New Versions of Injectable Fillers keep coming…..and more are on the way!

Next to Botox coming out of a needle, the use of injectable fillers is only slightly less popular as a cosmetic injection method. While collagen was the only injectable filler for lines and wrinkles from 1981 to 2003, there has been a virtual explosion of new injectable fillers since then…..now numbering six commercially available fillers….and four of these have become available in the last year. And collagen as an injectable filler has now become of historic interest only.

The new revolution in injectable filler materials has been the change from collagen to hyaluronic acid. A natural sugar, hyaluronic acid (HA), lasts longer and has much less potential for adverse reactions than collagen. The battle amongst HA manufacturers revolves around the claim of which one is the longest lasting. Despite differing claims, conclusive proof that one type of HA lasts longer than the other remains lacking. Clinical trials for most manufacturers has compared their version of HA to collagen as the control. Few direct comparison studies have yet to be done. While the amount or concentration of HA per cc would suggest greater longevity, there are other issues of importance as well such as the degree of cross-linking. These issues will eventually sort themselves out but it is fair to tell patients that HA injections will last between 4 and 8 months on average, and some perhaps longer. One thing is for certain, however, and that is more variations of HA injectable fillers are coming….and such competition will drive the price of a syringe down. (which is more than can be said for Botox!)

Two non-HA injectable fillers also became commerically approved last year. I call these type of injectable fillers, particulated synthetic injectable fillers. The concept is that they contain a portion of non-resorbable beads or particles mixed in a carrier solution. Radiesse uses ceramic beads and ArteFill uses plastic beads. Either way, the beads do not go away and some percent of permanence remains. As a result, they last longer than the HA fillers even if 80 - 90% of the particulated filler does go away. Because they have the potential to become lumpy due to scarring around the beads, their use in the lips is not recommended. In theory, build-up of the beads can occur over time with multiple injections so that their effect may seem to last longer over time.

With such a wide selection of injectable fillers available today, it can be confusing to the patient. For the physician injector, it is important to use more than one of the available injectable fillers for different areas and different problems.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

INJECTABLE FILLERS – Many Types, Different Uses

Up until 2002, only one type of facial line and wrinkle filler was available – injectable collagen derived from cow proteins. While it lasted only a few months, due to its animal origins, it was the only treatment option available. Since 2002, six (6) new injectable fillers have been approved for use in the United States, all of which are made up of different (and better by the way) materials which last longer with fewer skin problems. This has resulted in a great amount of confusion and misinformation for patients. (and some doctors as well) With the certainty that more new injectable fillers are on the way in the next few years, it is important for even the patient to have some basic understanding of the similarities and differences between the choices that they have.

Today’s injectable fillers can be classified into two basic types: hyaluronic acid (HA or hyaluron) and particulated (particle-containing) compositions. While both come out of a needle, they are quite different. HAs are now the gold standard of fillers since they arrived in 2002 and have relegated old-style collagen to an almost historic footnote. Since they are synthetic ‘knock-offs’ of natural human hyaluronic acid, the patient does not need a skin test prior to injection and they last at least twice as long as collagen. The alleged differences between the four commercially-available HA injectates (Restylane, Hylaform, Captique, and JuvaDerm) is largely marketing-driven and no clinical studies has ever compared how long all of them last compared to each other. Because they are like injecting a ‘soft form of Jello’, they can be used anywhere on the face including the lips (even though the FDA has never approved any injectable filler for use in the lips) without fear of excessive lumpiness. I prefer JuvaDerm at present due to his observations that it appears to last the longest. (6 – 8 months) The next few years will bring other more concentrated HA injectable fillers to the scene that undoubtably will last even longer. The particulated fillers contain synthetic beads or particles (plastic or ceramic) in different liquid carriers. (Radiesse, ArteFill) Due to the non-resorption of the beads (which usually make up less than 25% of the solution), longer-lasting effects are seen than with the HAs. Equally important, because the beads do not resorb, some ‘permanency’ of volume can be achieved over time with repeated injections. However, because of the particles and the potential risk of lumpiness, these particulated fillers should not be injected into the lips. They are best used for deeper lines and folds such as that of the cheek-lip fold which is a common cosmetic concern for aging patients.

Since no injectable filler is ideal for every patient or type of facial line or wrinkle, the best plastic surgeons usually work with two or three different ones to custom treat each facial problem.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis