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Injectable FillersMore and more substances are appearing on the market to be injected into the face. These are some of the more common ones: COLLAGEN — This thick white material was the only available injectable filler for 2 decades. Collagen is the main structural protein throughout the animal kingdom, although there are slight chemical differences between the collagen of different species. Originally extracted from cow skin, injectable collagen is in recent years made from human skin, appropriately processed to make it free from hepatitis, AIDS, and other viruses. This human-derived collagen does not require the preliminary skin test that was necessary with the earlier bovine product. Collagen is still a good material to fill in facial furrows and fine lines. HYALURONIC ACID — This transparent viscous (like thick syrup) material, which occurs naturally in the body, is available from several manufacturers. The most well known brand currently is RESTYLANE. Others are CAPTIQUE and PURLANE. It largely substitutes for collagen injections and is useful either to fill in shallow skin wrinkles and lines or to go under the skin to fill out broad depressions like the nasolabial folds ("smile lines"). It is also very useful to plump up the lips. More recently it is proving helpful to fill in hollows and grooves in the region between the cheeks and the lower eyelids. Dr. Cedars has been using hyaluronic acid for filling since it became available in late 2003. SCULPTRA ® — Unlike collagen and hyaluronic acid, this product is very watery when it is injected deep to the skin. It is actually a suspension of fine particles in local anesthetic and water and prior to injection needs to be shaken up, looking rather like a child's snow globe. Although the product is only on the market in the United States since 2004, the material itself is the same as that used here for several decades as one of the most common surgical sutures. The manufacturer's claim is that it stimulates the body to produce collagen. As a result the fullness produced by Sculptra® builds up gradually over several months. Several injections, usually at one-month intervals, are required to produced the desired effect. Once achieved the fullness lasts, according to the manufacturer, perhaps 2-3 years. The FDA approval for Sculptra® is for treatment of facial wasting in people with HIV, and any other cosmetic use is "off-label," legal for a physician to do but not officially accepted as safe and effective. The manufacturer hopes to have FDA approval for cosmetic use in all patients in the future. Off-label use of Sculptra® has shown it useful in filling hollow areas in the nasolabial folds (smile lines), marionette lines (between the corner of the mouth and the lower jawline), central cheeks, the region between the cheeks and the lower eyelids, and the temples. It can also be used to create extra fullness over the cheek bones. Dr. Cedars has been using Sculptra® since it became available at the end of 2004. |
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