The last two years have been rough for collagen-based dermal fillers—and it shows in the announcements by two leading manufacturers, Allergan and Johnson & Johnson, that they will no longer produce their respective collagen products (the human-derived CosmoDerm and CosmoPlast, the bovine Zyderm and Zyplast for Allergan; the porcine Evolence for Johnson & Johnson). For more than two decades, collagen has been the filler of choice for many dermatologists. Considering donor tissue origins, it’s natural that questions could arise. Plus, collagen-based fillers require skin allergy testing and are relatively short-lived.

As in many markets, money drives the evolution of new products, and facial fillers are no exception. The popularity of non-animal hyaluronic acid (HA) dermal fillers (known as replacement fillers because they replace lost volume) and PLLA and PMMA fillers (known as stimulatory fillers because they stimulate collagen and fibroblast production) has been strong in the recent past. Juvéderm, Perlane, Restylane, Radiesse, and Sculptra currently dominate the US market. Dermatologists report HA, PLLA and PMMA fillers as bring more versatile, longer-lasting, bulkier, and better for deep-volume filling than collagen.

But what about fine and thin line use, such as for foreheads or smokers lines around the mouth? Collagen was usually considered better in those instances. But Restylane Fine Lines is one HA product that makers hope to cover this application.

What will the world of fillers look like in the future? Who can say? But certainly change is afoot. Although fillers that indirectly stimulate fibroblast production are holding sway, direct injection of fibroblasts with Human Dermal Fibroblasts (HDFs) may be a trend. UK dermatologists are currently testing Valveta, a filler derived from the foreskins of male babies that is reputed to repopulate skin with healthy young cells and be long-lasting, if not permanent.

The new products are made using the same patented NASHA technology used in Restylane injectable filler, giving the creams a pleasing consistency while preserving moisture and adding lustre to the skin.

Q-Med explains the purpose of the new products in an official press release: “The secret to beautiful skin is balanced skin hydration combined with a healthy and protective skin barrier. Restylane Skincare combines these two qualities in an innovative series of creams [that] supplement the effect of injectable Restylane products.”

What is NASHA?

Non-Animal Stabilized Hyaluronic Acid is the secret to Restylane’s success. Hyaluronic acid is present in many of your body tissues, serving many important functions. Because HA can bind water, it hydrates the skin and lubricates the joints. Stabilization allows the product to last longer and produce visible, enduring results.

Although Restylane and Perlane have been around longer than most wrinkle fillers, they are not the only ones to use hyaluronic acid. Products like Prevelle, Hydrelle and others are now widely available for similar purposes. But according to Q-Med, these fillers are not interchangeable with Restylane.

The least modified competing products are still considerably more chemically changed than the NASHA gels. Competing products are either not as viscous as the NASHA gels, which means that they cannot build and retain volume in the same way, or they are considerably more chemically changed.

The new line of Restylane Skincare products will be available in Sweden and Europe this summer. If they become available here in Cincinnati, we will be sure to let you know.

233 patients were treated randomly with Cosmoplast or Sculptra Aesthetic at 3-week intervals.  Injections were performed to reduce the appearance of the nasolabial folds – the lines that travel from the nose to the corner of the mouth. Post treatment visits were conducted at 3 weeks, 3 months, 6 months, 9 months and 13 months after the final injection.

Highlights of the study:

• During post-operative evaluations, Sculptra scored much higher on the wrinkle assessment scale.
• When the patients treated with Sculptra were followed an additional 12 months, they exhibited results lasting over two years.
• Results had a very natural appearance. “[Sculptra] works gradually to replace lost collagen due to aging, resulting in a more natural-looking appearance” said Dr. Gary Monheit of the University of Alabama Medical Center.
• Side effects were mild or moderate in intensity and overall, they occurred more frequently in the collagen group.

Links

• Official press release from CNN
• Sculptra in Cincinnati, Ohio

Results are Short Term

Like many injectable products, Prevelle Silk is made with hyaluronic acid. Except with Prevelle you get a slightly lower concentration of HA, meaning the results will wear off in a shorter time.  That might sound like a drawback to some people, but for others it isn’t. A filler with short-term results actually provides a way to “test drive” injectable treatment.

Dr. Christopher Hess, a Virginia plastic surgeon, says his patients have been seeing results last about 2 months. If you enjoy the treatment and the cosmetic improvements, you can always come back in a few months for treatment with a different wrinkle filler, one that provides enduring results.

The Lidocaine Factor

Prevelle is manufactured with the anesthetic lidocaine. The significance of this addition can often be exaggerated in the marketing for these fillers, but when combined with traditional pain management techniques, it may enhance the comfort level of your injection.

According to the official website, clinical trials demonstrated a significant improvement over the filler Captique:

In the clinical study, 69% (29) of the 42 patients who responded to the questionnaire preferred treatment with PREVELLE Silk over Captique. Of these 29 patients, 97% (28) preferred PREVELLE Silk because it was less painful.

Contact our office in Cincinnati for more information on Prevelle Silk.

Acupuncture, the ancient Chinese therapy of strategic needle placement in the body, is long believed to alleviate a variety of physical ailments and emotional imbalances.  But could it be a cost-effective wrinke treatment?

In this ABC News segment, plastic surgeon Dr. Bruce Genter is critical of acupuncture for the purpose of wrinkle treatment, pointing to the lack of scientific evidence.

Julia Engstrom, who is featured in the video, says she has undergone Botox treatment and laser treatment in the past. She believes facial acupuncture has improved her skin texture and reduced her wrinkles. Nearing the end of 10 treatments, she says her improvements have come through improved sleep and relaxation. “I’ve noticed that my skin is a lot smoother, [there’s] a lot less red pigment in there and the wrinkling seems to be a lot less,” Engstrom said.

In an article for Prevention magazine, licensed acupuncturist and Traditional Chinese Medicine practitioner Phyllis Olson asserts that acupuncture can indeed lessen the appearance of wrinkles. She attributes this to a core premise of acupuncture – that health is reliant upon the healthy flow of chi (energy) in the body, which can be disrupted for a myriad of reasons. Acupuncture treatments are believed to break up energy blockages that prevent optimal blood flow to certain places in the body, improving circulation.

Acupuncturist Beata Maslanka acknowledges that acupuncture doesn’t yield visible results that compare to Botox or other facial fillers, but claims that beauty actually comes from within; when internal imbalances are resolved, people look better overall. Olson agrees, noting that the treatments foster relaxation of facial muscles, thereby reducing wrinkles. “Aside from the light, momentary stings, acupuncture is really quite relaxing,” she adds.

Althugh one can wonder about the salutary effects of relaxation and optimism, the visible results Engstrom points to are hard to discern from the video, and people sometimes have a tendency to see (and believe) what they want to see.

If acupuncture does produce any wrinkle-relaxing effects, how long can one expect them to last? NYC dermatologic surgeon Barney Kenet, MD tells Prevention: “If acupuncture relaxes the muscles, it might reduce wrinkling temporarily. As for the increased blood flow, at most it will probably give you a temporary rosy complexion–something you don’t want if you have an inflammatory condition such as acne or rosacea,” he warns. “Otherwise, cosmetic acupuncture is relatively harmless.”

Maybe it is harmless if you ignore the cost of acupuncture. The average price is about $60 to $100 per session, with 10 sessions recommended by Olson, followed by monthly maintenance procedures.

In contrast, the average Botox treatment in the US costs $472 and a single treatment will last 3-6 months. By comparison, this makes acupuncture wrinkle treatments appear costly as well as unproven. Dr. Genter (whose Philadelphia Botox patients are displayed on his site to demonstrate the wrinkle reducing effects of injectables) says: ”If it increases your well-being that’s great, I just don’t know that it can make your face look younger.”

Botox treatments in Cincinnati, Ohio

Facts to know about Juvederm XC

• Contains a small amount (0.3%) of local anesthetic
• Composed of colorless hyaluronic acid – a hydrator and cushioning agent
• Results last about 9 -12 months
• Those allergic to lidocaine or Gram-positive bacterial proteins should not use Juvederm XC
• Traditional pain control methods can still be used to further minimize discomfort
• Safety profile and frequency of side effects is very similar to non-lidocaine Juvederm

But the looming question for many people is, are these treatments comfortable?

Fortunately the answer is yes, thanks to local anesthetics that numb one or more areas of the face beforehand. Lidocaine is the one most frequently used by plastic surgeons.

Lidocaine blocks pain signals, relieves swelling

Your dentist uses Lidocaine as as a quick and simple way to numb the mouth prior to potentially painful dental work. Likewise, plastic surgeons have found that it’s an excellent local anesthetic for injections. Lidocaine blocks the pain signal sent by the nerve endings on the skin in response to injections of the dermal filler solution. Patients quickly feel the anesthetic taking effect, and numbness kicks in.

The Benefits of Lidocaine for facial cosmetic procedures

• reduces or eliminates pain when the doctor is injecting into sensitive facial tissue
• minimizes tissue swelling that occurs when solutions are injected subcutaneously (underneath the skin)
• reduced swelling allows the surgeon to resculpt the targeted areas of the face with more accuracy to get the most attractive, natural looking result
• allows you to relax during the procedure
• during longer procedures – filling in the cheek area, for instance – it eliminates the need for general anesthesia

Several of the new dermal fillers, including Radiesse, Prevelle Silk, and Hydrelle, even come pre-mixed with Lidocaine.

To learn more about Lidocaine

1. Read about Prevelle Silk at Dr. Mandell-Brown’s Ohio office
2. See this MedicineNet article about lidocaine
3. View Mayo Clinic Lidocaine website

The most common theory behind this procedure posits that Botox injections can relax muscles and affect a woman’s posture in such a way that simulates lifting of the breasts.  Dr. Mandell Brown answers the question conclusively:

“Rather than spend four or five or ten thousand dollars on a breast lift, lets do $200-$300 of botox. Are we just throwing away the 300 dollars then? Yes. Is there any research to support that this would be even remotely effective? No. In reality, the tissue’s too heavy for that to happen.”

Click here to read more about breast lift surgery in Cincinnati.

Through November 1 of 2009, we’re offering our patients a special deal on injectable treatments that will help fund the Juvenile Diabetes Research Foundation.

Contribute $25 to $100 and receive double discount on Botox, Dysport, or soft tissue fillers.   For example, write a check to Juvenile Diabetes Research Foundation (JDRF) for $25.00 and receive $50 off Botox, Dysport, or Soft Tissue Fillers of your Choice.  Write a check for $100 and receive $200 off Botox, Dysport or Soft Tissue Fillers (Perlane, Sculptra, Juvederm, Radiesse)

Contact our office for more information on this great cause and this special offer!

The recent FDA approval of Sculptra for cosmetic use has spawned a renewed interest of the drug in the cosmetic surgery industry and in the media. The Today Show recently featured Sculptra injectable wrinkle filler on a segment of “Today’s Health.” The first half of the segment features a brief treatment demonstration and some patient testimonials, and the second features Dr. Roshini Raj of the NYU school of medicine explaining the details of Sculptra treatment. She discusses the advantages and disadvantages of Sculptra and of course, makes a comparison to Botox.