SOFT BODY FILLERS...
Together with Fat injections, you can think of these substances as soft tissue body fillers.
These soft tissue fillers can be used alone or in conjunction with other cosmetic surgery procedures such as
Microdermabrasion, Botox and Facelifts and can often be performed at
the same time to enhance your result.
These treatments are indicated for people desiring to correct skin depressions such as wrinkles and depressed scars, but they can also be used for contouring.
When injected underneath the skin these fillers can plump up the wrinkles and sunken areas of your face such as the sides of the nose, the smile and frown lines or augment your lips if they are thin, temporarily restoring a smoother and younger look.
The injection of soft-tissue filler is well accepted by
patients because the procedure can be performed as an in-office
procedure, with few or no side effects. The patient can return to
work and normal activity soon after treatment. An ideal filler would
be inexpensive, easily available, and relatively long lasting, but
not necessarily permanent. It would be painless at the time of
injection, and it would produce reproducible results. There should
be minimal adverse effects (such as bruising, irritation, allergic
reaction, migration, and infection). At present, there is no
substance that can meet all the requirements.
It is important to remember that these fillers
are not permanent, with exception of Goretex and Artecoll.
Goretex is a synthetic tubular material, which can be placed
under the skin as a filler (Softform) or as an implant to augment
the cheek or chin. Artecoll (Artefill),
used in Europe, consists of tiny acrylic microspheres suspended in
collagen and is used for corrections of depressions and deeper
creases but not for fine lines or for lip augmentation.
Artefill has recently been approved by the FDA for use in our country. Microdroplet
Liquid Silicone has been around for a long time and, although
permanent, it is not recommended and is not approved by the FDA as a
soft tissue filler. All these products can be associated with risks
such as infection, granuloma formation (foreign body reaction)
resulting in visible nodules,
malposition /migration creating deformity and extrusion
through your skin. My preference is to use your own tissues such as fat
transplantation, but, as an alternative, a good choice is Hyaluronic
Acid ( Restylane ),
since as a filler it represents an improvement over the rest in
regards to safety and lasting effects or the newest fillers Radiesse and Sculptra
which are intended to restore volume and correct the signs of facial
fat loss. Often your result with
fillers will be enhanced when combined with Botox.
The source materials for soft tissue fillers can
be divided as follows and some of these are not as yet FDA approved:
AUTOLOGEN /ISOLAGEN
Autologen is an injectable collagen derived from your own skin.
Autologen is processed from skin excised during other surgical procedures where the excessive skin is discarded or is harvested in an office procedure just for that purpose.
The skin is then sent to the Collagenesis Company, which prepares it for injection.
The company has also established a BioBank for long term storage allowing for skin and tissues to be stored indefinitely.
Autologen is a safe procedure requiring no allergy testing and the results are much longer lasting then Collagen.
With Isolagen your fibroblast cells are grown and
multiplied to form the filler. A biopsy is taken of your skin and
sent to the Isolagen company’s laboratory for cell culture and
expansion. After 8 weeks of processing, the patient’s fibroblast
cells are sent back to be injected. Three treatments are
recommended. Isolagen does preserve the patient’s fibroblast cells
for future treatments. The effects on wrinkles are expected to be
long lasting but the cost is prohibitely high. May have potential in the future
when the cost is lowered and the process is further refined.
COLLAGEN/COSMODERM/COSMOPLAST/CYMETRA
Collagen ( Zyderm,
Zyplast ) is a natural bovine protein injected in small amounts underneath your skin to fill the skin creases and wrinkles.
It works best for small depressions and a skin test to determine whether you are allergic to it is performed one month before treatment is
started. Since it is absorbed it does require a touch-up every 1 - 3
months. Not often selected today because there are better fillers
that last longer. Cosmoderm and Cosmoplast are the equivalent to
Collagen’s Zyderm and Zyplast except that they come from
laboratory-grown human cells. Cosmoderm and Cosmoplast do not
require allergy testing since they are not of bovine origin.
The
effects last approximately 3 months.
Cymetra is an injectable human tissue matrix procured from
donor tissue that has undergone a patented process. It is then
converted into smaller particles consisting of spheres, and this
framework is then repopulated by the patient’s own skin cells.
It
is otherwise similar to Autologen but less expensive and the
correction should last for a few months after multiple treatments,
remembering that after the first treatment you may not see much
change. Again like Collagen not as popular today because its effects
are not as long lasting as other fillers.
RADIESSE ( RADIANCE )
Is
an injectable version of a familiar molecule – calcium
hydroxyapatite, which is synthetic bone and can be used in its other
solid form to augment cheeks and chin. Since this is the substance
that forms the non-cellular architecture of our bones it is non
allergic and its effects are long lasting possibly a few years.
Radiesse both fills and stimulates the body to produce new
collagen. In a key study conducted in four medical centers 80%
of patients showed improvement in the nasolabial fold at one year
when compared to cosmoplast, which showed improvement only in
5%. It
is useful only for deep wrinkles, like the nasolabial folds and to
restore facial fat loss in HIV patients, since it will harden the overlying
skin.
FAT GRAFTS
Fat graft transplantation
consists of removing fat from one area of your body and using it to
fill and contour your face and enhance your lips. In my experience
fat grafts tend to last longer than other soft tissue fillers and
are well tolerated since it is your own living cells that are used.
The fat is extracted usually from the abdomen and the procedure can
be performed under local anesthesia or under general anesthesia
during liposuction or another surgical procedure.
The
injected sites will look fairly normal after a few days, but
overfilling is necessary to compensate for fat absorption, which
inevitably will occur.
HYALURONIC ACID ( RESTYLANE,
and others )
Restylane
is a unique hyaluronic acid-base filler derived from a bacterial
cell-line while Hylaform is derived from an avian source – rooster
combs. Juvederm and Puragen are other similar hyaluronic acid-base
fillers. Restylane and Juvederm both come in three gel versions depending on the grade
of viscosity and the different size of the particles. Restylane Fine
Lines ( Juvederm 30 ) having the smallest particle size is
designed to treat only the fine wrinkles since it is injected into
the superficial layer of your skin. Restylane (Juvederm HV-30 ) is
injected in the deeper layer of your skin and it is used for deeper
wrinkles and for lip augmentation. Perlane ( Juvederm HV-24 ) having
the largest particle size, instead, is injected underneath your skin
for augmentation of folds and shaping your facial contour.
Hyaluronic acid is a natural component of our skin and is
present in all living organisms. It is especially important in our
body skin since it clings to water keeping our skin full and supple.
Our body also uses hyaluronic acid to lubricate our joints.
It is
rapidly gaining in popularity and can be used alone or in concert
with other procedures. It is marketed in over 60 countries and has
an excellent safety history. It rarely causes allergic reactions and
its effects last about 6 months.
SCULPTRA
Sculptra
has been approved by the FDA for
correction of fat loss related to human immunodeficiency virus ( HIV
) to reduce the sunken appearance in the cheek, temple and eye areas
of these patients. It is a very promising filler and may be
indicated in correcting the loss of fat volume which occurs in early
aging of the face thus postponing the need for a facelift. Sculptra is an injectable implant that
contains microparticles of poly L-lactic acid, a biocompatible,
biodegradable, synthetic polymer that has been widely used in
resorbable sutures. It increases the thickness of the skin in the
treated areas by stimulating your body's tissue to produce your own
collagen thereby improving the appearance of the fat loss in
your face. It is
important to understand that the skin depression may reappear after
the first treatment since Sculptra requires a longer process than
other fillers because your collagen production takes time.
Therefore
multiple treatment sessions are required but most patients will
obtain the desired result with 3 treatments spaced about 3 - 4
weeks
apart ( however some patients will require more
depending on the severity of the problem and an estimate will
be provided at the time of consultation ). Expectations and
individual results may vary, but long term results at 2 years have
shown very good patient satisfaction and a 5 year study is underway.
Like all other filler injections minimal to no swelling and bruising
is noticed following the treatment and one of the side effects is
that you may feel some bumps in the treatment area which are not
typically visible.
