Wrinkle Fillers Volume Replacement
Collagens Hyaluronic Acid Radiesse Sculptra

Wrinkle fillers (Dermal fillers) can consist of human fat, human collagen, bovine collagen, hyaluronic acid (found naturally in the body's connective tissue), synthetic substances or combinations of those materials.

The older, short-acting fillers are made of natural products such as collagen and fat that are quickly absorbed by the body. The new long-acting fillers mostly rely on synthetic materials for that extra durability. Each product has a different "location" preference and duration.

Some are best used in deep wrinkles, some in shallow lines, and some for plumping or restoring volume. Choosing the one that works best for your needs and desires calls for physician experience and the availability of choices.

Collagen products available in the U.S. include Bovine (from cows) and Human-tissue engineered - grown in a lab under strict FDA standards. Collagen products from both sources typically last 3 to 4 months. The latest collagen, Evolence, which comes from porcine cources, has a duration of 6 months or longer.

• Zyderm (Bovine)
• Zyplast (Bovine)
• Cosmoderm
• Cosmoplast
• Evolence

Hyaluronic Acid products are nearly identical to the natural hyaluronic acid found in the body. Unlike bovine collagen, there is no need for pre-testing. Currently the two HA fillers that Dr. Pilest prefers are Juvederm and Restylane. Both last from 6 to 9 months.

• Perlane
• Restylane
• Prevelle Silk
• Juvederm

What is Hyaluronic Acid?
Hyaluronic acid is a naturally occurring sugar. It is found in the human body in the skin, cartilage, joints and the eye. In skin tissue, hyaluronic acid fills the space between collagen and elastin fibers. The role of hyaluronic acid in skin is to deliver nutrients, hydrate the skin by holding in water, and to act as a cushioning agent.

How is Hyaluronic Acid made?
Perlane, Restylane and Juvederm are sterile, clear, colorless dermal (skin) filler gels made of chemically modified hyaluronic acid. Hyaluronic acid is a naturally occurring substance found in the fluids surrounding cells and tissues. It is chemically, physically and biologically similar in the tissues of all species. Made from highly purified natural hyaluronic acid the gel is gradually absorbed by your body through natural mechanisms.

Radiesse

Radiesse consists of smooth particles of calcium that, after injection, also form a scaffold that is slowly filled with human collagen. Studies show it lasts for a year to 18 months, although the spheres may last as long as five years before breaking down.

The component of Radiesse calcium hydroxylapatite (CaHA) microspheres, has been used over the years in for vocal cord insufficiency, tissue marking and for oral defects.

Sculptra

Sculptra, which is approved for lipoatrophy, facial wasting, consists of a synthetic substance called polylactic acid that has long been used in medical products such as dissolvable stitches. It adds volume to skin and lasts about two years.

Sculptra is designed to replace volume. It can be used with other filler products. Sculptra is rapidly becoming a very popular product and has enjoyed years of success in Europe under the name NewFill.

Why would I need volume replacement?
Over time, your skin loses its full, firm, youthful appearance. This is the result of a natural aging process: your skin is damaged, becomes thinner, or loses its natural elasticity. As a result, it becomes loose and starts to wrinkle. Fat tissue, which also helps to fill out your face, is lost, causing skin to sag and further wrinkle. This reduction in skin volume can make your face look thin and narrow, possibly making you appear older than you are. Sculptra can help your skin regain a firm and youthful appearance by restoring skin volume you may have naturally lost.

How do I choose the best dermal filler?
Dr. Pilest has over 28 years of experience in corrective and cosmetic dermatology. He will discuss with you the various fillers, what they will accomplish and the potential advantages and disadvantages of each. Often two or more products may be required to achieve best results.A denser firmer dermal filler may be used as a base with the more fluid fillers used to complete the correction closer to the skin's top surface.

What else can I do to prevent wrinkles?
Diet and exercise are more important than you think when it comes to youthful-looking skin. Plenty of water, fresh fruits, time each day spent "moving" to increase capillary strength and bring oxygen to the skin cells - and of course proper rest. The right kind of pillow can also make a difference. If you wake up with "sleep wrinkles" on your face, consider special pillows such as the Face Saver Pillow.

Overview

Filler: Human collagen; brands include CosmoDerm, CosmoPlast, Cymetra.
What it is: Purified natural substance from human tissue.
Duration: Two to six months.
Bottom line: Safe but fades fast; no allergy test required.

Filler: Bovine collagen; brands include Zyderm and Zyplast.
What it is: Purified collagen from cows.
Duration: Two to six months.
Bottom line: Requires allergy test before treatment; fades fast.

Filler: Porcine collagen; brands include Evolence.
What it is: Purified collagen from pig tendons.
Duration: Six months or longer.
Bottom line: No allergy test.

Filler: Hyaluronic acid; brands include Restylane, Juvederm, Perlane and Prevelle Silk.
What it is: Synthetic versions of a natural substance found in the body's joints.
Duration: Depending on the product formulation, from six to 12 months. Prevelle has a lesser duration.
Bottom line: More expensive than collagen but lasts longer; safe; rare allergic reactions.

Filler: Calcium hydroxy-lapatite microspheres; brand name Radiesse.
What it is: Synthetic, biocompatible substance.
Duration: 12 to 18 months.
Bottom line: Longer-lasting but not permanent; can cause lumpiness if improperly injected or injected in unsuitable areas such as the lips..

Filler: Synthetic polylactic acid in microspheres; brand name Sculptra. It's approved for other purposes but also used off-label for replacing lost facial volume from fat loss that comes from aging.
What it is: Synthetic, biocompatible substance.
Duration: Two years.
Bottom line: Longer-lasting but not permanent. A volume replacement stimulator - not a wrinkle filler.

Filler: Polymethyl-methacrylate microspheres suspended in bovine collagen; brand name ArteFill.
What it is: Synthetic, biocompatible substance injected with bovine collagen carrier.
Duration: Five years or more.
Bottom line: Considered permanent; requires allergy test; treatment success dependant upon injection technique. Unskilled injections may result in unremovable lumps or nodules. Currently unavailable.