Soft Beautification®

Collagen

Bovine Based
More than 220,000 injection procedures were performed in 2005, according to the ASPS. Since the 1980s, injectable collagen has been used as a soft-tissue filler. Collagen is a naturally occurring protein that supports various parts of the body including skin, tendons and ligaments. Commonly used injectable collagen is made from purified cow skin and is used to fill wrinkles, lines and scars on the face. The primary risk of injectable collagen is allergic reaction. injectable collagen absorbs into the body.

• Zyderm / Zyplast are collagen injections that are FDA approved and typically last 3 months.

• Cymetra (Micronized Alloderm)
  injectable human tissue collagen matrix derived from cadaver tissue, screened for contamination. Filler for lips, nasolabial folds, deep wrinkles and lines. Bruising is the most common side effect. Multiple treatments needed; lasts 2 months. FDA approved.
  
  
• CosmoDerm / CosmoPlast
  Derived from human tissue that has been purified and grown in a laboratory. Doesn't need a skin test. Approved for frown lines, crow's-feet, forehead lines, smile lines, vertical lip lines, marionette lines, lip border and for certain scars. CosmoDerm is used for superficial lines, while CosmoPlast is used for more pronounced wrinkles. The most common side effect is bruising. The results are immediate, lasting up to six months depending on the area treated. FDA approved.
  
  
• Fascian
  injectable derived from donor-fascia (connective tissue made of collagen) of the thigh muscle. Stimulates collagen formation, adds bulk. Bruising is the most common side effect. Lasts up to 6 months. FDA approved.
  
  
• Autologen
  injectable collagen prepared from the patient's skin. Small pieces of skin are harvested from the patient, processed and prepared for injection or frozen for later use. An alternative to traditional collagen injections. Bruising is the most common side effect. It is expensive and time consuming. It requires 2 or 3 treatments over a 6 to 8 week period to produce collagen; not permanent. FDA approval is not required.

• Plasmage
  Plasma emulsion (protein) is made of patient's blood and Vitamin C complex. It's a soft tissue filler to add volume, and lasts up to 3 months. The most common side effect is bruising. FDA approval is not required.

Fat injections have been used for years to add volume, fill wrinkles, lines and enhance the lips. More than 48,000 fat injection procedures were performed in 2005, according to the ASPS. Fat injections involve taking fat from one part of the patient's body (abdomen, thighs or buttocks) and re-injecting it beneath the skin. Unlike bovine collagen, allergic reaction is not a factor as the fat is harvested from the patient's own body. Results are variable, but can be permanent.

Hyaluronic Acid

Hyaluronic acid exists naturally in all living organisms and is a natural component of connective tissues, including the skin. According to the ASPS, nearly 490,000 hyaluronic acid injection procedures were performed in 2005. Hyaluronic acid has been used to treat joint pain.

Restylane® is a soft tissue filler made of hyaluronic acid, manufactured by recombinant technology which adds volume to minimize wrinkles and lines. As the substance naturally occurs in humans and all animals, allergic reactions are rare.

Captique™ is another soft tissue filler made of hyaluronic acid which received FDA approval in 2004.

Hylaform® & Hylaform Plus® are soft tissue fillers composed of hyaluronic acid extracted from rooster combs — both received FDA approval in 2004.

Two additional tissue fillers composed of hyaluronic acid, Perlane® and Restylane® Fine Line, are used outside the United States but are not approved by the FDA.

• Juvederm (24HV, 30, 30HV)® Hyaluronic acid gel. Temporarily corrects moderate to severe facial wrinkles and folds. The results are immediate; corrects facial wrinkles or folds for up to six months or longer. Temporary redness, pain/tenderness, firmness, swelling, and bruising at injection site; should not be used in patients with severe allergies, particularly allergies to bacterial proteins. FDA approved. Click here for more information
  
  
• Restylane®
  Non-animal derived hyaluronic acid. Soft tissue filler that adds volume. Results are immediate, may last up to 1 year. Side effects include redness, swelling, rare allergic reaction. FDA approved for filling moderate to severe wrinkles around the nose and mouth. All other use considered off label.
  
  
• Restylane Fine-lines®
  Non-animal derived hyaluronic acid. Soft tissue filler that adds volume. Results are immediate, may last up to 1 year. Most common side effects are redness, swelling, tenderness, especially at sight of injection; acne-like formations are rare. In use outside U.S. Not FDA approved for any use in the U.S.
  
  
• Perlane®
  Non-animal derived hyaluronic acid. Soft tissue filler that adds volume. Results are immediate may last up to 1 year; subsequent injections may require less Perlane^®. Most common side effects are pain, redness, swelling, itching, discoloration, and tenderness at the point of injection. In use outside U.S. Not FDA approved for any use in the U.S.
  
  
• Captique®
  Non-animal derived hyaluronic acid. Results are immediate, may last up to 1 year. Soft tissue filler that adds volume. Most common side effects are bruising, swelling, rare allergic reaction. FDA approved for filling moderate to severe facial wrinkles and folds around the nose and mouth.
  
  
• Hylaform®
  Hyaluronic acid extracted from rooster combs. Soft tissue filler that adds volume. Results may last up to 6 months. Most common side effects are redness and swelling. People with sensitivities to avian products may have an allergic reaction. FDA approved for filling moderate to severe wrinkles around the nose and mouth. All other use considered off label.
  
  
• Hylaform Plus®
  Hyaluronic acid extracted from rooster combs. Contains large hyaluronic gel acid particles. Soft tissue filler that adds volume. Results may last longer than 4-6 months. Most common side effects are redness and swelling. People with sensitivities to avian products may have an allergic reaction. FDA approved for filling moderate to severe wrinkles around the nose and mouth.

Two additional soft tissue fillers being studied for their wrinkle reducing and volume-adding qualities are Artefill® (formerly Artecoll®) and Radiesse™ (formerly Radiance™). Artefill® is a permanent "micro-implant" to fill facial wrinkles and lines, which is currently used in Europe, Canada and Mexico. Radiesse™ is composed of calcium hydroxylapatite, which has been used in the body for multiple applications including cheek and chin implants. Radiesse™ is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs. Another filler, Sculptra®, which is made of synthetic polylactic acid contained in microspheres, can be used to restore volume to the face of HIV patients suffering from facial lipoatrophy.

• Artefill® (formerly Artecoll®)
  75% percent bovine collagen and 25% polymethyl-methacrylate microspheres (non-silicone, carbon-based polymers). Artefill's manufacturer claims the injectable is permanent, as the microspheres do not absorb into the body. The body forms collagen around the microspheres that adds bulk. Possible complications include lumping, granulomas (localized skin reactions to foreign bodies, which can appear as hardness or a rash), micro-spheres can possibly move to other areas of the body. Results are immediate, need to wait 3 months between injections. FDA advisory panel recommended approval with conditions 2/03. Contraindicated for lip augmentation.
  
  
• Radiesse™ (Bioform)
  Microspheres of calcium hydro-xylapatite suspended in an aqueous gel carrier. Reported to last 1-2 years. The body forms collagen around the micro-spheres that adds bulk. According to manufacturer, clumping, lumping, and nodules can appear when injected into the lips. Little risk of allergic reaction. Results are immediate. FDA approved only for vocal cord paralysis, radiographic tissue marking, and maxillofacial augmentation. All other use considered off label.
  
  
• Sculptra
  Synthetic polylactic acid contained in micro-spheres. Restores lost facial volume in people with HIV. The body forms collagen around the micro-spheres. Most common side effects are redness, bruising, lumping and granulomas. Results are gradual and typically last two years. Approved by FDA with condition that it be used to reconstruct HIV patients suffering from facial lipoatrophy. In use outside the U.S. as New Fill™, to fill wrinkles.

In 1992, the FDA banned the use of injectable silicone when it stopped the use of silicone gel-filled breast implants. Patients requesting treatment besieged physicians who had been using the material with good results. In 1998, a court-appointed panel of scientists concluded there was no credible evidence linking silicone implants to chronic fatigue syndrome, lupus or any other disease. Recently, the FDA approved the use of injectable silicone for certain cases of retinal detachment. This approval has paved the way for the renewal of microdroplet silicone injection therapy as an off label use of an approved device. This allows patients and their physicians to use their discretion in the use of the device for a purpose not intended by the manufacturer.

Tiny amounts are injected on a monthly basis until the desired results are obtained. Usually four to eight treatments are required. It is not the silicone that leads to the enlargement. Instead, each microdroplet of silicone that is injected stimulates the development of collagen that surrounds the silicone droplet. Much as a grain of sand in an oyster leads to the formation of a pearl, the silicone induced collagen production is what leads to the filling or enlargement. For this reason, it is essential to wait several weeks between each injection session since it is hard to predict the exact amount of collagen formation that will take place.

A full treatment program can take from six to twelve months. Patients do not complain of pain during or after treatment, but swelling occurs for a day or two, and bruising can last a week. With each subsequent treatment, the amount and duration of bruising declines. Adverse reactions have been attributed to adulterants, or to the use of nonmedical-grade silicone. Almost all other problems result from poor technique: failure to use the microdroplet technique, overfilling or superficial placement.

In spite of problems that resulted from injection of large amounts of liquid silicone when used as a tissue filler, the injection of small amounts in a controlled fashion proved to be a very successful and permanent filler. The procedure is technique sensitive and must be used carefully, but years of experience, including our own, demonstrates excellent results with minimal problems. It is very well suited to lip augmentation and soft tissue filling. Small nasal defects can be corrected, often avoiding the need for secondary surgery following less than ideal rhinoplasty results.

Next to oxygen, silicon is the second most common element in the earth's crust. Silicone comprises a family of chemical compounds called polymers. Silicone polymers are widely used in industry. In medicine, these polymers coat sutures and lubricate disposable syringes, needles and venous catheters. An insulin-dependent diabetic may receive 5 cc of silicone per year via daily injections.

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