Beyond collagen, the new filling agents
By: Nathan Newman, MD
For centuries physicians have been searching for the perfect filler material to erase wrinkles and to augment facial structures. Until recently, our choices were limited to animal derived collagen, silicone and our own fat. Today, advanced technology and modern techniques have made available new and different options to enhance our looks. FDA approved fillers in the United States are just a part of this world-wide
armamentarium.
The major categories of approved filling materials
- Collagen
- Hyaluronic Acid
- Polylactic Acid (PLA)
- Calcium Hydroxyapatite
- Autologus Adipose Tissue Graft (Fat Transfer)
Skin & Aging
As we age, genetic, environmental and natural factors cause the skin to change. These changes in the skin are of two kinds – volume loss and crease formation. Volume loss occurs as the amount of fat is decreased most prominently on the cheeks. This causes the droopiness and hollowness that makes us look tired, unhealthy and aged. As the volume of fat which the skin is draped on is lost, the laugh line grooves from the nose to the mouth deepen, the bags under the eyes seem to bulge and the cheeks may look sunken in. The creases however are caused by repeated muscle movements which cause the skin to wrinkle, and over time these lines deepen and are etched onto the skin surface. These creases are most commonly seen on the forehead, frown lines, crow’s feet on the sides of the eyes, the laugh lines, around the lips and on the chin.
The filling materials used to correct volume loss are Polylactic Acid (PLA), Calcium Hydroxyapatite, and Autologus Adipose Tissue Graft (Fat Transfer) These fillers are injected deeper into the skin and usually last for years. The fillers used to fill the creases and lines in the skin are collagen and Hyaluronic Acid which can be injected more superficially into the skin and on average last from 3 to 6 months.
The New Collagen
Unlike the original collagen (Zyderm and Zyplast which are derived from bovine or cow collagen), the new collagen (Cosmoderm and Cosmoplast which are human derived collagen) are not associated with a high risk of allergic reaction and therefore do not require allergy testing.
Hyaluronic Acid
Hyaluronic acid is a naturally occurring polysaccharide of the intercellular matrix in the skin. No allergy test is required. Hyaluronic acid injectable fillers include Restylane, Perlane and Hylaform, Hylaform Plus, and Captique. The major difference between the different hyaluronic acid fillers is their particle size.
Polylactic Acid (PLA)
In the United States it is called Sculptra. Its safety has been proven for years in Europe where it is called New-Fill.No allergy testing is required. Unlike the other filling materials which come in ready to inject syringes, Sculptra comes as a powder that must be mixed and prepared well in advance of being injected. The PLA in the dermal skin causes new collagen to be formed around it and this new collagen plumps up the skin. Unlike the other fillers Sculptra does not give immediate improvement but gradually builds the volume over two months. The improvement achieved is then maintained for at least two years.
Calcium Hydroxyapatite
Marketed as Radiesse, calcium hydroxylapatite, an element found in bone and teeth, is injected into the soft tissues and over time it is replaced by the body’s own collagen. No allergy testing is needed. The effect is long lasting from six months to two years. Radiesse will show-up on x-ray and radiologists and dentists must be informed that you have had Radiesse injections.
Autologus Adipose Tissue Graft
One of the most natural and least risky ways to replace the fat volume lost in the face is to take excess fat from one part of the body and to place it back where it has been lost in the face. The fat is alive and when injected into the face it becomes part of the tissues surrounding it. Being a living tissue, unlike the other fillers, the fat will look natural and undetectable with facial movement and over time it will change along with the rest of the face, never looking fake. The fat cells that are successfully grafted into the face are there permanently and will last for many years. It is the most cost effective and the most versatile of all the injectable fillers available today to restore the volume loss.
Summary
In order to achieve a healthy, younger, smoother, and plumper skin, you should have a consultation with your cosmetic surgeon to evaluate your individual needs and desires. Together, you can choose a filler, a combination of fillers, or other procedures to give you your desired look.
