What is Available
A range of temporary and some permanent fillers has been developed in recent years to aid in cosmetic work. The more commonly recognised agent is collagen. Produced from cow’s hide, this has proved effective in reducing lines and wrinkles, filling scar depressions and enhancing both lip line and fulness.
Other versions of collagen are around now too produced from human tissue, with the latest being based on recombinant DNA technology. This should reduce one of the problems that use of collagen has produced in the past. As collagen molecules are species specific, with the resultant problem of allergy arising to it, all those wishing to use the bovine produced form needed a test dose at least a month before treatment, then repeated a week or so before the actual therapeutic session.
Collagen, due to its underlying concerns and the rise of better, longer-lasting, less problematic fillers, has fallen by the wayside now.
Natural Skin Fillers
The skin is naturally supported by two main substances collagen and hyaluronic acid. For many years the function of hyaluronic acid was not understood. It is present in many different tissues in the body. Basically a long connected chain of sugar molecules, it tends to bind water between its chains. It is now understood to support the water that exists between all cells in the body.
Structurally it is the same across many species. This means hyaluronic acid can be obtained from non-human sources without the concern that it may produce allergies directly.
To prevent synthetic hyaluronic acid being too rapidly eliminated from the body a chemical bond every 200 units is produced to stabilise it.
At Springdale we use hyaluronic acid, Restylane, produced from Sweden, which is manufactured from a bacterial process. Its advantage over standard collagen, along with the low risk of allergy, is that in most applications it lasts twice as long.
Restylane is now registered in New Zealand for cosmetic medical applications. Recent changes in classification have meant that fillers now fall into a category of implants. Therefore many more fillers have been introduced with the less stringent registration and use process.
A less dense form for filling very fine superficial lines has been available for some time. But it seems to break down and disappear very quickly. A new version that appears more durable has been produced and will be available as this site is updated. A denser version that is good for lip augmentation and filling deeper folds like the nasolabial one seems to last a little longer than the standard form. Being denser it is not so suitable for the smaller lines.
This newer filler has actually been in use for some time as a filler in deeper tissue problem areas in the body. People with bladder continence problems have had it injected at the bladder outlet to reinforce this with good relief. It has also been used to improve vocal cord function.
Its basic structure is a lattice work, rather like scaffolding, that allows other tissue to build into it. It occurs naturally in the body in our bones where it allows bone structure to build. If placed in other tissue it tends to become a form for this tissue to build up bulk in.
To enable ready injection it is suspended in a gel carrier, mainly water and glycerin with some sodium carboxymethylcellulose. These support gel elements are eliminated as the local tissue replaces it. It tends to last in its effect from two to four years, although it can be longer.
So far its use in lips has been less than ideal due to causing a slight lumpiness. In other areas it needs to be placed below the skin. This means it is not ideal for fine lines. But areas that need building of bulk and more wide folds etc respond very well.
For some time people have been experimenting with fat transplantation, taking fat from areas with excessive or extra amounts and placing it in areas needing filling. The advantage with this is that there is usually plenty of the product available and, as it is taken from the patient’s own body, it will not be rejected as foreign.
However the body does break a certain amount of it down and success is based on particular techniques being employed. To get the best results quite a bit of swelling occurs immediately after the treatment and takes some days to settle down.
Currently the results do seem a little uneven for us to be using this at Springdale as a regular treatment, but we have used it in areas of scarring where fat loss has occurred.
Used for water purification in some areas of the world and for tissue building effects used in the USSR for breast enhancement, polyacrylamide gel tends to remain unchanged for many years in the tissue. Hence it is a long-term filler. People need to consider this when using it: would they still want the enhancement many years after they have initially used it?
As all our tissues do continue to shrink with time, often some addition to the initial treatment may be needed. But also this shrinking may make long term enhancement stand out. Otherwise it is a very useful filler.
Again it needs to be placed below the skin, meaning it is less useful for fine lines. But folds and treatments such as lip enhancement respond very well to it. It can also be used for enhancing areas such as receding chins, less prominent cheeks, and improving the shape of noses.
Aquamid is not a registered medicine and is available to be used under Section 29 of the Medicines Act 1981.
More agents are being developed all the time in this area. Some are more successful than others. Great care needs to be taken in choosing agents as they are placed in areas that are in full view should problems develop.