Background
The skin is the body's largest organ, and is divided into 3 layers: the epidermis, the dermis, and the hypodermis (also known as the subcutis).
The epidermis is the outermost layer of skin and contains regenerative layers of skin cells. The dermis is the next layer and contains connective tissue (i.e. collagen) and other fibers that give the skin strength and elasticity. The deepest layer, known as the subcutis or hypodermis, is composed primarily of fat. The subcutis supports blood vessels and nerve fibers that feed the overlying dermis and epidermis.
As skin ages, the supportive components of the skin are gradually destroyed. For example, elastic fibers in the dermis break down and are permanently lost. Collagen fibers degrade and undergo chemical modifications that destroy their function. There is also gradual loss of hyaluronic acid, a substance that maintains the texture in the skin. Thus, the skin becomes stiffer, thinner, and sags. In addition, wrinkles also appear over facial muscles as they stiffen with age. Thus, areas subjected to repeated movements with facial expression, such as the forehead, and around the eyes and lips, become wrinkled. Finally, the normal healing processes and cellular repair are gradually diminished; leaving older skin less resilient to environmental insults. Excessive sun exposure (including tanning beds) and smoking can greatly accelerate the aging process.
Now the ABCs of Fillers and Botox
Collagen and other injectable wrinkle fillers give skin a plumper, smoother appearance. Although collagen is the best known wrinkle filler, there are many other substances doctors can use to plump up your skin, including fat from your own body and synthetic materials. Here's a detailed explanation of how collagen works, followed by a discussion of other injectable wrinkle fillers your doctor may recommend.
What is collagen?
To understand collagen, you must first understand your skin.
Skin consists of three layers: epidermis, dermis, and subcutaneous tissue (hypodermis). The uppermost layer, known as the epidermis, controls the loss of water from cells and tissue. Without this protective barrier, the body would quickly dehydrate.
Just below the epidermis lies the second layer, the dermis. The dermis, although it contains blood vessels, nerves, and hair follicles, is primarily made up of a protein called "collagen." This protein forms a network of fibers that provide a framework for the growth of cells and blood vessels. Because it is the primary component of the dermis, collagen acts as the support structure for the skin.
The hypodermis is a layer of fat and connective tissue that contains larger blood vessels and nerves. It also hosts sweat glands, and fat and collagen cells. The hypodermis is responsible for conserving your body's heat and protecting your vital inner organs.
Why do fine lines and wrinkles appear with aging?
In young skin, the collagen framework is intact and the skin remains moisturized and elastic. Young skin is resilient to the many facial expressions we adopt as well as everyday environmental exposure. But over time, the support structure weakens and the skin loses its elasticity. The skin begins to lose its tone as the collagen support wears down. Every time you smile, frown or squint, you put stress on the collagen in your skin. The effect of these facial expressions is cumulative and facial lines and wrinkles begin to appear.
Can't collagen creams smooth out fine lines and wrinkles?
Collagen creams work only on the skin surface and, like other moisturizers, primarily slow the rate of water loss from the skin and help keep the skin supple. A moisturizer with or without collagen cannot penetrate the skin and is not designed to be absorbed. No moisturizer can undo the cumulative effect of collagen loss and make wrinkles disappear.
How do collagen injections work as wrinkle fillers?
Collagen injections replenish the skin's natural collagen. The natural beauty of your skin is enhanced as the contour of the support structure is restored.
Zyderm and Zyplast are bovine-derived collagen products that can replace the collagen your skin loses over time. Zyderm and Zyplast are placed in the skin -- in the dermis where the body readily accepts it as its own.
CosmoDerm and CosmoPlast are bioengineered human collagen products that are used for similar indications as Zyderm and Zyplast; they have the advantage of not requiring a skin test prior to the first treatment. Other human-based collagen products include Autologen, Cymetra, and Fascian.
Collagen should be injected into your skin only by a trained health care professional. By supplementing your skin's own collagen, collagen replacement therapy helps smooth facial lines as well as some types of scars.
Are there other injectable wrinkle fillers available?
While new products are constantly being introduced into the market, here are some of the injectable wrinkle fillers available now:
· Botulinum toxin ( Botox, Botox Cosmetic, Myobloc) is not an actual wrinkle filler. Rather, botulinum toxin is injected into facial muscles to immobilize the underlying cause of lines and wrinkles. Botulinum toxin may improve eyebrow furrows, crow's feet, and forehead creases.
· Calcium hydroxyappetite (Radiesse) is a semi-permanent, bioresorbable (dissolves in the body) wrinkle filler that's suspended in an aqueous gel and used for soft tissue augmentation.
· Fascia injections use a specific type of connective tissue harvested either from your own body or from a deceased human donor. This wrinkle filler can be implanted surgically or injected. The main drawback is that within a year of injection, your body will reabsorb the fascia.
· Fat from your own thighs or abdomen can be also be injected. There's no risk of allergic reaction and a few people achieve permanent results. This can also be implanted surgically.
· Hyaluronic acid (AcHyal, Captique, Dermalive, HylaForm, Juvederm, Perlane, Restylane, Rolifan) is a substance normally produced by the body that gives your skin its volume and fullness. Hyaluronic acid injections work by filling the space between collagen and elastin fibers within the skin, which replenishes the natural volume lost with aging. There's no risk of infection, but you will need repeated treatments to maintain the result as it's only a temporary fix. Hyaluronic acid also attracts and binds water, and this also helps maintain fullness in the area of injection.
Some hyaluronic acid materials are thicker and can add significant volume and structure while other products are smoother and less viscous, thus having the ability to flow more consistently. Juvederm may last longer, maintaining the appearance for up to 12 months with less tissue injury and inflammation.
· Poly-L-lactic acid (Sculptra) is injectable filler used to replace lost facial fat. This biodegradable, biocompatible synthetic polymer from the alpha-hydroxy-acid family that has been widely used for many years in dissolvable stitches and bone screws.
· Polymethylmethacrylate beads (PMMA microspheres) are tiny round, smooth plastic particles. These permanent microspheres are not absorbed by the body. PMMA microspheres in natural sources are used to add volume. Synthetic PMMA microspheres in bovine-based collagen (ArteFill) are used to improve skin folds such as nasolabial folds.
What can I expect with a wrinkle filler treatment?
With wrinkle filler injections you will receive a small injection of local anesthesia to numb the area being treated. Remember, there is a possibility of slight bruising, and you may experience puffiness, redness, and tenderness around the treated site.
It's important to discuss with your doctor exactly what you can expect from each treatment. Together, you can prioritize which facial areas are most important to you and discuss how many treatments you may need and the estimated cost. It's important to know that one treatment may not remove every line on your face.
Depending on the substance injected, you will likely need continued treatments to maintain the smoothing effect.
How many injections of wrinkle fillers will I need?
That depends on which wrinkle filler you use. Just like natural collagen, collagen replacements begin to lose form and will eventually wear down. Treatment may require collagen injections two to four times a year to maintain the smoothing effects. Hylaform and Restylane are also eventually absorbed by the body. Synthetic materials such as Artecoll last longer, but carry a higher risk of allergic reaction. Fat, depending on how it is used, can sometimes achieve permanent results, but the effects are usually temporary.
What is available at Contoure?
Juvederm®, Perlane® and Restylane® are stabilized forms of hyaluronic acid used in the correction of lines, wrinkles, and folds of the facial skin. These proven non-allergenic, natural cosmetic dermal fillers are used for cosmetic purposes to restore volume and fullness to the skin, thereby improving its appearance. Injectable fillers may also be used to enhance the appearance of the lips and some types of scars.
The filler is injected through an ultra fine needle beneath the surface of the skin, under the wrinkle, where it corrects the line or wrinkle by plumping and smoothing out the skin depression. The filler acts as a natural cosmetic filler to restore volume and fullness to the skin, thereby "softening" and improving its appearance.
Injections collagen may be used in the correction of lines, wrinkles, and folds of the facial skin. Using an ultra fine needle, collagen is injected beneath the surface of the skin under the wrinkle where it corrects the line or wrinkle by plumping and smoothing out the skin depression. Collagen is used for cosmetic purposes as a "filler" substance to restore volume and fullness to the skin, thereby "softening" and improving its appearance. Collagen may also be used to enhance the appearance of the lips and some types of scars.
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