PlasticSurgery.com Staff Report © 2007-2009
When *Charlene, a Canadian radio personality in Alberta, Canada, noticed that dark, hollow circles under her eyes were starting to spread toward her nose, she resorted to wearing sunglasses in her public appearances.
"I tried expensive cosmetics and creams, but nothing worked," Charlene says.
Because she had good results with Botox on her forehead and Restylane to plump her lips several months before, she turned to her dermatological surgeon, Barry A.S. Lycka, M.D. at Age Reversing Dermatology in the city of Edmonton, Alberta in Canada to see what could be done about reducing those dark circles.
His suggestion: Evolence; a collagen filler developed in Israel and currently being tested by the Food and Drug Administration (FDA) for general use in the United States.
"After the injections, my face was a little swollen for a couple days but I immediately noticed the dark areas had been plumped up nicely," Charlene says. "The filler gave me more confidence because no sunglasses are needed in public."
The approved list of U.S. facial fillers and wrinkle removers -- most notably, Botox, Restylane and Juvederm -- has become so popular that manufacturers, suppliers, and physicians are eager to supply more. In the United States during 2006, Botox -- an anti wrinkle treatment -- was injected into 3.1 million people, while the injectable filler Restylane was used by 1.5 million patients, according to the American Society of Aesthetic Plastic Surgery (ASAPS).
A survey of 800 U.S. women between ages 35 and 69 revealed that 63 percent would choose a facial injectable treatment over a surgical procedure! In contrast to plastic surgery procedures, such as a facelift, the common advantages of injectables are:
- No need for incisions
- Immediate results
- No time out for recovery
So what is the downside? With only a few exceptions, facial injectables are absorbed by the body; therefore, patients must return for additional injections to maintain the new look.
...63 percent would choose a facial injectable treatment over a surgical procedure!
The Future of Facial Fillers
The new crop of dermal fillers and wrinkle removers U.S. patients will soon see include:
Dr. Lycka -- who has used Evolence for about a year -- says its new factor is porcine collagen, which is not broken down by the body as quickly as bovine collagen. "I have Evolence patients who are holding up beautifully after six months," he says. "We know from testing that Evolence lasts at least six months; I suspect it may last a year or two and then slowly break down." Dr. Lyca and other experts say the best use for Evolence is reducing the "nasolabial folds" (the creases of skin that run from the sides of the nose to the corners of the mouth), in the lips, and under under the eyes; an area that tends to become hollow and darken with age. The substance is produced by ColBar Life Science, Ltd. in Israel.
Puragen and Puragen Plus
Facial fillers made from hyaluronic acid similar to Restylane and Juvederm, Puragen and Puragen Plus are smooth gels said to last about six months, with FDA approval of the Mentor Corporation product still pending. Both products contain an anesthetic," says Claudio De Lorenzi, M.D., a board certified plastic surgeon in the city of Kitchner in Ontario, Canada, and president of the Canadian Laser Aesthetic Surgery Society (CLASS). "I think both doctors and patients will enjoy a filler that is less painful to inject."
Made by Medicis Pharmaceutical of St. Paul, the injectable is comparable to Restylane and currently undergoing FDA study. Perlane is used outside the United States, and according to the ASPS, no allergy testing is required; it is a non-animal, soft tissue filler. "Perlane works best when injected into the deeper layers of the face," says Hema A. Sundaram, M.D., a board certified dermatologist and former National Institutes of Health (NIH) researcher in Washington, D.C. (Dr. Sundaram is one of a select group of U.S. cosmetic surgeons approved to instruct other doctors on the best uses of Perlane, and she conducts FDA studies of new cosmetic surgery technologies.)
Reloxin and Puretox:
Reloxin, made by Allergan, is still being tested in the United States and sold in Europe under the brand name Dysport. It is an anti wrinkle treatment like Botox. Some experts hope that Reloxin will break Botox's grip on the U.S. public:
"South American and European tests show that Reloxin is equivalent to Botox and may treat a wider area, especially in the forehead," says Joel Schlessinger, M.D, a dermatological surgeon in Omaha, Nebraska. Dr. Schlessinger is also president of the American Society of Cosmetic Dermatology and Aesthetic Surgery in Tallahasee, Florida. His medical group, Advanced Skin Research Center in Omaha, frequently performs FDA medical trials on new substances. "Dysport has an advantage because it takes effect quicker and may last a little longer," Dr. Schlessinger says. Puretox is another potential Botox rival, made by Mentor, and said to be quicker acting. Yet according to Coyle Connolly, M.D., a board certified dermatologist and researcher in Lynwood, New Jersey, "The word among researchers is Reloxin and Puretox will not start a price war to compete with Botox. All three will probably be comparably priced."
In the United States during 2006, Botox -- an anti wrinkle treatment -- was injected into 3.1 million people...
According to its manufacturer, FzioMed, Inc. of Santa Barbara, California, Laresse contains two well-studied absorbable medical polymers. "Laresse is a jel and facial filler made from various plastics that have been used in medicine for years," says Henri Gaboriasu, M.D., a Washington state plastic surgeon who received his M.D. degree from the University of Paris, and serves on the editorial board of an English publication dedicated to advances in medicine. "Of all the new facial fillers coming onto the U.S. market, I think Laresse is the one most worth following." A biomaterial first used in spine surgery and later developed into a facial filler, Laresse is also expected to last six months. The substance has been in use in the United Kingdom since June 2006, with a pending FDA approval.
This facial filler should last for 10 years. Distributed by Contoura and manufactured by a Danish company, Aquamid is made from biomedical materials, and has been safely used for years. Currently sold and used in Europe, FDA tests in humans are currently underway in the United States. According to the ASPS, Aquamid is a permanent facial filler made from the same biomaterial used in contact lenses and other implanted medical devices. "Aquamid is used to remove fine lines and fill lips while Aquamid reconstruction is used to correct deep facial folds, and to fill chins and cheeks and for reconstructive use after traumatic events," says Dr. Gaboriau. It is additionally used to remove the furrows between the eyes.
"The driving force behind injectables is what we now know about aging," says Dr. Sundaram.
"Years ago, plastic surgeons just pulled patients' skin tighter. That done. Since, we have learned that human aging is actually all about volume loss," she says. "The older face is like a deflating balloon; we lose underlying supporting tissues and that allows the outer skin to sag, droop and wrinkle. So facial injectables are a quick rejuvenation from within.
"My personal opinion is that a physician can do a whole face lift with Restylane and Perlane with no scarring, incisions or downtime."
* Patient asked for medical privacy