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Injectable Wrinkle Fillers

Have Face-Lifts Gone Out of Style?
An Update on Injectable Wrinkle Fillers

The number of face-lifts performed in the U.S. declined in 2006 for the first time ever.

More and more people who are interested in preserving their youthful appearance are opting for preventive measures and mini-procedures before the damage is advanced.

It will be interesting to see what today’s 30-year old who faithfully takes advantage of these treatments will look like in 30 years. My guess is 25 years younger than her peers who didn’t do so; and more natural than her peers who instead have had two or three face-lifts.

Thirteen dermal fillers are now U.S. FDA-approved for cosmetic line filling. They are Zyderm 1, Zyderm 2, Zyplast, Cosmoderm, Cosmoplast, Hylaform, Hylaform Plus, Captique, Perlane, Juvéderm, ArteFill, Radiesse and Restylane.

Two wrinkle fillers developed and FDA-approved for other medical purposes are used off-label as cosmetic line fillers. They are Sculptra and Silikon 1000.

Each type of filler is designed for very specific use. For example, CosmoDerm is used for superficial wrinkles while CosmoPlast is designed for deep wrinkles and scars. There are special formulations for lips as well.

Your doctor can advise you on the various options. Layering of two or more wrinkle fillers is sometimes prescribed for optimal results.

Injectable Wrinkle Treatments: Instant but Short-Lived

Though the results are instant, the biggest problem with the first generation of wrinkle fillers is that the results don’t last long, especially relative to the price.

Collagen, whether purified human or purified bovine, lasts from two to six months and costs between $350 and $400. The good thing is that, if the results don’t please you, they will quickly fade.

Human collagen brands include Dermalogen, CosmoDerm, CosmoPlast and Cymetra. Bovine collagen injections require an allergy test four weeks prior to the procedure, which means a waiting period and an extra doctor’s visit. Some brands are Resoplast, Zyderm and Zyplast.

The second generation of wrinkle fillers is synthetic or animal-derived hyaluronic acid. Brand names are Restylane, Hylaform, Captique and Juvéderm.

Hyaluronic acid is a substance found in the body’s joints. It is the strongest topical moisturizer known and holds up to one thousand times its volume of moisture. So as a wrinkle filler, a little bit goes a long way and the effects last from six to 12 months. The cost is between $275 and $1000 per treatment.

Studies conducted at the University of Michigan Medical School found that wrinkle fillers containing hyaluronic acid led to "robust collagen production" while also interfering with collagen breakdown.

Collagen fillers generally contain lidocaine to make the procedure easier to tolerate. Hyaluronic acid products, with the exception of Puragen Plus, cannot be combined with lidocaine. Your doctor may prescribe an anesthetic ointment to be applied pre-treatment.

Injectable Wrinkle Treatments: Longer-Lasting Fillers

Longer-lasting wrinkle fillers developed for medical use are sometimes used off-label to fill facial wrinkles. Radiesse (also called Radiance) was FDA-approved for treating vocal cord defects, but used off-label as a wrinkle filler before receiving FDA approval for this use in 2007.

Radiesse contains microspheres of calcium hydroxylapatite. The effects last from one to two years. Expect to pay $1500 for each 1 cc syringe.

Like hyaluronic-based fillers, Radiesse is both an instant filler and a collagen stimulator. The body gradually breaks down the Radiesse and replaces it with new collagen in just four to six weeks.

This action sometimes results in the formation of small granulomas or micronodules which, while not visible to the eye, can be felt by the patient. For this reason, Radiesse is not recommended for lip filling.

Sculptra is a dermal wrinkle filler made of microspheres of synthetic poly-L-lactic acid. It is FDA approved for facial wasting caused by certain HIV drugs but is used off-label as a wrinkle filler. The effects last for about two years. Be sure your doctor is experienced in its use as a wrinkle filler.

Like Radiesse, Sculptra dissolves in the body and is replaced by new collagen. Also like Radiesse, Sculptra sometimes causes granulomas and should not be used for lips.

Expect to pay $1000 per treatment.

Your doctor may prescribe a pre-treatment anesthetic ointment. Be sure to follow doctor’s order for aftercare. You may be advised to massage the treated area daily for at least a week. This will improve your results and may help prevent the formation of lumps.

Injectable Wrinkle Treatments: Permanent Wrinkle Fillers Have Arrived

The first permanent dermal filler, ArteFill, received FDA approval in 2007. ArteFill is made of microspheres of polymethyl-methacrylate suspended in bovine collagen.

Interestingly, the results are not quite instant for the same reason that they are permanent. Artefill is injected in amounts small enough to only partially fill the wrinkles.

Over the next two to six months, the bovine collagen is absorbed by the body. The body grows its own new collagen to enclose the non-biodegradable microspheres and finish the job of filling in the wrinkles.

The 1998 clinical trial results have been everything the manufacturer hoped for. Participants return periodically for evaluation.

Facial wrinkles filled in the clinical trial have not returned. Rather, volunteers have started to request ArteFill injections for new wrinkles that have cropped up in the intervening eight years.

Allergy pre-testing is required because of the bovine collagen coating. Lidocaine is included to reduce discomfort. Lumps may appear and usually respond to steroid injection. Rarely, surgery is required to remove them. Eighty per cent of the eventual tissue augmentation is the patient’s own natural collagen. The cost is $700 to $1000 per treatment.

Silikon 1000 is FDA-approved for intra-ocular injection to press a detached retina back into place, stop retinal bleeding and prevent blindness. It is not approved for injection into the skin but is used off-label as a permanent facial wrinkle filler.

Prior problems of silicon migration and large lumps are being addressed by injection of Silikon 1000 in microscopic droplets which are quickly encapsulated by the body’s immune response thereby cementing them in place. This requires multiple treatments of no more than 0.5 cc each to achieve a smooth result. Average cost is $1500 to $2000 for a three-treatment regimen.

Injectable Wrinkle Treatments: Cautions

Aside from the risks mentioned above, there have been cases of practitioners knowingly or unknowingly using counterfeit injectable wrinkle fillers.

The results range from infection or paralysis to permanent disfigurement or death.

Last March, a California hairdresser was arrested for injecting fake Botox into a woman, who later died. It is estimated that 5% of dermal fill injections given in the United States use counterfeit material.

Never submit to such injections in other than a medical setting. Ask how many of these procedures your doctor has performed.

If the doctor you choose is not a plastic surgeon or dermatologist, be sure to ask about his or her training in dermal filling.

You can also ask to see the hologram on the sealed box of the material to be injected. This is not a guarantee because counterfeiters are getting quite good at copying the legitimate packaging.

The FDA has stepped up efforts to stop counterfeiters. Eventually drugs will be monitored between manufacturer and your doctor’s office using radio frequency devices. In the meantime, buyer beware.

Injectable Wrinkle Treatments: Less Radical Alternatives

Afraid of the needle or not ready to spend $800 to $2000 dollars a year for wrinkle filling injections? Read about the latest topical peptide anti-aging treatments.

Are you afraid of needles, scalpels and other invasive cosmetic procedures? Look into advanced peptide based skin care from Apotek.

No Botox, No Surgery, Just Smart Skin

This article is for informational purposes only. It does not purport to offer medical advice.

 

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