New technologies offer longer lasting results

Technologic advances have led to a cascade of new dermal implants to correct facial contour defects resulting from aging, photodamage, trauma, scarification, or disease. “With dozens of filling agents now available, clinicians should know which substance is best suited to treat particular contour irregularities and volume deficits,” says UAB cosmetic dermatologist Marian E. Northington, MD.

In 2006 Americans underwent more than 1.5 million soft tissue filler procedures, the majority to address effects of aging. “Patients increasingly want nonanimal, longer lasting fillers that provide safe, comfortable, and cost-effective correction,” Northington says.

Dermal devices fall into three categories: temporary biodegradable, semipermanent biodegradable, and permanent nonbiodegradable. She further describes fillers as either volumizers, which plump skin, or stimulators, which create volume and encourage long-term or permanent collagen deposition.

Restylane
The temporary volumizer Restylane is best suited for rhytides, scars, and lip augmentation, Northington says. A nonanimal-stabilized hyaluronic acid derived from streptococcal bacterial fermentation, Restylane has no risk of animal-based disease transmissions or allergic reaction. As it degrades, hyaluronic acid progressively binds more water, maintaining volume until filler material dissipates. Results last 6 months or more. Injections cause erythema and edema for 1 to 2 days and cost $500 per syringe.

Radiesse
In December 2006 the Food and Drug Administration (FDA) approved Radiesse, a semipermanent filler for nasolabial folds, marionette lines, and facial wasting resulting from HIV- associated lipoatrophy. Both a collagen stimulator and volume replacer, Radiesse also is “appropriate for acne scars, volume restoration in and around cheeks, and correction of asymmetrical features. It is too viscous for lips,” Northington says. “The calcium hydroxylapatite-based microspheres in Radiesse act as a scaffold for collagen formation.” Over time hydrolytic enzymes break down calcium hydroxylapatite into calcium and phosphate. Redness and swelling fade in a few days, and the cost is $900 per syringe. Results can last as long as 2 years.

ArteFill
ArteFill, the first FDA-approved permanent filler, minimizes nasolabial folds. Polymethylmethacrylate (PMMA) microspheres are suspended in bovine collagen gel with 0.3% lidocaine. Screening for animal protein allergies requires a 28-day skin test.

The body does not absorb or break down PMMA, allowing it to continually stimulate collagen remodeling and maintain aesthetic improvements over time. “Preliminary analyses of 5- and 8-year results indicate ArteFill is safe and durable,” Northington says. “The results are very natural looking.”

Side effects can include temporary redness, swelling, and bruising. Some dermatologists have concerns about potential granuloma development, and only physicians with demonstrated expertise for appropriate placement and depth should inject ArteFill. “Patients who are committed to the look and feel of implants may favor this permanent option,” Northington says. ArteFill costs about $3000 per treatment area.

For more information:
Dr. Marian Northington
1.800.UAB.MIST
mist@uabmc.edu