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Skin Fillers Are Hot Topic on Anti-Aging at
Dermatology Conference
July 29, 2004 Several new skin fillers have
recently received approval from the U.S. Food and Drug Administration
and they have become the current rage in anti-aging products for senior
citizens wanting to remove wrinkles.
A report on the latest advances in these
look-younger products and how they work was presented today at the
American Academy of Dermatologys summer scientific session ACADEMY
04 in New York by dermatologist Leslie Baumann, M.D. She is an
associate professor of clinical dermatology and director of cosmetic
dermatology at the University of Miami.
"For years, dermatologists have known that wrinkles
result from the loss of three crucial skin components -- collagen,
elastin and hyaluronic acid," said Dr. Baumann. "Today, we can replace
two of these components -- collagen and hyaluronic acid -- that are lost
as the skin ages. It is my hope that one day we will be able to replace
elastin, as well."
The First Fillers
While bovine collagen has been the undisputed
filler of choice for the treatment of facial wrinkles since injectable
skin fillers were introduced in the 1970s, its short-lived results and
potential for allergic reactions limited its potential.
Two years ago, human bioengineered collagen --
which consists of collagen derived from human cells -- was approved by
the FDA for treating facial wrinkles, acne scarring and lip reshaping.
Although human bioengineered collagen is an improvement over bovine
collagen because it does not pose an allergy risk, dermatologists still
sought a filler that could safely and effectively replace hyaluronic
acid, the other primary component lost in aging skin.
"In the last six months, two new fillers have been
approved by the FDA that are able to replace the naturally-occurring
sugars in the skin known as hyaluronic acid," said Dr. Baumann. "These
fillers work by pulling water into the skin, resulting in increased skin
plumping and volume. In addition, several other fillers have been
recommended for FDA approval that will expand our treatment options even
more in the near future."
Hyaluronic Acid Fillers
Recently approved by the FDA as a skin filler,
hyaluronic acid is a naturally-occurring component of the skin that
functions by holding together collagen and elastin, providing a
framework for the skin. When injected into the skin in gel form,
hyaluronic acid binds to water and provides volume to easily fill in
larger folds of skin around the mouth and cheeks. Patients notice an
immediate plumping of the skin in the treated areas.
One of the main advantages of hyaluronic acid gel
is that it does not pose an allergy risk for patients and there is no
risk of transmitting animal diseases by injection. Since a skin check
for allergies is not required with hyaluronic acid gel, patients can be
treated on their first visit to the dermatologist. Dr. Baumann also
emphasized that the results of hyaluronic acid last approximately four
to six months and require less volume to fill wrinkles and hard-to-treat
skin folds compared to collagen.
Despite its numerous benefits, Dr. Baumann
cautioned that hyaluronic acid gel does not contain lidocaine, an
anesthetic, so injections can be painful. In addition, there is usually
temporary inflammation that produces swelling and redness following
injection with hyaluronic acid gel -- especially in the lip area.
"Currently, the trend is to use a combined
treatment of hyaluronic acid and collagen to maximize the benefits of
each filler," said Dr. Baumann. "By injecting collagen first, you numb
the area, give it support and structure, and stabilize the skin to
prevent bruising. When hyaluronic acid gel is injected afterward, the
patient cannot feel it because they are numb from the collagen injection
and are less likely to bruise, but they get the benefit of adding volume
and water content to the skin. Using these fillers together, two of the
major skin components that are lost with skin aging are replaced,
resulting in a more youthful and natural appearance."
Fillers on the Horizon
Polymethylmethacrylate
One of the new permanent injectable skin fillers
that is awaiting FDA approval is polymethylmethacrylate, made from a
mixture of micronized plastic spheres and bovine collagen. When
polymethylmethacrylate is injected into the skin, the collagen works by
holding the synthetic spheres in place until it dissipates after
injection -- leaving the spheres behind to prop up the wrinkles. These
spheres stimulate the body's own production of collagen, which then
forms around the spheres.
"While the main benefit of polymethylmethacrylate
is its permanence, it also can be its downfall if not injected
properly," explained Dr. Baumann. "That's why it is extremely important
that patients consult a dermatologist or dermatologic surgeon skilled in
the procedure once it is approved by the FDA."
Other side effects of polymethylmethacrylate
include permanent or long-term lumps and temporary swelling and redness,
especially when used in the lips.
Hydroxyapatite with a Methylcellulose Vehicle
For patients looking for longer-lasting results
than collagen but not the permanent results of polymethylmethacrylate, a
new filler known as hydroxyapatite with a methylcellulose vehicle --
which is currently FDA approved for other purposes -- is being studied
as an injectable skin filler. The synthetic compounds used in this
filler contain beads of calcium hydroxyapatite, which is a substance
used to replace missing bones.
"Hydroxyapatite with a methylcellulose vehicle
provides a temporary correction of wrinkles that we think lasts about
one year, but the exact duration of this filler has not been
demonstrated yet," said Dr. Baumann. "If not injected properly, the
calcium beads could clump together and result in lumpiness in the
treated area. More research needs to be done to determine this filler's
effectiveness and long-term results."
Poly-L Lactic Acid
Poly-L lactic acid is not really considered a skin
filler, but a "dermal stimulator" because it stimulates the skin cells
to make collagen -- providing a slow correction over time. Patients are
treated every month for four to five months until the correct results
are achieved, and Dr. Baumann estimated that results typically last one
to two years.
"Research studies of poly-L lactic acid for FDA
approval of wrinkles are just beginning," said Dr. Baumann. "If proven
effective, it could be a new option for patients looking for a safe,
long-lasting fix for wrinkles."
Before considering any skin filler treatment, the
American Academy of Dermatology recommends that patients ask the
following questions:
1. Are the results permanent or temporary?
2. What are the potential side effects?
3. Is the filler approved by the FDA for this
use?
4. How long has the physician used the
filler? How many patients has
the physician treated? Are before and
after photos available?
Headquartered in
Schaumburg, Ill., the American Academy of Dermatology, founded in 1938,
claims to be the largest, most influential, and most representative of
all dermatologic associations. With a membership of more than 14,000
dermatologists worldwide, the Academy is committed to: advancing the
diagnosis and medical, surgical and cosmetic treatment of the skin, hair
and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care
for a lifetime of healthier skin, hair and nails. For more information,
contact the AAD at 1-888-462-DERM (3376) or
http://www.aad.org . |
