Starting off, I would like to thank Marion Kenyon and the staff of Apollo Day Spa for inviting me to participate in their Open House on February 13. I performed a number of demonstrations using Botox and Juvederm tissue filler and answered many great questions from the observers present. In fact, their questions inspired me to fill this week’s newsletter with some basic but pertinent information about fillers and their most recent advancements.
The first soft tissue fillers consisted of bovine collagen, a substance first approved by the FDA back in 1981. As the name bovine would suggest, this product came from collagen collected from cows after they were slaughtered. The bovine was then ground up, purified, sterilized, and ultimately injected into people’s skin for correcting scars and filling lines & wrinkles. Even if the concept of being injected by cow material does not sound bad enough to you in a Frankenstein-like way, there were in fact many other disadvantages. The results did not last long, and patients needed prior skin testing as allergic reactions at injection sites were common.
Fortunately, there have been tremendous advances in filler biotechnology since the days of injecting cow parts into human skin. Although no perfect filler exists, hyaluronic acid fillers remain the most reliable on the market. Most of the fillers produced by various companies are based on this chemical. Hyaluronic acid (HA) is a naturally occurring chemical that is highly concentrated in connective tissue and collagen. It is ideal to use because it is chemically the same as human tissue, thereby eliminating the need for skin testing and having virtually no adverse reactions. I have been using these materials in my practice for five years, and none of my patients have ever had a negative skin reaction.
One of the most important features of HA is that it is hydrophilic, meaning that it attracts and binds water. As a result of this characteristic, it can intertwine with the body’s own collagen, giving the skin area flexibility while also hydrating the area, thereby adding smoothness and substance to the skin. With aging and damage to the skin (think sun and smoking), naturally formed HA decreases. This reduction of HA causes dehydration of the skin and loss of flexibility, finally resulting in wrinkles.
If pure, natural HA is injected under the skin, like collagen, it can be rapidly broken down by the body and removed. The companies that make the current generation of HA fillers form a more stable molecule by a chemical process called “cross-linking”. This “cross-linking” makes the chemical resistant to breaking down while retaining its ability to attract water. The most cross-linked versions of HA are essentially thicker or more concentrated, making them last longer. That is why Perlane and Juvederm UltraPlus, the thickest products currently approved by the FDA, are rated to last at least one full year.
I always truthfully tell my patients who are receiving fillers (and observers) that the lines and wrinkles will look better immediately after the procedure and will improve steadily over the next several weeks. I have even seen cases where the improvement is noticeable over a period of several hours, demonstrating the fullness progressively over that time.
The whole area of dermal fillers is an exciting field where research is ongoing constantly and I have continued to follow new developments through the medical literature and regular conferences. I will inform you all as new products come on the market, along with information on which products actually work and which you should not waste your money on.
If you have any questions concerning this post and any other skin issues, please leave a comment, or call our office directly at (207) 873-2158 oremail through our website.