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Injectable Fillers

What are Injectable Fillers?

A variety of materials have been employed over the years in an effort to fill unwanted lines or to plump thin lips. Some of these materials have also been used to treat depressed scars due to chicken pox or other trauma to the skin. A brief summary of these materials is as follows:

COLLAGEN

Collagen is a generic term for the protein matrix which forms the structural protein lattice of connective tissues like the dermis layer of the skin.

ZYDERM 1 and ZYDERM 2 Collagen is bovine-derived collagen used to treat fine to moderate lines, wrinkles, and scars. ZYPLAST Collagen is bovine-derived collagen which is chemically stabilized, to be used in deeper lines and wrinkles and thicker skin areas. These are the original forms of injectable collagen, which have an excellent safety and patient satisfaction record in over 1.5 million patients over the last three decades. Although allergic reactions are rare, skin testing must be done at least four weeks before the initial therapeutic injection in order to insure that there is no allergic response.

COSMODERM Collagen is human-derived collagen used to treat superficial lines. COSMOPLAST Collagen is cross-linked human-derived collagen used to treat deeper lines and wrinkles in thicker-skinned areas. COSMODERM and COSMOPLAST Collagen is grown in the laboratory under carefully-controlled conditions from non-cadaver human dermal fibroblasts, using the same tissue engineering techniques originally developed to create products used to treat burns and other wounds. Because the material is human in origin, skin testing is not required prior to first use.  With the development of longer-lasting and more stable injectable fillers that are less subject to re-absorption, Collagen-based fillers have fallen out of favor and are no longer the first-line treatment.

Allergan will be discontinuing the production of bovine (Zyderm/Zyplast) and human (Cosmoderm/Cosmoplast) collagen products in 2010.

HYALURONIC ACID is a polysaccharide / glycosaminoglycan that is identical in all species and tissue types. It plays an important role in giving volume to the skin, shape to the eyes and elasticity to the joints. There are numerous product lines in the Hyaluronic Acid family from multiple manufacturers, but they share similar characteristics and differ in terms of concentration and/or the inclusion of local anesthetics.

TRADE NAME COMPOSITION CONCENTRATION INDICATION/AREA OF USE MANUFACTURER
Juvederm Ultra (2006) Hyaluronic Acid(non-animal stable hyaluronic acid (NASHA)) 24 mg/ml Nasolabial foldsLipsPeri-orbital Inamed/Allergan
Juvederm Ultra Plus (2006) Cross-linked HA(non-animal stable hyaluronic acid (NASHA)) 30 mg/ml Nasolabial FoldsAcne Scars Inamed/Allergan
Restylane (2004) Hyaluronic Acid(non-animal stable hyaluronic acid (NASHA)) 20 mg/mL , 1% cross-linked, 400 μ particle size, 100,000 gel particles / ml Nasolabial foldsLipsPeri-orbital Q-Med/Medicis
Perlane (2004) Cross-linked HA(non-animal stable hyaluronic acid (NASHA))   Nasolabial FoldsAcne Scars Q-Med/Medicis
Hydrelle Hyaluronic Acid with Lidocaine   Nasolabial foldsLipsPeri-orbital Coapt Systems
Prevelle Silk Hyaluronic Acid with Lidocaine   Nasolabial foldsLipsPeri-orbital Mentor
Hylaform (2004) Hyaluronic Acid (from Rooster combs) 4.5-6.0 mg/ml, 20% Cross-linked, 500µ particle size Nasolabial FoldsAcne Scars Genzyme/InamedAllergan
Hylaform Plus (2004) Hyaluronic Acid (from rooster combs) 4.5-6.0 mg/ml, 20% cross-linked, 750µ particle size Nasolabial FoldsAcne Scars Genzyme/InamedAllergan
Captique (2004) Hyaluronic Acid (biosynthesized) 4.5-6.0 mg/ml, 20% cross-linked, 500µ particle size Nasolabial FoldsAcne Scars Genzyme/Inamed/AllerganMentor

RADIESSE

The injectable material RADIESSE is comprised of 30% Calcium Hydroxylapaptite (CaHA) bio-ceramic particles 25-45µ in diameter, identical in composition to the mineral portion of human bone and teeth, suspended in an 70% aqueous gel carrier (carboxy methylcellulose), making it exceptionally compatible with the human body. Calcium hyroxylapaptite (CaHA) has been used for decades in plastic and reconstructive surgery, orthopedics, otology, otolaryngology, neurosurgery, dentistry, maxillofacial surgery, and urology. Once injected, the gel carrier provides the matrix within which cellular infiltration can occur. RADIESSE is indicated for treatment of deep lines and wrinkles including the nasolabial folds and marionette lines, and can also be used to add volume to the cheek bones and jaw line, as well as the back of the hands.  It is a long-lasting filler that is not indicated for use in the lips.  Over time, the calcium hydroxylapatite is degraded to calcium and phosphate and absorbed by the body.

AUTOLOGOUS FAT

Your own fat, harvested through liposuction, can be re-injected into unwanted lines and areas of soft tissue deficiency. This has the advantage of utilizing your own tissue as a filling material, eliminating the concern of allergic reactions to foreign material. The procedure can make use of a portion of the fat that would otherwise be discarded after a standard liposuction or body contouring procedure, or small amounts of fat for transfer can be harvested from an inconspicuous area as an independent procedure.

How do Injectable Fillers Work?

Botox injection is performed without anesthesia because it is virtually painless. The injections are made using an ultra-fine needle placed directly into the muscles responsible for the unwanted expression lines. The wrinkle-reducing effects are not permanent, and injections may need to be repeated three to four times per year to maintain the improvement. Research has suggested, however, that long-term use of the injections leads to a longer duration of effect, although some patients may develop a tolerance or partial immunity to the effects of Botox over time. Patients over the age of 65 may not experience such dramatic results, and, because each patient is unique, the degree or completeness of results may vary. Botox is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging (see Facelift, Brow Lift, Blepharo plasty).

Are Injectable Fillers Right For Me?

BOTOX is a medically-purified form of a natural bacterial protein (Botulinum Toxin ) which has been known for centuries to produce muscle paralysis. The therapeutic use of Botox is a recent development, beginning in approximately 1980 with the use of the medication to treat certain conditions involving the eye muscles. It was discovered that certain wrinkle lines were temporarily eliminated when the Botox treatment spread to involve the muscles which cause the wrinkles. Many surgeons and dermatologists began treating unwanted lines and wrinkles in their patients by injecting Botox into the tiny facial muscles that create wrinkles, producing a temporary cosmetic paralysis of these muscles, which eliminates the ability of these muscles to contract and produce wrinkles. Botox gained FDA approval for use in the treatment of unwanted wrinkles in the glabella (the frown lines between the eyebrows) in April, 2002. It is also commonly used “off-label” (without FDA approval) to treat “crow’s feet” wrinkles at the corners of the eyes, horizontal forehead wrinkles, tight muscle bands in the neck, and even migraine headaches due to muscle hyperactivity.

The Procedure

In the forehead area, Brow Lift with surgical division of the procerus and corrugator muscles responsible for the unwanted frown lines may provide permanent correction of the unwanted muscular activity producing these frown lines, eliminating or reducing the need for Botox treatments. Similarly, division of the platysma muscle bands in the neck may relieve the appearance of tight cords in the neck which are sometimes effectively treated with Botox. Other molecular variants of Botox are being developed, in the hope of longer duration of effectiveness, or as alternatives for use in treating patients who may develop resistance to the toxin over time.

Alternatives to Injectable Fillers ?

Botulinum Toxin (Botox) works by binding to the nerve endings, preventing the release of the chemical transmitters that activate the muscles. Blockage of these transmitter signals from the nerves to the muscles results in diminished or absent activity in the affected muscles, preventing them from contracting.

The risks of Injectable Fillers

Possible delayed side effects are temporary weakness of nearby muscles; in rare cases, eyelid drooping may occur, or patients may develop headache or flu-like symptoms. Since the wrinkle-reducing muscle paralysis effect of Botox is completely reversible with the passage of time, any side effect is only a temporary condition. Rarely, patients may develop an immunity or tolerance to Botox, and the treatments may become less effective. Your plastic surgeon will explain all potential associated risks at the time of your consultation.

Your new look after Injectable Fillers?

As with any other medical and cosmetic surgical procedure, careful patient selection is important. You may be a good candidate for Botox treatment if you have any of the following conditions:

* Moderate to deep vertical or oblique lines between the eyebrows
* Moderate to deep transverse or horizontal lines in the forehead
* Deep “crow’s feet” in the lateral eyelid area
* Certain types of muscle tension headaches caused by spasm of the forehead muscles

Botox treatment may not be appropriate for you if you are pregnant or nursing, if you have certain neuromuscular diseases, or if you are taking certain medications (aspirin or anticoagulants, aminoglycoside antibiotics, quinine, or calcium channel blockers). You should understand that the treatments provide temporary effects, and that Botox is not a substitute for surgical facial and forehead rejuvenation.

Frequently asked questions about Injectable Fillers

The wrinkle-reducing action of Botox on the treated areas requires several days before fully taking effect. Voluntary and involuntary activation of the muscles in the treated areas will gradually diminish and disappear after a few days to a week, and you will notice that muscular activity in the treated areas will gradually return generally within two to three months. To maintain your result, we recommend a repeat treatment at that time. Second and subsequent injections may have a longer duration of effectiveness. Immediately after the injection, patients may experience slight bruising or temporary pain around the injection area that quickly fades. Normal activities can be performed immediately after leaving the office.