New Haven, Conn. — New fillers for facial lines, wrinkles and creases have exploded on the scene in recent months in sharp contrast to the situation in February 2003, when the U.S. Food and Drug Administration had approved only one filler — bovine collagen (Zyplast and Zyderm), provided by only one company in this country (Inamed).
New fillers, which include hyaluronic acid products previously approved in Europe and Canada, provide significant improvement of age-related facial lines and creases and offer malleable products with long-lasting results. The availability of several types of products also offers the opportunity to use several fillers in one procedure, says Jeffrey Dover, M.D., associate clinical professor of dermatology, Yale University School of Medicine, New Haven, Conn.
Successful fillers of the future will include long-term, short-term and medium-term fillers — and patients and doctors will choose which of those they would like to use alone or in some combination, Dr. Dover says. For example, long-lasting fillers such as fat, Perlane, Radiance, or Artefill may become fillers of choice for the nasolabial fold, while a shorter term filler might be used in the lips."Right now, we do a lot of combination treatments," Dr. Dover says. "For example, Restylane doesn't make the border of the lips look quite as sharp as collagen, so for the edge of the lips, our favorite is collagen, and for the body of the lip, my favorite is Restylane. For the nasolabial fold, I prefer Restylane but in the future, Perlane will be preferable because it lasts longer and gives a beautiful soft fill. But it's not FDA approved yet."
Recently approved products Fillers have come a long way since they have joined ranks with bovine collagen, offering particular advantages.
Human collagen (Cosmoplast, Cosmoderm) was a step up in many ways — a clean, safe alternative to bovine collagen that did not require any skin tests. Collagen, either bovine or human, rarely causes swelling, Dr. Dover says.
"Collagen is fantastic ... if the patient wants to look great that night," he says.
Immediate results are the main advantage of human collagen, despite it being more expensive than bovine collagen and not as long lasting as some newer filling agents.
Europe has seen the development of many non-collagen-based fillers.
"Probably the most exciting so far is hyaluronic acid," Dr. Dover says.
Restylane, an FDA-approved productmanufactured by Q-Med and licensed by Medicis, uses non-animal-based hyaluronic acid. The two other NASHA products are Restylane Fine Lines and Perlane, neither of which is FDA approved. The difference between the three products is the size of the particles, with Perlane having the largest particles followed by Restylane, and then Restylane Fine Lines, says Dr. Dover.
"The bigger the particle, the longer it lasts," Dr. Dover says.
Hylaform (Inamed), a hyaluronic acid product FDA approved in April 2004, is derived from cock's comb. Allergic reactions are extremely rare with any type of hyaluronic acid product, Dr. Dover says, and skin tests are not required.
The advantages for these products include no delay in receivingtreatments and they last much longer than collagen — perhaps as much as one and a half to two times as long.
"Instead of three to four months with collagen, Restylane provides approximately six months and Perlane, six to eight months," according to Dr. Dover.
Another significant advantage is that hyaluronic acid products are very malleable — they remain soft and compressible for months after treatment. Restylane and Perlane, for example, can be compressed and the product is malleable even three or four months later, Dr. Dover says. If lumps do form, they can be removed with pressure and molding.
The one disadvantage of hyaluronic acid is that because water is drawn to the molecule, it tends to cause almost immediate swelling, which can last one to three days after treatment, Dr. Dover says. It is especially noticeable in lips, less so in the nasolabial fold, he says.