Turn Back the Clock Without Losing Time: A Complete Guide to Quick and Easy Cosmetic Rejuvenation
By Rhoda S. Narins, M.D., Paul Jarrod Frank, M.D.
Dermalogen, a form of collagen that is used less often than bovine collagen, is human collagen made from tissue obtained from human tissue banks. The indications for this implant are the same as those for collagen. Patients who are allergic to collagen or who are opposed to using animal-based products may prefer Dermalogen. Because virtually no allergies to Dermalogen exist, you can also be treated immediately; no prior skin testing needs to be done.
Dermalogen is injected just like collagen, but it usually takes three monthly treatments to build up the desired area. However, some dermalogic surgeons find Dermalogen lasts longer than collagen.
Restylane and Hylaform (Hyaluronic Acid)
We have in our bodies a naturally occurring sugar polysaccharide called hyaluronic acid. The natural effect of this substance is to retain water and elasticity in the skin and thus keep skin looking young. Unfortunately, as we age this substance also markedly decreases. But with Restylane and Hylaform, which are synthetic agents based on this sugar, there's a way to replace it.
Originally used by orthopedic surgeons to lubricate and functionally enhance damaged joints, hyaluronic acid-based agents are quickly becoming some of the premier filler agents in the market.
These two agents are the most common filling substances used in countries outside the United States, and they are awaiting FDA approval here. Restylane is a hyaluronic acid that is a thick gel made synthetically. This is a distinct benefit because there is no risk from disease. Hylaform is a hyaluronic acid made from roosters' coxcombs. Because hyaluronic acid is almost exactly the same compound whether it comes from an animal, a human, or is laboratory made, there is only an extremely small chance that it will cause an allergy. Therefore, no allergy testing is required. Treatment can be given immediately with immediate results. This is an ideal treatment for patients who are allergic to collagen because these agents can be used to treat the same areas. Furthermore, these agents, particularly Restylane, are reported to last longer than collagen. Unlike collagen, these substances cannot be given with built-in anesthesia, but most people don't need it. The debate is going on as to whether Restylane or Hylaform is better. Although Restylane appears to be better due to the nonanimal source, there are reports that it may have a higher chance of producing a skin reaction. Which substance lasts longer is also yet to be determined. The FDA is currently comparing the longevity of Restylane to that of collagen at six centers, including ours.
Once a popular filling substance, silicone was used in hundreds of thousands of patients with terrific results. But although it was considered a great filling agent for years, it was never FDA approved for this use. However, it had the advantage of being a permanent filler that could be used for several different types and depths of skin defects. Unfortunately, people using impure products, overzealous use of silicone, and bad publicity related to silicone implants have squelched its use over recent years. But silicone may be coming back. The FDA has approved a newer, purer type of silicone for use in the eye to reattach retinas. Studies are planned for the use of silicone as a skin filler for the treatment of wrinkles.
Although not FDA approved as a filling substance, silicone is sometimes used for this purpose in a microdroplet technique as an off-label use, which means that it is approved for other uses but not specifically for this one. This is not that unusual a practice; for example, BOTOX is narrowly FDA approved for ophthalmological use but is now a mainstay of cosmetic dermatology and should be approved for this soon.
Silicone is useful in all the areas where collagen is used, including nasolabial folds, crow's-feet, forehead and frown lines, lip augmentation, puppet lines, and acne scars. It can also be used for cheekbone and chin augmentation and, like fat transplantation, which will be discussed later in this chapter, in treating cheek hollows. Silicone is permanent and can be used to fill in any type of defect. If you don't like it, you can't remove it, but most patients are satisfied with their results.
Since silicone is an inert, nonreactive substance, no allergy testing has to be done. There is a small chance of a nonallergic inflammatory-type reaction, a lump in the skin usually when large amounts are injected at one treatment session. Anesthetic blocks usually need to be injected locally prior to using this type of implant.
Gore-Tex is a nonbiologic agent made of expanded polvtetrafluoroethylene, a synthetic polymer used for hernia repair and skeletal augmentation. This is true also of Softform, a type of Gore-Tex. These substances are not injected but are inserted as tiny tubes under the skin. Gore-Tex is useful in filling in very deep folds and especially in nasolabial folds in men. Once implanted, your own tissue grows around it, and this fixes the filler in place.
Gore-Tex offers permanent filling with the option to remove it surgically at any time. Large amounts of anesthesia both locally and in blocks must be injected prior to implantation, and a few days of bruising and swelling are common after the procedure. Women generally have thin skin and can feel the implant, particularly when it is used in their lips or in the folds at the sides of their mouth. Although Gore-Tex is used extensively in lips, we feel many other filling substances give better results without the need for invasive surgery and without the side effects.
Other Filling Agents
There are a variety of artificial and natural filling substances that are used around the world. Many are not available in the United States or are rarely used because of their side effects or their inconvenience. They are not very good agents, in our opinion, and no FDA trials are planned. There are still other techniques we have not included because they require surgery and considerable recovery time. But we are certain the future will bring an even wider choice of filling substances, including nonbiologic, bioengineered collagen, a wide use of hyaluronic acid products, the return of silicone, and the continual refinement of fat transplantation.
But although these agents may be developed in the future, there are many filling substances available right now that offer you wonderful cosmetic improvement with minimal downtime so "even your best friend won't know" why you look relaxed and younger-unless, of course, you tell her.