Soft Tissue Augmentation Fillers And Implants - Skin Rejuvenation Procedures: Skin Health

Choosing a filler or implant

With so many old and new selections, deciding which filler or implant might suit your needs has become a complicated process. Do you want something temporary that has a very low risk, or would you prefer something permanent, even if it has a higher complication rate? Are you willing to try a new product, or do you want something that has a proven track record?

You'll also need to consider the area you're having filled. For instance, using fat to fill an area that once had fat, such as the cheeks, can give that area a natural look. But fat may not take as well in areas that have very little fat, such as the forehead. Some lip fillers can have long-lasting complications. Permanent or semi-permanent fillers, such as Radiesse and ArteFill, can cause lumps when injected in the middle of the lips. Hyaluronic acid fillers give better results with lower risk. You should also take your doctor's expertise with a particular material into account. Different fillers require different techniques and may be difficult to use correctly.

Your doctor can help you decide what's best for you. The following information on commonly used fillers and implants may also help guide you.

Hyaluronic acid

Hyaluronic acid is a complex sugar that all vertebrate animals produce. It's found in numerous tissues, including the skin and cartilage. It has been produced for medical purposes from rooster combs, plants, and bacteria. Because it is the same from species to species, it carries little risk of allergic reactions. In the skin, hyaluronic acid is the natural cushion that occupies the spaces between the collagen and elastin fibers, adding bulk to the skin's dermis.

The FDA has approved several brands of hyaluronic acid as skin fillers, including Restylane, Hylaform, Captique, and Juvederm, and several other brands are awaiting approval. Hyaluronic acid gels come in a variety of viscosities that can treat a range of wrinkles and other problems. Thin solutions treat finer lines and wrinkles such as crow's feet, while thicker solutions fill in deeper nasolabial folds, add volume to the face, and make the lips fuller. Hyaluronic acid fillers last longest in the areas of the face that move the least — six months in the nasolabial folds and three to four months in the lips. Hyaluronic acid is more costly than collagen, but it can last twice as long, so it may be more cost-effective in the long run.

Collagen

Collagen used to be the mainstay of soft-tissue augmentation, but its use has declined as newer materials with fewer side effects and longer-lasting results have hit the market. In the past, the most common form of collagen was bovine collagen (Zyderm and Zyplast), derived from cows raised under conditions that minimize microbial contamination. However, pregnant women and people who are allergic to cow products may not use this product. Most people now opt for human-derived collagen. Two such products — CosmoDerm and CosmoPlast — come from cultures of human fibroblast cells, which produce collagen. They work almost identically to bovine collagen, without the risk of contamination.

You could use your own collagen, too, through a more complicated process called Autologen. If you're having a facelift or other surgery that will remove excess skin, your doctor can send the skin to a laboratory that will extract and process the collagen. In about four to six weeks, you can receive injections of your own collagen.

Collagen fillers are sometimes used with hyaluronic acid for lip augmentation, with collagen injected into the edges of the lips to add definition and hyaluronic acid injected into the middle of the lips. Collagen treatments last for two to four months.

Autologous fat transplants

Who doesn't have a bit of fat to spare? If you have some extra fat padding your hips, thighs, buttocks, or abdomen, it could become a filler. Using a limited liposuction procedure, physicians extract fat from the area chosen, process it, and then inject it to fill lines or contour hollow areas of your face. This is known as an autologous fat transplant. Most people have a touch-up in three or four months; your doctor will have frozen some of the extracted fat for this purpose. After the second treatment, many people find that results will last 5 to 10 years.

In many ways, fat is an ideal filler. It's readily available, easy to get, and inexpensive. It's noncarcinogenic, and if it comes from your own body, it won't cause an immune reaction. Once implanted, it stays in place and is extremely long-lasting. It works best when injected into another fat-containing site, such as areas around the nose and mouth, cheeks, cheekbones, or jaw line.

Using fat is more complex and expensive than other procedures, however, so some doctors and patients prefer other products. And because your wrinkles have formed in skin, not fat, some experts contend that fat isn't very effective, but others swear by it.

Gore-Tex

Made of the same material (polytetrafluoroethylene) used in waterproof, breathable clothing, Gore-Tex has had mixed success as a cosmetic implant. Gore-Tex implants become permanent because the body's tissues entwine themselves in the nonbiodegradable synthetic fibers, which anchor the implant in place. However, it can also cause infections. And for reasons not fully understood, the body's tissues sometimes reject the implant and push it out through the skin, although this is a rare complication.

Microdroplet silicone

Unlike collagen, which fills the small groove of a wrinkle, silicone works by inducing the skin to produce more tissue. Just as a grain of sand can be the start of a pearl in an oyster, silicone initiates a reaction in the skin, causing collagen-producing fibroblasts to grow around the tiny injected beads.

Silicone has a checkered past in the cosmetic world. Previously, silicone solutions were not regulated, and impurities caused serious adverse reactions, sometimes years later. In other cases, the problem was the technique used. Doctors thought silicone behaved like collagen, which shrinks a few weeks after injection. Instead, the injected areas expand as the skin's tissues build up around the silicone, so the treatment areas appeared overfilled.

As of 2006, silicone has FDA approval for treating a detached retina in the eye, and the material is regulated for purity. Although it isn't FDA-approved as a soft-tissue filler, doctors may use it in this way. According to experts, safety studies are expected to be submitted to the FDA so that silicone can be considered for reapproval as a cosmetic filler. Only time will tell if some patients develop a late reaction to the silicone used today.

Silicone fillers and implants are permanent, so be sure your doctor is well schooled in the art of injecting them. Today, most doctors fill the area slowly and carefully over many months, since it's easier to add more filler than to remove it. Many consider it to be the filler of choice for problems such as HIV-related loss of underlying fat and some types of acne scars.

Radiesse and ArteFill

Successful use of these synthetic, permanent injectables depends on the technique used and the skill of the physician.

Radiesse (formerly Radiance) is a combination of gel and particles made of calcium hydroxylapatite, a substance found in teeth and bone. This material is used in orthopedics as a bone cement. As a filler, it provides a scaffolding for fibroblasts to inhabit while secreting collagen. The material usually lasts for a year or more before diminishing. Radiesse is approved by the FDA for use in the nasolabial folds and for the treatment of fat loss in the cheeks associated with HIV.

ArteFill, approved in 2006, contains tiny plastic beads of polymethylmethacrylate suspended in bovine collagen. The body absorbs the collagen, and the beads are engulfed by your own collagen to form a lasting implant that lifts lines, wrinkles, scars, and atrophic areas. Aside from uncommon allergic reactions to bovine collagen, side effects may include inflammation and small bumps in the skin.