Temporary long duration fillers (Part III of IV)
Temporary long duration fillers (2-3 years)
Two fillers derived from cadaver tissue include Cymetra and Fascian. Cymetra is an injectable form of Alloderm (dermis from a cadaver), approved by the FDA in 2000. Its lifespan in tissue varies between 3 and 9 months. Fascian is particulate graft material from derived from human cadaveric muscle tissue. In 1999 it has been introduced as injectable filler.
Radiesse is an amalgam of 30% calcium hydroxylapatite microspheres (25-45 µm) in a 70% gel consisting of 1.3% sodium carboxymethyl cellulose, 6.4% glycerin, and 36.6% sterile water. Despite have microscopic pieces of calcium this product is smooth and excellent for deep folds and wrinkles. Its clinical effects are reported to last for 2 years, with the added benefit of stimulating new collagen formation. There are no allergic reactions associated with Radiesse. This filler cannot be used in the lips but is outstanding for nasolabial folds. This filler is my personal favorite to address deep folds around the mouth, nose, and ‘hollowed out’ appearance below the eyes. The makers of Radiesse report its duration to be 2 years. From personal experience, I have seen the positive effects of this filler even longer, depending on the site of injection (likely due to its ability to enhance new collagen production). Additionally it maintains its ‘mold ability’ for 7 days, so if you notice some unevenness it can be massaged out.
Sculptra is a biodegradable, biocompatible, synthetic polymer from the alpha-hydroxy –acid family. It is comprised of crystalline, irregularly sized microparticles of poly-L-lactic acid. It undergoes volumetric in that is increases in size up to months after initial tissue introduction. As degradation continues, collagen production occurs as well. Patient typically should be under filled and are re-evaluated at two-week intervals if further augmentation is warranted. The benefits of Sculptra typically last between one and two years.
The public’s concerns regarding the use of donor tissue in this venue have impelled the development of Isolagen The theory behind this product is treating the atrophic dermis with cultured fibroblasts from one’s own body. It is a living network that produces an immediate fill with a continuum of growth over a period of 1 to 2 years. Follow up thus far has shown no loss in volume over a 4.5 year follow and is still awaiting final FDA approval. Although the company reports this product will be cost effective in that its results have so far been long lasting, the price tag remains to be seen.
Autogenous fat has been and remains an excellent option for volume restoration in the face. Although its durability and longevity as injectable filler is controversial it is inarguably a wonderful non-immunogenic, plentiful, and most often-short term option in the lips. Some surgeons believe that half of the fat volume remains while others believe all of the fat is eventually resorbed and the remaining volume is consistent with scar tissue. Usually three months between a second series of injections is allowed for. Additionally, the harvesting of fat has also been controversial with regard to the fragility and viability of the adipocyte before, during, and following transfer. There is much variety with regard to harvesting, preparation, and injection techniques most of which is anecdotal and based on surgeon preference.
Two fillers derived from cadaver tissue include Cymetra and Fascian. Cymetra is an injectable form of Alloderm (dermis from a cadaver), approved by the FDA in 2000. Its lifespan in tissue varies between 3 and 9 months. Fascian is particulate graft material from derived from human cadaveric muscle tissue. In 1999 it has been introduced as injectable filler.
Radiesse is an amalgam of 30% calcium hydroxylapatite microspheres (25-45 µm) in a 70% gel consisting of 1.3% sodium carboxymethyl cellulose, 6.4% glycerin, and 36.6% sterile water. Despite have microscopic pieces of calcium this product is smooth and excellent for deep folds and wrinkles. Its clinical effects are reported to last for 2 years, with the added benefit of stimulating new collagen formation. There are no allergic reactions associated with Radiesse. This filler cannot be used in the lips but is outstanding for nasolabial folds. This filler is my personal favorite to address deep folds around the mouth, nose, and ‘hollowed out’ appearance below the eyes. The makers of Radiesse report its duration to be 2 years. From personal experience, I have seen the positive effects of this filler even longer, depending on the site of injection (likely due to its ability to enhance new collagen production). Additionally it maintains its ‘mold ability’ for 7 days, so if you notice some unevenness it can be massaged out.
Sculptra is a biodegradable, biocompatible, synthetic polymer from the alpha-hydroxy –acid family. It is comprised of crystalline, irregularly sized microparticles of poly-L-lactic acid. It undergoes volumetric in that is increases in size up to months after initial tissue introduction. As degradation continues, collagen production occurs as well. Patient typically should be under filled and are re-evaluated at two-week intervals if further augmentation is warranted. The benefits of Sculptra typically last between one and two years.
The public’s concerns regarding the use of donor tissue in this venue have impelled the development of Isolagen The theory behind this product is treating the atrophic dermis with cultured fibroblasts from one’s own body. It is a living network that produces an immediate fill with a continuum of growth over a period of 1 to 2 years. Follow up thus far has shown no loss in volume over a 4.5 year follow and is still awaiting final FDA approval. Although the company reports this product will be cost effective in that its results have so far been long lasting, the price tag remains to be seen.
Autogenous fat has been and remains an excellent option for volume restoration in the face. Although its durability and longevity as injectable filler is controversial it is inarguably a wonderful non-immunogenic, plentiful, and most often-short term option in the lips. Some surgeons believe that half of the fat volume remains while others believe all of the fat is eventually resorbed and the remaining volume is consistent with scar tissue. Usually three months between a second series of injections is allowed for. Additionally, the harvesting of fat has also been controversial with regard to the fragility and viability of the adipocyte before, during, and following transfer. There is much variety with regard to harvesting, preparation, and injection techniques most of which is anecdotal and based on surgeon preference.
posted by Dr. Scott M Blyer at
7:33 PM
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