Derma Fillers by Dr. Michaels

Dermal fillers

Definition: an aesthetic filler is a product injected under the skin in different depths to create a desirable look.

The ultimate goal of a filler is to smooth out wrinkles and folds, even out scars, volumize furrows and sunken valleys, contour unevenness and laxity. Sculpt the face into a 360-degree rejuvenated look.

Dr. Neuber was the first physician to transplant fat from the arms into facial defects in 1893.  In the mid-20^th century soft tissue augmentation was done by silicone. Due to production of foreign body granulomas it was banned in 1992 until a new form was approved for ophthalmology use in the late 1990s.  So in the meantime, the US research came up with a collagen: initially bovine collagen (Zyderm and Zyplast) which was largely replaced by bioengineered human collagen (Cosmoderm; Cosmoplast) over the last 20 yrs.  In 2000 FDA approved cadaveric collagen (Cymetra; Fascian) however with multiple drawbacks. Other countries have been experimenting with hyaluronic acids since 1990s and a plethora of products followed. Different regulatory mechanism usually leaves the US a few months or years behind other developed countries in making the latest products available to us.

Options: Fat injections; Radiesse; Collagens; Hyaluronic acids; Sculptra; silicone; Artefill

Let’s talk about each option in more detail. For any questions, please, schedule a consultation with any of our experienced staff at Bluepoint Medical Spa 702.307.3330 to choose what is the best choice for you.

The fillers could be also divided into 3 categories : temporary, semi-permanent and permanent. We chose not to use permanent fillers for several reasons. We like temporary products if the patient is not sure about her goals and wants to try it out. Temporary benefits also include temporary adverse side effects!!

Collagen:

Bovine collagen was introduced in 1977. Before the injection is done, patient must come for 2 skin tests: 6 and 2 weeks before the elective procedure. The allergic reaction may occur as early as 6 hours after the injection or as late as 6 weeks after. Even if patient tests negative after 2 tests, the risk is never completely eliminated.  These reactions can be expected to resolve spontaneously within 24 months. We do not offer this filler for the above reasons.

Human bioengineered collagen: no skin testing is required. The effects are immediate and last 3-4 months. We do not offer human collagen either – due to high cost and short duration of effects.

Hyaluronic acid (HA)

In the last 15 years HA fillers became the gold standard in the cosmetic industry.

For the chemists in our midst, the HA or hyaluloran is a nonsulfated glucosaminoglycan (GAG) that occurs naturally in the skin  and other connective tissues. It is present in all animals, which makes it nonimmunogenic. It is polysaccharide that has an ability to bind water up to 1000 times its mass!!! We lose the HA with aging . the face looking more lax, sallow with dull skin.  The whole side effects after injecting HA products are very similar, mild and rare. Most likely bruising, swelling, rarely lumps, acneiform eruptions and very rarely hypersensitivity reactions. Major advantage of any side effects is that skin nodules can be easily dissolved with an enzyme – hyaluronidase. We – in our medical spa – have never had a need to use this correction yet.

HA products are several – all differ in the amount of crosslinking to achieve higher concentration and greater longevity. The biggest advantage of HA fillers is that they could be injected into any area of the face.

These fillers are very popular and we do offer several of them.  Please see our website www.bluepointmedicalspa.com for the options. The shortest acting is Juvéderm, the longest lasting is Voluma. 2 of them are FDA approved for lips: Restylane and Volbella that may last up to 2 yrs. We love using them on ourselves and our patients!

Radiesse

Approved in 2006 – it quickly became popular: it was used initially for HIV associated lipoatrophy. It is composed of 30% of calcium hydroxyapatite CaHA microspheres suspended in a gel carrier. As the gel dissipates, the calcium stimulates cutaneous cells to produce focal foreign body reaction and neocollagenesis. CaHA is similar to calcium spheres in human bones and has no antigenic properties. It is a radio-opaque material that can be seen under X rays.

It has been used in ENT and orthopedic specialties for over 25 years – and possesses excellent safety record. It offers immediate correction. Radiesse is quite pliable – apparently up to 72 hours, permitting timely manipulation and appropriate modification. It also can be combined with any other fillers. We love to use Radiesse for deep deposits , tunneling and crisscrossing.

We use Radiesse in any area on the face and it is FDA approved for hands. Again, it provides immediate effect.

Sculptra

Many physicians refer to Sculptra as dermal stimulator. It is not a true dermal filler. This agent is a synthetic, biodegradable, biocompatible , immunologically inert peptide polymer . It is manufactured from powdered, absorbable suture material e.g. Vycryl. It is thought to foster neocollagenesis by stimulating fibroblasts and gradually restoring

facial volume – meaning we only inject deeply and deposit the product on the bony structures.  Once the results are achieved they may last up to 2 yrs.

Sculptra is often combined with HA for instant gratification. Sculptra is always injected first, then massaged into the area. The lidocaine in the Sculptra provides reduction of pain and discomfort during subsequent injections.  The combination is very popular as Sculptra does not provide immediate effects. It may take up to 4 weeks to start seeing volumizing effects. Men tend to correct quicker than women – for unknown reason. The injected area is massaged 5x/day for 5 minutes for 5 days. As we are all human, we tend to forget to do that during the day – but we do emphasize to massage the treatment area every night for the next 5 days.

We like to schedule Sculptra 2-3 days in advance as the reconstituted product works the best after at least 2 days after reconstitution. And we also love to use it on ourselves and our patients.

Silicone

The use if this product is fraught with controversy. They were many adverse side effects with long lasting disfiguring, granuloma formation and migration of the material. It is has been purified and has slowly returning to the market. It is very popular in Brazil. There are 2 products approved by FDA  – both approved for ophthalmology use. If approved for aesthetic use , Silcone will be considered a permanent filler. It may last up to 23 years. Yes, twenty three years!

Artefill

Approved in 2006, as a permanent filler – it   may last over 5 yrs. – Artefill is not widely popular. The chemical structure is quite interesting. Particles of homogenous polymethylmetacrylate – in other words Plexiglass – are suspended in bovine collagen and lidocaine. Again, due to bovine collagen presence, 2 skin tests must be performed before treatment.

The disadvantage of the permanent fillers is the inability to foretell the longterm appearance of the patient. Skin and subcutaneous tissues change with age, however the filler stays where it was injected. Time will tell the exact risk/benefit ratio of permanent fillers.

It is important for the patient to work with the injector. We may notice areas that are contributing to the aged appearance which the patient may not have noticed.

It is crucial to know how much money is the patient willing to spend. These procedures are quite expensive, with discomfort and frequently with bruising. We will be asking many questions : for instance : What have you tried before? Were you satisfied with the results? What concerns do you have ? Do you bruise? Are you taking any medications that may cause bleeding? Do you hate it when your lipstick bleeds into the lines of your top lip? Do you have any events coming up?

Do you prefer top lip or bottom lip fuller? What amount of downtown are you willing to tolerate ?  etc. etc. etc.

After choosing a proper filler or a combo of fillers, we will proceed with the treatment. It is very satisfying to see results immediately and even a subtle change may contribute to an increased confidence and self worth.

Thank you for reading this quite a long article about fillers. Again, for the list of fillers available at our medical spa, please, visit our website www.bluepointmedcialspa.com or stop by and pick up the brochure. Or better yet, schedule an appointment with one of our aestheticians for a facial. During this time your skin will be evaluated properly and not only questions about fillers will be discussed, also the proper skin care. A glowing, healthy skin is the primary goal – before any filler should be considered.

D.K.Michaels MD

11/2018