IN THIS ISSUE Looking Ahead with Renewed Confidence The Increasing Popularity of Hyaluronic Acids to Improve Folds and Wrinkles Ask the Surgeon / Health Tip / What's New The Dangers You Don't Know About

As we age, wrinkles, lines, and folds begin to appear. The collagen and hyaluronic acid in the skin diminishes causing the skin to lose structure and volume. Now, you can add youthful fullness and reduce wrinkles with dermal filler injections. The Food and Drug Administration (FDA) has approved three fillers that are modified forms of hyaluronic acid, Restylane®, Hylaform®, and Hylaform Plus®.

Hyaluronic acid is a natural sugar molecule found in the skin, cartilage, joints, and the eyes of all living mammals. This gel compound serves many purposes including filling the space between collagen and elastin fibers providing cushioning; transporting nutrients from the blood to the skin; and retaining water within the cell promoting volume and protection. By adding these hyaluronic fillers, your skin is immediately rejuvenated and smoother.

Procedure

Depending on the extent of your treatment, the area may be numbed before treatment. An ultra fine needle is used to inject small amounts of the filler into the mid-to-deep dermis (skin). There is minimal discomfort and wrinkles and folds are plumped up instantaneously. Patients resume normal activity immediately.

The cost varies from patient to patient, depending on how much filler is necessary.

Typical Treatment Sites

Fillers can be used to improve the appearance of moderate to severe facial wrinkles and folds around the mouth, the nose, and the eyes. The most common areas are the smile lines around your nose and mouth, marionette lines at the corners of your mouth, frown lines between the eyes, and fine lines above the mouth. Hylaform® and Restylane® have also been used to improve the appearance of scars.

Advantages of Dermal Fillers

Since these fillers are naturally, modified forms of hyaluronic acid, there is no allergy testing required. You can be treated at your first visit. The procedure is non-invasive, usually takes less than an hour, and requires no recovery time. So, if you want to plan your treatment on your lunch break, go right ahead. Patients enjoy smoother skin right away. The results of hyaluronic acid last approximately six months and require less volume to fill wrinkles and hard-to-treat skin folds compared to collagen.

Hylaform versus Restylane

The effects of these fillers are very similar. The main difference is how they are derived. Hylaform gel, manufactured by Inamed Aesthetics, is a form of crosslinked hyaluronic acid (5.5 mg/mL) derived from the rooster combs of domestic fowl. Inamed states that Hylaform Plus® has larger hyaluronic gel acid particles than their original product, Hylaform®. Restylane®, manufactured by Medicis Aesthetics, is made from streptococcal bacterial fermentation and does not require an animal source. At 20 mg/mL, Restylane® has a higher concentration of hyaluronic acid than Hylaform gel.

Both fillers have been proven safe as dermal fillers. Hylaform® was approved in April 2004 by the FDA. Restylane® was approved in December 2003. In addition, both fillers have been used to augment the lips; however, the FDA has not approved them for this purpose.

Injectable bovine collagen was developed in the 1970s. The FDA approved it for soft-tissue augmentation in 1981. Since it is animal-based (cow), allergy testing is required before your first treatment. The collagen is injected under the skin in small amounts to fill in the wrinkles. Results last between three to five months, with multiple treatments necessary for deeper wrinkles.

BOTOX® Cosmetic injections have become a popular way to reduce the appearance of crow's feet and furrowed brows. Botox® is purified protein produced by the Clostridium botulinum bacterium. It is administered via tiny injections right into the overactive muscles that cause lines to form; results persist for up to three months. Botox® received FDA approval in 2002 for the treatment of moderate to severe frown lines between the brows.

Autologous fat is extracted from the patient's own body via liposuction. It is usually harvested at the time of another procedure. There is no risk of allergy or rejection and the results are still temporary, lasting from three to six months.

Radiance is composed of tiny microspheres of calcium, hydroxlapatite (CaHA), suspended in a carrier gel of sodium carboxymethylcellulose, glycerin, and water. This injectable filler can last up to two years; however, it has not been approved by the FDA yet.

An FDA panel is reviewing an application for Artecoll®. This permanent treatment, already available overseas, reduces facial wrinkles by injecting polymethyl methacrylate spheres into a collagen-containing vehicle. The spheres trigger the body's own collagen to plump out the wrinkle.

Right Choice for You

Do you want to look younger? Would you like to have smoother, rejuvenated skin? Dermal fillers may be the right option for you. Schedule an appointment with your facial plastic surgeon to discuss which treatment will meet your individual needs.

Advantages of Hyaluronic Acid Filler

• No allergy testing necessary
• Minimally invasive
• Procedure is performed in less than an hour
• No recovery time
• Long-lasting results

Photo above shows wrinkles located in the upper lip area. Product used was Restylane to smoothen out the fine wrinkles. Lower photo shows the improvement with less visible wrinkles, one month later. Photos courtesy of the American Academy of Facial Plastic and Reconstructive Surgery.