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Injectables At-A-Glance

By ASPS


For centuries, physicians and patients have sought non-surgical therapies to remove or reduce the appearance of facial wrinkles and aging. Many materials have been tried; some with good results, others with disastrous results and others have proven ineffective.

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For centuries, physicians and patients have sought non-surgical therapies to remove or reduce the appearance of facial wrinkles and aging. Many materials have been tried; some with good results, others with disastrous results and others have proven ineffective.

Most therapies available or those currently under investigation fall into two categories: wrinkle-smoothing agents of Botulinum toxin and soft tissue fillers that add volume.

Since the 1980s, injectable collagen has been used as a soft tissue filler. Collagen is a naturally occurring protein that supports various parts of the body including skin and joints. Injectable collagen is made from purified cow skin to fill wrinkles, lines and scars on the face. The primary risk of injectable collagen is allergic reaction. Marketed under the names Zyderm and Zyplast, injectable collagen absorbs into the body and must be repeated. Results last up to six months. Nearly 800,000 people had collagen injections in 2001, according to the American Society of Plastic Surgeons.

Fat injections have been used for years to add volume, fill wrinkles, lines and enhance the lips. Fat injections involve taking fat from one part of the patient's body (abdomen, thighs or buttocks) and reinjecting it beneath the facial skin. Unlike collagen, allergic reaction is not a factor as the fat is harvested from the patient's own body. Results are variable, but can be permanent. More than, 70,000 people had fat injections in 2001, according to the ASPS.

Botulinum toxins

Botulinum toxins have been used for neck spasms, cranial nerve disorders and eye spasms. With the recent FDA approval for cosmetic use, the drug is used to smooth facial wrinkles. When injected into facial wrinkles botulinum toxins block nerve impulses, temporarily paralyzing muscles and smoothing wrinkles. Currently Botox® is the only form of botulinum toxin approved by the FDA for cosmetic purposes, but two others, MyoblocTM and Dysport® are under FDA review for cosmetic use.

More than 850,000 people had Botox® injections in 2001, according to ASPS, representing 15 percent of non-surgical cosmetic plastic surgery procedures. Fifty-five percent of all Botox® procedures were performed on people between the ages of 35 -50.

Injectable

Description

Purpose

Side Effects/Risks

Results

FDA Approval

Botox Botulinum toxin type A Smoothes wrinkles Allergic reaction, bruising, numbness, droopy eyelids, body may become immune Can begin to take effect 5-7 days, maximum effect in two weeks April 2002
Myobloc Botulinum toxin type B; Requires larger dose than Botox but takes effect more quickly. Myobloc has a longer shelf life than Botox. May serve as alternative to patients resistant to botulinum toxin type A. Smoothes wrinkles Allergic reaction, bruising, numbness, droopy eyelids, body may become immune Can takes effect in 4-6 hours, maximum effect in 2 weeks Pending Approved only for cervical dystonias. U.S. patients can consent to off-label use for cosmetic treatment.
Dysport Botulinum toxin type A; Requires larger dose than Botox but manufacturer claims injections are stronger and last longer with patients returning twice a year rather than four treatments with Botox. Smoothes wrinkles Allergic reaction, bruising, numbness, droopy eyelids, body may become immune Can begin to take effect 5-7 days, maximum effect in two weeks Pending

Hyuralonic Acid

Hyaluronic acid exists naturally in all living organisms and is a natural component of connective tissues, including the skin. Hyaluronic acid has been used to treat joint pain. Restylane is a soft tissue filler made of synthetic hyaluronic acid, which adds volume to minimize wrinkles and lines. As the substance naturally occurs in humans, allergic reactions are rare. Restylane is being used in Canada and Europe. Hylaform is another tissue filler composed of hyaluronic acid extracted from rooster combs. It is currently used in Europe and Canada.

Injectable

Description

Purpose

Side Effects/Risks

Results

FDA Approval

Restylane Non-animal based derived hyaluronic acid Soft tissue filler that adds volume Rare allergic reaction Immediate lasting up to 1 year FDA has results of clinical trials-hearing pending
Hylaform Hyaluronic acid extracted from rooster combs Soft tissue filler to add volume Redness, swelling, higher rate of allergic reaction-animal based product Vary, usually 3 - 6 months Pending

Two additional soft tissue fillers being studied for their wrinkle reducing and volume-adding qualities are: Artecoll® and Radiance TM. Artecoll is a permanent "micro-implant" to fill facial wrinkles and lines, which is currently used in Europe, Canada and Mexico. Radiance is composed of calcium hydroxylapatite, which has been used in the body for multiple applications including cheek and chin implants. Radiance is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs.

 

Injectable

Description

Purpose

Side Effects/Risks

Results

FDA Approval

Artecoll 75% percent collagen and 25% polymethylmethacrylate microspheres (non-silicone, carbon-based polymers) Artecoll's manufacturer claims the injectable is permanent, as the microspheres do not absorb into the body Lumping, granulomas (localized skin reactions to foreign bodies, which can appear as hardness or a rash), microspheres can possibly move to other areas of the body Immediate Approved by FDA's General and Plastic Surgery Device Panel with conditions Feb. 2003
Radiance

(Bioform)

Calcium hydroxylapatite (a substance found in bone and teeth, made into an injectable paste) Reported to last 2-5 years. Little risk of allergic reaction Clumping, lumping, granulomas, microspheres may move to other areas of the body Pending. Immediate according to manu-facturer Cosmetic approval pending. Approved for vocal cord paralysis and urinary incontinence; can be used off-label

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (888-475-2784) or visit http://www.plasticsurgery.org


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