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Resorbable Filling Substances


Bovine Collagen
Zyderm and Zyplast (Inamed Corp) are composed of highly purified bovine dermal collagen that has been used to correct facial imperfections since the 1980’s. The bovine collagen is processed to create a product that is similar to human collagen. There are three forms: Zyderm 1, Zyderm 2, and Zyplast. Four weeks prior to the procedure, a test dose is administered in the forearm to determine if you have a sensitivity to the implant material. Three percent of people tested may have sensitivities. Frequently a second test dose is administered. Collagen is most commonly used to fill out superficial wrinkles, skin depressions and some scars. It has been largely replaced by newer substances including human collagen and hyaluronic acid gel.
Hyaluronic Acid Gel
Hyaluronic acid is a natural polysaccharide (sugar like substance) that is commonly found in the connective tissues of the body. The source of the material can be from animals (avian protein; i.e., roosters or poultry), or bacterial fermentation which is non-animal. Its normal function in the body is to bind water and to lubricate moving parts like joints. The most common areas for treatment are the nasolabial folds (creases from the nose to mouth), the nasomental creases (corners of the mouth) and around the lips, as well as cheek and chin contours. Since there is no anesthetic supplied in the syringe, a topical anesthetic or local block may be needed to maximize comfort. Aside from expected temporary redness/puffiness for the first day or two, there are few complications to report and we are seeing longevity of four to six months and even longer in some patients. As the substance naturally occurs in humans, allergic reactions are rare.
The FDA approval of Restylane marked the beginning of a wave of new bioengineered substances for the treatment of lines, depressions, and wrinkles. Our male patients are very satisfied with the results of Restylane, which lasts six months or longer in most cases. Because it is a gel, it offers a soft, natural-looking correction.

Restylane, Perlane, and Restylane Touch are all the same material packaged in a different particle size. Perlane has a large particle size while the size of Restylane particles is small. We use the larger particles when I need to fill deep wrinkles and the smaller ones when I need to fill superficial ones. We have been surprisingly pleased with this family of products and our patients love the variety and durability that they offer.

Restylane is the only product presently approved by the FDA for use in the United States; however since Perlane and Restylane Touch are the exact same molecule, they will hopefully be approved soon. We use Restylane to treat nasolabial creases (smile lines) most commonly but it can also be used for other deep creases around the mouth and between the eyebrow when BOTOX is not effective. Perlane is great for restoring volume. It is used for deep creases including the nasolabial creases and for facial sculpting.

The latest addition to the expanding Restylane family of hyaluronic acid fillers is SubQ, a revolutionary new injectable treatment for facial sculpting. It can produce the high cheek bones or a more defined chin and jaw line. Restylane SubQ is based on the same patented hyaluronic acid gel formula used in the other Restylane products but it has much larger gel particles, three times as thick as Perlane. The gel safely biodegrades on its own. SubQ can also be used for restoring facial volume where cheeks have hollowed from weight loss and the inevitable breakdown of collagen and elastin fibers. The gel is injected deeply under the skin under a local anesthetic in one treatment, and the newly enhanced contours are immediate.
The Plastic Surgery Group is one of the first providers in the region to offer Perlane® to their patients. The makers of Restylane® recently received FDA approval for their next generation product, Perlane®. Perlane® is made from the same natural, biocompatible substance as Restylane®, but the particles are larger, making the gel thicker. This allows our doctors to achieve a deeper, smoother correction that may potentially be longer lasting! The most common areas that Perlane® is used to correct are the nasolabial folds, the areas around the mouth as well as in the tear troughs (the hollows under the eyes). Results are immediate!
Hylaform and Hylaform Plus
Hylaform and Hylaform Plus are hyaluronic acids that are similar to Restylane®. Hylaform Plus has a larger particle size and is designed for deeper creases. A study comparing the duration of correction for Hylaform Plus and Restylane® has been conducted and the findings will be presented in the near future. For now, it is safe to say that most plastic surgeons tell patients to expect three or four months of correction from Hylaform.
Captique is basically the same as Hylaform with the major difference that it is manufactured rather than harvested from rooster combs. This allows the product to be produced without any animal proteins that theoretically can cause allergic reactions. It is the same concentration and thickness as Hylaform, and it is reasonable to assume it will have the same longevity.
Other Hyaluronic Acid Based Products Under Development
Juvderm has been used in Europe and is a major step forward for the hyaluronic acid fillers. It is a homogenous gel that does not contain gel particles. It is manufactured and is not derived from animals. Three versions are presently available and they are well suited to a broad range of applications. There are three varieties of Juvaderm 18, 24, and 30 that vary in the concentration of hyaluronic acid contained. The variety of concentrations allows a broad range of uses for this filler ranging from filling crow’s feet with a less dense product to smoothing nasal furrows with a more dense variety. Juvaderm is currently undergoing clinical trials in the United States.

“You never want to be the first one on your block to try a new technique or procedure. Wait until it has been fully evaluated.”

Poly-L-Lactic Acid
Developed by a French dermatologist, Sculptra is based on a substance called poly-L-lactic acid (PLA) which occurs naturally and has been used in suture material for years. PLA stimulates production of the body’s own collagen within the line or wrinkle, making the skin appear smoother and firmer. Sculptra is reconstituted before it is injected and is most commonly used in the nasal labial folds, cheek hollows and scars. The substance is non-allergenic and typically two to three treatment sessions are recommended for best results.
Human Tissue Fillers
One of the fascinating categories of filling agents is derived from human tissue. Most of these products are obtained from cadaver tissue through tissue banks. Donor suitability is determined according to the standards of the American Association of Tissue Banks (MTB) and FDA. Cadaver collagen must meet criteria established for extensive testing for human immunodeficiency virus antibody (anti-HIV 1-2), Hepatitis B surface antigen (HBsAG), Hepatitis B core antibody (HBcAB), Hepatitis C antibody (anti HCV), human T-lymphotropic virus type I antibody (anti HTLV-1), and rapid plasma regain (RPR) for syphilis.
CosmoDerm® and CosmoPlast® (Inamed Corp) contains human collagen that has been purified from a single fibroblast cell culture. This product does contain 0.3% lidocaine, so additional local anesthesia is usually not required. No skin test is required because this is fashioned from human tissues rather than an animal source. CosmoDerm® and CosmoPlast® are injected just below the surface of the skin to fill in superficial lines and wrinkles and to define the border of the lips.
AlloDerm® is human dermal tissue that has been decellularized to remove the risk of rejection or inflammation. It comes in strips in a freeze dried form to be implanted into lips, nasal defects, and around the eyelids. AlloDerm® is sometimes used as a soft-tissue replacement in facial reconstruction to build up cheeks, chins, hollows and asymmetries. It can be rolled or layered so that it can be implanted under the skin to fill out depressions. Cymetra was introduced in 2000. It is micronized AlloDerm® tissue in an injectable form. It also needs to be reconstituted. More than one treatment may be required to achieve the level of correction envisioned. AlloDerm® may last up to two years; Cymetra may last two to four months.

“The key with soft tissue fillers is to select a safe product that has a long track record.”

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