How plump do you want them?

Life without Silicone: What's new with injectable wrinkle fillers?

Does your mother say you look too thin? Normal aging is often accompanied by loss of volume in the face. Our cheeks become hollow, our lips thin and the circles beneath our eyes sag lower. Wouldn’t we love to use a little fat from our bellies to replace the baby fat in our lips and cheeks! In fact we can, but harvesting fat creates additional discomfort, and long-term results are unpredictable.

The history of injecting silicone to fill wrinkles and contour the face dates back to the 1940’s. While many physicians became experts at injecting microdroplets to fill wrinkles and sculpt the face, larger amounts of silicone occasionally created inflammatory reactions and deformities that were difficult to correct. In our search to develop an ideal artificial material to replace lost facial fat, scientists have developed a diversity of products (Table 1), creating confusion for patients and physicians alike.

Collagen was developed as a safer alternative to silicone and was used with great success for many years. Cow collagen required a skin test to avoid allergic reactions. Human collagen was less allergenic, but was hampered by unsubstantiated fears of infection. Regardless of the source, the correction lasted only three months before it needed repeating. Nevertheless, many patients returned regularly for injection of fine lines in the lips and face. Larger volumes were augmented by surgical implantation of solid silicone, Gore-Tex and other plastics.

Restylane

The first FDA-approved product that was not processed from human or animal tissue. No skin test is required, and improvement lasts at least 6 months. Available since 2003 for the cosmetic correction of lines in the face, Restylane has achieved great popularity. Restylane is made of hyaluronic acid, a natural gel present in the soft tissues of our bodies which absorbs water as it gently disintegrates. Juvéderm is a similar product that may last up to one year. Both are commonly used for volume replacement and for filling creases, and are smooth enough to augment the lip and fine lines.

Three longer-lasting collagen stimulators were approved by the FDA in 2006. These three products are best injected deep into the skin to add volume and fill deeper creases, but they are not recommended for fine lines and augmentation of the lip itself.

>> Read more on our experience with Restylane

Radiesse (calcium hydroxylapatite)

Has been used in the United States for vocal fold augmentation since 2002 and was approved for cosmetic correction of nasolabial folds in December 2006. Radiesse contains a suspension of fine ceramic particles that stimulate new collagen production and lasts about one year.

>> Read more on our experience with Radiesse

Sculptra (poly-L-lactic acid)

Was one of the first semi-permanent fillers to reach the US market. Approved in August 2004 for patients with facial wasting due to human immunodeficiency virus, the FDA has permitted general cosmetic use since September 2006. Sculptra requires multiple treatments but can be used to add large volumes and lasts about 2 years.

>> Read more on our experience with Sculptra

Artefill (polymethylmethacrylate)

Was approved for use in the United States in October 2006, after engineers created a smaller, smoother particle compared to its European and Canadian predecessors. Artefill is a permanent implant that stimulates new collagen growth. Improvements last at least 5 years. Artefill does contain cow collagen for immediate results, and requires a skin test one month before treatment.

>> Read more