Beauty News About Facial Fillers

Joshua Fox, MD, on what patients need to know and ask before facial plastic surgery.

New York, NY August 3, 2004 -- Gone are the days when those of us who wanted a little lift had no choice but to head to the operating room for a surgical facelift. Today, facial injections are outpacing traditional surgery by a wide margin, and there are more than a dozen different filler agents on the market to choose from. While the differences between them can be hard to detect, beneath the surface, these variances can be critical to achieving the best results with an injection procedure.

The right filler to choose is an individual decision for a patient and his or her doctor, says Joshua Fox, MD, a leading dermatologist and founder of Advanced Dermatology and The Center for Laser and Cosmetic Surgery. Each substance will perform slightly differently, will offer temporary, semi-permanent or permanent effects, and will carry its own set of benefits and potential risks, Dr. Fox explains.

The Veteran: Collagen based products Collagen is the most popular injectible filler, if for no other reason than its longevity on the market. Zyplast and Zyderm are both FDA-approved bovine collagen compounds, and have been used in millions of procedures since the collagen injection was popularized in the early 1980s. Collagen has a long-standing track record of safety and effectiveness, Dr. Fox says, but because its an animal-based product, patients need to have one or preferably two skin tests a month apart to ensure theyre not allergic or sensitive to it. Whats more, it only lasts a few months. Newer Collagen based products include CosmoPlast and CosmoDerm, which are made from human Collagen and are felt to last a little longer than regular collagen products and dont require any skin testing.

The Newcomers: Hyaluronic Acid based products and Radiance Restylane and Hylaform are hyaluronic acid-based injectible fillers that won back-to-back FDA approvals over the past year as alternatives to collagen-based products. Once injected, these fillers interact with the bodys own production of Hyaluronic Acid to add volume to the treated area. Each can last up to six months. Restylane has three forms; for fine, for moderate and for deep lines. Hylaform comes in one form and is beneficial for deep dermal injections to address moderate to severe wrinkles as well as lip augmentation. These products (Restylane and Hylaform) typically last up to six months and give a more natural look. When there is a need to fill in deep wrinkles where volume is needed these products are a lot more expensive that Collagen. They also dont have a built in anesthetic and cause more swelling and bruising.

Radiance is a new combination of Collagen and calcium Hydroxyapatite that offers a smoother, more rounded finish than traditional collagen, and it can last from six months to five years. The FDA recently approved Radiance for use as an injectible filler for laryngeal augmentation and oral/maxillofacial defects. But many doctors are using it in an off label usage for the nasolabial folds. There have been some reports of lumping and migration of the compound after treatment. With such a long-lasting filler this may be a concern for some patients as well as the high cost.

The Longshots: Silicone and Fat Injections

Silicones FDA approval as an injectible filler was pulled in 1991 due to possible health risks associated with the compound. More recently it was approved as Silicone 1000 for retinal tamponade. However, because its the only truly permanent filling agent on the market it has risks of shifting or long term misplacement, some physicians still use it in an off-label capacity, or in conjunction with other injectible fillers. The micro-droplet technique must be used requiring many treatments to get results.

Fat injections can initially be more costly and more risky than the others, simply because each procedure involves two different processes; one to harvest the fat from another part of the body, and another to implant it. Whats more, fat is often broken down by the body. On the positive side, Dr. Fox notes, There is no risk of allergic reaction in fat injection and large volumes of fat are easily available. And once harvested the cost of the individual injections is less.

How to choose?

Dr. Fox advises that patients first choose a board-certified dermatologist or plastic surgeon with extensive experience in facial injections with multiple different filling agents. Then discuss the following factors with your physician prior to deciding on any procedure, he urges:

1.     How long can you wait? Collagen injections require at least one months notice, so you can get the skin test(s) needed to ensure youre not allergic to the bovine Collagen. If youre in a hurry, consider hyaluronic acid fillers, cosmoplast, cosmoderm or fat injections, which dont require skin tests.

2.     How long do you want it to last? From a few months with Collagen to possibly one or two years with Radiance, the length of time you want to go between procedures is an important criterion to consider when choosing your filler.

3.     What is your pain threshold? While the effects of surgery are different for everyone, some of these filler agents are known for inducing more pain, swelling, bruising or tenderness than others. In addition, your doctor may revise the protocol for the procedure itself based on your tolerance for pain and other side effects.

4.     How comfortable are you with the unconventional? For some, traditional Collagens veteran status makes it the only choice. Others are happy to try new products like Hylaform, Restylane, CosmoDerm, CosmoPlast or fat transfer. Still others are willing to go off-label with some combination of therapies like Radiance or even Silicone.

Bio: Joshua L. Fox, M.D., F.A.A.D.

Joshua L. Fox, M.D. is a leading authority in the field of dermatology with an expertise in skin cancer, cosmetic surgery, and laser procedures. As an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery, Dr. Fox has been an expert resource on dermatologic topics for numerous television networks including ABC, CBS, CNN, NBC, Telemundo, talk shows, radio stations, newspapers and magazines. Dr. Fox has served on the board of the National Rosacea Foundation and has done clinical trials in both medical and laser therapy in Rosacea. He has received multiple research and clinical awards including recognition from Top Doctors, Who's Who, Journal of Dermatologic Surgery and Oncology, Community Service Award from the American Society of Dermatologic Surgery, the prestigious Husic Award as well certificates of recognition for service from multiple hospitals, civic, educational and community organizations. Dr. Fox has authored and presented papers of his research on lasers, cosmetic procedures, stretch marks, scars, skin cancer, bug bites, photosensitivity and various rashes.

As founder and director of Advanced Dermatology and The Center for Laser and Cosmetic Surgery, Dr. Fox and associates have expanded the practice to the one of largest in dermatology, laser & cosmetic surgery with more lasers than any hospital or dermatology practice on the eastern coast. Dr. Fox is a graduate of the New York University Medical Center of Skin and Cancer and has been on the advisory board of the Psoriasis Foundation and National Rosacea Foundation among others. He has also been a fellow of many societies including the International Academy of Cosmetic Surgery, International Academy of Cosmetic Dermatology, and the Society for Investigative Dermatology. Dr. Fox is the founder of the AAD Melanoma/Skin Cancer Prevention Program in Queens, New York since 1987. Dr. Fox has been Chief of Dermatology of several major teaching hospitals including Mt. Sinai Hospital of Queens and Jamaica Medical Center and is currently on the staff of ten NY area hospitals. Dr. Fox and Advanced Dermatology the Center for Laser & Cosmetic Surgery have been used as a resource center educating dermatologists, laser surgeons, & cosmetic surgeons and others about lasers, cancer and cosmetic surgery.

Contact Information:
Melissa Chefec
203-968-6625
e-mail protected from spam bots
MCPR

# # #