
Restylane®
The FDA approval of Restylane marked the beginning of a wave of new bioengineered substances for the treatment of lines, depressions, and wrinkles. Our male patients are very satisfied with the results of Restylane, which lasts six months or longer in most cases. Because it is a gel, it offers a soft, natural-looking correction.
Restylane, Perlane, and Restylane Touch are all the same material packaged in a different particle size. Perlane has a large particle size while the size of Restylane particles is small. We use the larger particles when I need to fill deep wrinkles and the smaller ones when I need to fill superficial ones. We have been surprisingly pleased with this family of products and our patients love the variety and durability that they offer.
Restylane is the only product presently approved by the FDA for use in the United States; however since Perlane and Restylane Touch are the exact same molecule, they will hopefully be approved soon. We use Restylane to treat nasolabial creases (smile lines) most commonly but it can also be used for other deep creases around the mouth and between the eyebrow when Botox is not effective. Perlane is great for restoring volume. It is used for deep creases including the nasolabial creases and for facial sculpting.
Contact us for more information on Restylane®
Restylane Sub Q®
The latest addition to the expanding Restylane family of hyaluronic acid fillers is SubQ, a revolutionary new injectable treatment for facial sculpting. It can produce the high cheek bones or a more defined chin and jaw line. Restylane SubQ is based on the same patented hyaluronic acid gel formula used in the other Restylane products but it has much larger gel particles, three times as thick as Perlane. The gel safely biodegrades on its own. SubQ can also be used for restoring facial volume where cheeks have hollowed from weight loss and the inevitable breakdown of collagen and elastin fibers. The gel is injected deeply under the skin under a local anesthetic in one treatment, and the newly enhanced contours are immediate.
Contact us for more information on Restylane Sub Q®
Perlane®
The Plastic Surgery Group is one of the first providers in the region to offer Perlane® to their patients. The makers of Restylane® recently received FDA approval for their next generation product, Perlane®. Perlane® is made from the same natural, biocompatible substance as Restylane®, but the particles are larger, making the gel thicker. This allows our doctors to achieve a deeper, smoother correction that may potentially be longer lasting! The most common areas that Perlane® is used to correct are the nasolabial folds, the areas around the mouth as well as in the tear troughs (the hollows under the eyes). Results are immediate!
Contact us for more information on Perlane®
Hylaform and Hylaform Plus
Hylaform and Hylaform Plus are hyaluronic acids that are similar to Restylane. Hylaform Plus has a larger particle size and is designed for deeper creases. A study comparing the duration of correction for Hylaform Plus and Restylane has been conducted and the findings will be presented in the near future. For now, it is safe to say that most plastic surgeons tell patients to expect three or four months of correction from Hylaform.
Contact us for more information on Hylaform & Hylaform Plus
Captique
Captique is basically the same as Hylaform with the major difference that it is manufactured rather than harvested from rooster combs. This allows the product to be produced without any animal proteins that theoretically can cause allergic reactions. It is the same concentration and thickness as Hylaform, and it is reasonable to assume it will have the same longevity.
Contact us for more information on Captique
Other Hyaluronic Acid Based Products Under Development
Juvederm has been used in Europe and is a major step forward for the hyaluronic acid fillers. It is a homogenous gel that does not contain gel particles. It is manufactured and is not derived from animals. Three versions are presently available and they are well suited to a broad range of applications. There are three varieties of Juvederm 18, 24, and 30 that vary in the concentration of hyaluronic acid contained. The variety of concentrations allows a broad range of uses for this filler ranging from filling crow’s feet with a less dense product to smoothing nasal furrows with a more dense variety. Juvederm is currently undergoing clinical trials in the United States.
Contact us for more information on Juvederm
"You never want to be the first one on your block to try a new technique or procedure. Wait until it has been fully evaluated."
Poly-L-Lactic Acid
Developed by a French dermatologist, Sculptra® is based on a substance called poly-L-lactic acid (PLA) which occurs naturally and has been used in suture material for years. PLA stimulates production of the body's own collagen within the line or wrinkle, making the skin appear smoother and firmer. Sculptra® is reconstituted before it is injected and is most commonly used in the nasal labial folds, cheek hollows and scars. The substance is non-allergenic and typically two to three treatment sessions are recommended for best results.
Contact us for more information on Sculptra®
Human Tissue Fillers
One of the fascinating categories of filling agents is derived from human tissue. Most of these products are obtained from cadaver tissue through tissue banks. Donor suitability is determined according to the standards of the American Association of Tissue Banks (MTB) and FDA. Cadaver collagen must meet criteria established for extensive testing for human immunodeficiency virus antibody (anti-HIV 1-2), Hepatitis B surface antigen (HBsAG), Hepatitis B core antibody (HBcAB), Hepatitis C antibody (anti HCV), human T-lymphotropic virus type I antibody (anti HTLV-1), and rapid plasma regain (RPR) for syphilis.
Cosmoderm®/Cosmoplast®
CosmoDerm® and CosmoPlast® (Inamed Corp) contains human collagen that has been purified from a single fibroblast cell culture. This product does contain 0.3% lidocaine, so additional local anesthesia is usually not required. No skin test is required because this is fashioned from human tissues rather than an animal source. CosmoDerm® and CosmoPlast® are injected just below the surface of the skin to fill in superficial lines and wrinkles and to define the border of the lips.
Contact us for more information on CosmoDerm® & CosmoPlast®
Alloderm® / Cymetra™
AlloDerm® is human dermal tissue that has been decellularized to remove the risk of rejection or inflammation. It comes in strips in a freeze dried form to be implanted into lips, nasal defects, and around the eyelids. AlloDerm® is sometimes used as a soft-tissue replacement in facial reconstruction to build up cheeks, chins, hollows and asymmetries. It can be rolled or layered so that it can be implanted under the skin to fill out depressions. Cymetra™ was introduced in 2000. It is micronized AlloDerm® tissue in an injectable form. It also needs to be reconstituted. More than one treatment may be required to achieve the level of correction envisioned. AlloDerm® may last up to two years; Cymetra™ may last two to four months.
Contact us for more information on AlloDerm® & Cymetra™
"The key with soft tissue fillers is to select a safe product that has a long track record."
Artefill®
ArteFilll® is a semi-permanent filler currently used in Europe, Canada and Mexico. It is made up of 75% percent bovine collagen and 25% polymethyl-methacrylate microspheres (PMMA) which are carbon-based polymers. PMMA has been used in dental work, hip prostheses, and bone cement. The product is mixed with a local anesthetic, lidocaine to numb the area to be injected. Over 3 months, the collagen fibers get absorbed, leaving the PMMA behind, which are too large to be broken down and remain permanently. It is tunneled under the skin, massaged and molded to fill the area to be treated. ArteFill® can be used for acne scars, nasolabial folds, and for filling depressions such as sunken cheeks. Possible complications include lumping, inflammation, granulomas or localized hardening, rash, and the migration of the microspheres into other areas. Because of its permanence, ArteFilll® is considered more risky than other biological fillers.
Contact us for more information on ArteFill®
Radiesse FN™
Radiesse FN™ (BioForm) is composed of calcium hydroxyapatite, which has been used in the body for multiple applications including cheek and chin implants. Radiesse™ is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs. Calcium hydroxyapatite has been used for many years for other medical purposes in both injectable and solid implant forms, such as facial reconstruction. It is only FDA approved only for vocal cord paralysis and urinary incontinence, however, off-label use is permitted in the US. Radiesse FN™ is a pure, synthetic calcium hydroxyl apatite composed of calcium and phosphate ions which occur naturally in the body so they are biocompatible. The particles are in a gel carrier made up of cellulose, glycerin and purified water. The product manufacturer claims that Radiesse FN™ will remain soft and pliable as it permeates soft, fibrous tissue. As with any long term filling agent, there is a possibility of a foreign body reaction which can cause lumps or granulomas, and migration.
Contact us for more information on Radiesse FN™
Injectable Liquid Silicone
Liquid silicone varies by degree of purity, and the form that is being used in the US is sterile, purified, medical injectable grade silicone. The newest method of injection is referred to as the “micro droplet” technique, which has the advantage of causing fewer hard lumps than previous variations. Liquid silicone is only approved by the FDA for ophthalmic uses, so cosmetic uses are considered an off label use of an approved product.
Recycling your own Body Fat
Fat is perhaps the most widespread material used as a filling substance in facial rejuvenation. The fat that is injected into facial areas comes from your own body, so there is no chance of an allergic reaction or “rejection”. Fat can be used in higher volumes than most other injectable materials and can be used to create a fuller, more youthful appearance by reestablishing pleasing contours. Injections of fat into the deep layers of facial tissue can soften the angular, thin appearance that often accompanies aging. Fat is the first choice of material when injections of volumes greater than 10cc are needed.
The fat must be harvested from your own body, typically from the abdomen, thighs or hips. After it is extracted, it is placed in a centrifuge to separate the fat from blood and other fluid. The fat is then packed into a syringe ready to be injected. Because fat molecules are somewhat larger than other injectable materials, it is usually injected more deeply and with a larger gauge needle. Volumes of up to 50 -100 cc’s can be injected at one stage. Fat injections are particularly useful in the lips and perioral area, in cheek hollows and around the eyes, as well as for some scars.
"Fat is one of the most commonly used fillers for plumping-up deep folds and restoring youthful contours"
Fat injections have a very variable life span. The fat is slowly absorbed by the body, although the amount of absorption is variable, and hard to predict. Typically, more than half of the fat used in injectable treatments is absorbed with six months of the procedure, although it may last longer. Almost all people will permanently retain some of the injected fat. Two to three follow up treatments are usually advised and can lead to a more permanent correction.
Contact us for more information on Fat Injections
|
