Dermal Fillers

DERMAL FILLERS
Wrinkles are best classified into Dynamic and Static lines. The dynamic lines which are due to muscle activity are best treated with Botox while the static lines more commonly due to environmental damage and aging are more frequently addressed with the use of dermal fillers. The variety of dermal fillers are numerous and will be reviewed individually. Soft tissue loss is most commonly addressed with the use of Sculptra, Alloderm or fat injections. Skin Tightening, Skin Resurfacing and Skin Rejuvenation are additional skin concerns which are addressed utilizing Laser Technology and will be discussed in a subsequent section.

Injectable dermal fillers are designed to augment areas of facial creases and wrinkles. They are manufactured in such a way as to be considered either temporary, semi-permanent and most permanent. These fillers are quite often used in conjunction with Botox to help improve the areas of both dynamic and static lines. Alternatively, the use of the so called volume fillers are designed to augment areas of soft tissue loss.

The problem for the consumer is that the choice for any number of these products becomes difficult for a variety of reasons. Not only does the duration of effect vary between the different products but the volume of each syringe, the side effects as well as manufacturing costs make the final decision for the patient somewhat difficult. In general, the fillers are designed to be injected at different levels into the dermis and subcutaneous tissue layers.

Lip augmentation or enhancement is commonly achieved utilizing various dermal fillers discussed below. The details of lip augmentation itself is outlined in the facial procedure section under the heading of lip augmentation. Hyaluronic acid fillers are routinely recommended for initial treatment sessions so that patients are able to assess whether or not they truly like their new look on a temporary basis. More permanent solutions include the use of ALLODERM or Softform.

TEMPORARY DERMAL FILLERS
Collagen fillers were initially the product of choice but has more recently been replaced with the use of RESTYLANE and PERLANE (Medicis) and JUVEDERM (Allergan).

It should be noted that these temporary fillers are classified as Hyaluronic acids which are naturally produced by the body and play an important role in giving firmness to the skin. Not only are there differences within each product line in terms of molecular size and shape but the extent and degree of cross linkage also varies. It is these structural differences which make the products amenable to treating either fine superficial lines or the deeper grooves of advanced aging and skin damage.

The main limitation in the use of these products relates to their longevity. Although the average duration of effect is 3 months, this time frame may be less or longer. Research has identified that the more an anatomical area moves the shorter the duration of product. This is one of the main reasons why injection into the lip mucosa and nasolabial folds which are considered dynamic areas often last less time than when this material is injected into static areas of the face. The use, benefits and limitations of the different products will be reviewed at the time of your consultation in an effort to allow you to make an informed consent on the product which you prefer.

Individuals who are facing the natural process of aging now have more options than ever when it comes to diminishing the appearance of unwanted wrinkles and creases. The most popular of the dermal fillers currently on the market are JUVERDERM and RESTYLANE. Although JUVEDERM and RESTYLANE share some of the same benefits, they do have some differences and those considering dermal filler injections should consult with a skilled practitioner to learn which treatment option is best for them.

Juvederm vs. Restylane
Both JUVEDERM and RESTYLANE are FDA approved and aid in restoring the skin’s natural youthfulness and overall vitality. Depending upon personal preference and your desired results, JUVEDERM and RESTYLANE are both effective treatments for patients 35-60 years of age.

Similarities

  • Both fillers are made from hyaluronic acid, a naturally occurring substance that helps to hydrate and add volume to the skin.
  • Each is effective for smoothing wrinkles, sculpting lips, and improving other facial features
  • Both are minimally invasive and require little to no recovery time

Differences

  • JUVEDERM typically takes a maximum of 24 hours for recovery and RESTYLANE can take anywhere from two to three days for swelling to go down
  • Results for JUVEDERM are reported to appear instantly and the results for RESTYLANE won’t be as evident until about a week after the procedure
  • The results of JUVEDERM typically lasts from three to nine months while results for RESTYLANE can last for six months or more

SEMI PERMANENT DERMAL FILLERS
Dr. Van Wyck refers to these fillers as semi permanent because they do indeed last longer than the temporary fillers mentioned above. They more common products include the use of EVOLENCE and RADIESSE, both distributed by Canderm.

EVOLENCE is a combination of collagen and a sugar side chain (Glymatrix). One of the problems with collagen alone was the fact that the product did not last for any length of time. With the addition of the sugar attachment a lasting effect up until 12 months can be achieved. Although originally used in the lips (among other locations) a problem with residual lumps have been noted and for this reason Dr. Van Wyck no longer uses this product for lip augmentation.

About EVOLENCE®
EVOLENCE® dermal fillers represent a breakthrough in the treatment of the effects of aging, providing a long-lasting, advanced collagen treatment for soft tissue deficiencies, especially facial lines, folds, and wrinkles. For the first time, you can choose a natural solution for immediate results that last for up to 12 months, so you can look refreshed, without having costly repeat treatment every few months.

Unlike some other dermal fillers, EVOLENCE® is made from one of nature’s fundamental and most abundant building blocks – collagen. In fact 70%-80% of our skin’s dermis is made up of collagen. Collagen depletes naturally over time as we age, the pace of which may be affected by the degree of sun damage, genetics, hormonal changes, smoking, pollution, and other factors. This ongoing collagen loss leads to the appearance of an aged or a tired look through the formation of wrinkles, lines, folds, and changes in facial contour.

EVOLENCE® can be your solution to replace lost collagen with collagen. Injected just below the skin’s surface, EVOLENCE® advanced collagen adds volume to contour, fill, or smooth away wrinkles and folds, supporting your own existing collagen network. The visible results are immediate – with minimal to no downtime post-treatment – and last for up to 12 months.

EVOLENCE® offers a technological breakthrough in using collagen to correct lines, wrinkles, and folds through our patented GLYMATRIXTM technology. ColBar LifeScience Ltd. has created a novel technology that utilizes natural ingredients to create this advanced collagen product.

First, we break down the porcine source material into pure collagen molecules. Then we recreate the strong molecular bonds that exist in nature using a naturally occurring sugar rather than the synthetic materials used by other manufacturers. The result is a 100% natural collagen substantial enough to fill even deep facial contours instantly and to last as long as 12 months.

Currently, there are two advanced collagen dermal filler products:

  • EVOLENCE®, recommended for the correction of moderate-to-deep wrinkles, lines, folds, and contour deficiencies.
  • EVOLENCE® BREEZETM, a more finely textured consistency, ideal for fine-to-moderate wrinkles and contour deficiencies.

Both EVOLENCE® and EVOLENCE® BREEZETM may be used individually or in combination for your most natural, refreshed look. About RADIESSEAn alternative product is RADIESSE which is a calcium based product in which micropheres are suspended in an injectable gel. Although the calcium is eventually broken down, it is meant to stimulate the production of collagen which is why this particular product may last up to 18 months. The fact that each and every patient has a variation in collagen stimulation, there remains some variation in the longevity of this product between patients. Expectations, side affects and the anatomical indications of this product will be reviewed at the time of your consultation.

In December 2006, the Food and Drug Administration approved RADIESSE for the treatment of deep facial folds and wrinkles as well as for augmenting and restoring areas of the face affected by lipidatrophy, or fat loss. RADIESSE, like other dermal fillers, is injected just beneath the surface of the skin to add volume to sunken areas and to enhance overall facial appearance. Significant results are typically visible after only one treatment, but additional treatments are usually necessary for maintenance.

RADIESSE contains particles of a synthetic substance known as calcium hydroxylapatite that are suspended in an injectable gel. Calcium hydroxylapatite, although synthetic, is similar to a substance found naturally in bones and has long been used in medical devices.

Ideal candidates for RADIESSE include individuals with deep wrinkles and facial folds who want smoother, younger-looking skin. RADIESSE is also ideal for restoring facial fullness in patients with HIV who frequently suffer from lipidatrophy – a condition marked by sunken cheeks and hollows around the eyes.

Benefits of RADIESSE include:

  • Improved facial contouring
  • Procedure is minimally invasive
  • Immediate results
  • Results generally last for at least one year
  • Little or no downtime

As with other dermal fillers, RADIESSE should only be injected under the supervision of a board certified plastic surgeon. Side effects are generally mild but may include redness, bruising, swelling, and possibly infection.

The Procedure
RADIESSE is a synthetic solution made up of a compound known as calcium hydroxylapatite (CaHA) – a compound similar to that found in teeth and bones. The RADIESSE injection procedure is a fast, and fairly painless one. Radiesse is injected into the skin in the desired areas, where it then works to augment and add volume to the depressed or creased areas. An injection of numbing medicine may be used before the additional injections are administered by your health care professional.

The Healing Process
After RADIESSE injections, a patient may experience mild swelling – which typically subsides within 24 hours of the procedure and with the help of ice. Mild bruising or small spots may also temporarily appear in the area of the injections, but these too will heal within a short period of time. Once injected, RADIESSE takes on the form of the tissue surrounding it and becomes fairly soft when it’s injected into fat.

Results, however, are immediate and last as long as nine months. Patients who receive RADIESSE injections walk away from the procedure with a more youthful, healthy facial appearance. RADIESSE costs vary according to the extent of the procedure and the doctor, but consumers should always remain wary of someone offering RADIESSE injections at extremely low prices.

RADIESSE side effects and the healing Process
Doctors have yet to conclude if there are any severe RADIESSE side effects; however, as with all cosmetic treatments, RADIESSE injections do carry some risks, although typically minimal. Some of the more common RADIESSE side effects include mild swelling and bruising surrounding the site of injection, but this typically subsides after 24 hours with the help of ice.

The benefits of RADIESSE often outweigh any minimal RADIESSE side effects. Benefits include improved facial appearance and lasting results. In most instances, the results of Radiesse injections can be expected to last for up to nine months.

PERMANENT DERMAL FILLER
The only available permanent filler on the market is ARTESENSE, previously referred to as ARTECOLL. Historically speaking silicone was the most common permanent filler, however due to the number of adverse side effects it has been removed from the North American market. ARTESENSE is PMMA or polymethyl methacrylate beads in a collagen matrix. Although effective due to its permanent nature there are potentially more side effects including granuloma formation. This will all be reviewed with you in detail prior to proceeding with your treatment.

Before your book your ARTESENSE treatment, Dr. Van Wyck may give you a skin test which is used to determine if you are sensitive or allergic to the collagen or anesthetic in the product. During the procedure, ARTESENSE is carefully injected into the skin. You may be given a topical anesthetic to avoid pain, especially in the lip area. When a foreign object is inserted into our body, our body reacts by forming connective tissue (collagen) around it so when ARTESENSE is injected into the skin, your body will naturally form connective tissue around it. This process is usually complete in 3 months.

Depending on the patient and the correction to be made, a second or third injection may be needed if the degree of correction from the first injection is not optimal. ARTESENSE is a permanent implant that remains for the life of the patient and it’s effects have been shown to last 10 years and longer. However, final results will vary depending on each patient as the skin continues to age, as well as facial mimicry (frowning, squinting, smiling, etc.).

Common uses for ARTESENSE:

  • Folds and wrinkles of the face
  • Lip augmentation
  • Acne scars
  • Laugh lines (nasolabial folds)
  • Horizontal forehead frowns
  • Frown lines (glabellar)
  • Depressed corners of the mouth