Injectable Fillers

Background
Collagen has been the most common substance used for soft tissue augmentation. It was approved for this purpose in 1981 by the FDA and since then nearly 2 million patients have received collagen and injectable filler treatments. Collagen is actually part of the natural support structure of your skin. Wrinkles form when this natural collagen thins. This thinning is mostly a process of aging, however, other important factors include the amount of sun exposure received over a lifetime, smoking history, pollution, health and lifestyle. With decreased collagen support, wrinkles and lines start to form wherever the skin moves.

The filler is injected with a very fine needle into the skin of the wrinkles to be treated. The lines or wrinkles that can be effectively treated include the worry lines (Forehead lines), frown lines (Glabellar folds), crow's feet (Periorbital lines), lip border (Vermillion border), smile lines (Nasolabial folds), vertical lip lines (Perioral lines), and marionette lines (Oral commissures). Fillers have an immediate effect on lines and wrinkles. Most patients are very pleased with the results of injectable fillers and experience no side effects.

Most commonly used injectable fillers include:

• Juvederm
• Artefill
• Sculptra
• Restylane
• Perlane

Dr. Parson and his staff will individually look at you and your unique situation and recommend the best filler to fit your needs.

JUVÉDERM™ Injectable Gel
Juvéderm™ is a smooth consistency gel made of hyaluronic acid - a naturally occurring substance in your skin that helps to add volume and hydration. Juvéderm™ injectable gel is eased under the skin to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your "smile lines" or "parentheses" (nasolabial folds - the creases that run from the bottom of your nose to the corners of your mouth). Juvéderm™ provides a smooth, natural look and feel. Juvéderm™ injectable gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

ArteFill
Facial wrinkles are a result of the natural aging process. Over time, the skin loses its ability to repair itself as the underlying elastin and collagen fibers break down and lose elasticity. Heredity, UV exposure, and repetitive facial movement can all contribute to the development of facial wrinkles and folds. ArteFill is the first and only FDA-approved non-resorbable wrinkle filler for the correction of smile lines.

ArteFill gives immediate, visible results with no down time. Results improve over the course of several months and ArteFill usually requires only 1 or 2 treatments. ArteFill is a dual-acting injectable wrinkle filler. Its patented formula contains 20% ArteFill Precision-Filtered Microspheres™ (made of PMMA, the same material used for dozens of medical implants over the last 50 years) and 80% ArteFill Purified Bovine Collagen™ gel with lidocaine, an anesthetic. Artefill requires one collagen allergy pre-test. First, ArteFill visibly corrects the wrinkle. Then the microspheres provide the permanent support your skin needs to correct the wrinkle and prevent further wrinkling.

Sculptra®
Sculptra® is a sculpting agent that restores volume to correct the signs of facial fat loss. It is an enduring treatment approved by the FDA for restoration and/or correction of the signs of facial fat loss, or lipoatrophy, in people with human immunodeficiency virus. It is the first FDA-approved product of its kind for this condition.

Facial fat loss, or lipoatrophy, is the loss of fat beneath the skin, which can result in sunken cheeks, indentations, and hollow eyes. Sculptra® is a safe, synthetic, and biocompatible material that is injected below the surface of the skin in the area of fat loss. It provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas. No skin testing is required. Sculptra® has been safely used outside the United States since 1999 in over 150,000 patients under the trade names New-Fill™ and Sculptra®.

Restylane® or Perlane®
Restylane® or Perlane® are cosmetic dermal fillers that replace lost volume and restore youthful contours to the skin to smooth away moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). Restylane is the world's most used, most studied dermal filler, and has been used in over 70 countries and in more than 1.4 million treatments in the U.S. If you're considering treatment for your facial wrinkles and folds, Restylane® and Perlane® can be used to help you reach your goal of a more youthful appearance. The procedure is non-surgical, and its effects are virtually instantaneous.

Restylane and Perlane® are made of hyaluronic acid. In the human body, natural hyaluronic acid provides volume and fullness to the skin. The hyaluronic acid in Restylane and Perlane has been modified slightly to last longer than the body's hyaluronic acid. The hyaluronic acid in Restylane and Perlane is produced by a biotechnical process. Restylane and Perlane are hydrophilic or "water loving." The hydrophilic nature of these hyaluronic acid molecules and their three dimensional structure allows them to bind many times their own weight in water. As hyaluronic acid begins to degrade, each molecule binds to more water which helps to maintain its volume for about six months.

Restylane and Perlane contain no animal proteins. This limits any risk of animal-based disease transmission or allergic reactions. Restylane and Perlane contain trace amounts of gram-positive bacterial proteins and are contraindicated for patients with a history of allergies to such material. No allergy testing is required before use.

Consultation
At your initial visit with Priscila Ferrand, our nurse injector, a directed physical examination will be performed and a medical history will be taken with attention to current medications, allergies, previous plastic surgery and skin care regimen. An inquiry will be made into past sensitivity to collagen injections or a history of multiple severe allergies or anaphylactic reactions. She will examine you in front of the mirror and discuss your skin concerns. Priscila will describe the technique of collagen replacement therapy along with its risks, benefits and hopeful outcomes. Photographs may be taken of the areas to be treated so that the lines or wrinkles of concern can be compared with their appearance following treatment.

The Day of Collagen Injection
You will be asked to remove any make-up from your face with mild soap and water. The areas to be treated will then be swabbed with alcohol, a numbing cream will be applied and allowed to sit for approximately 20 minutes. A very fine needle will be used to inject the selected filler into the skin at a very specific depth. Depending on the number of areas to be treated, the procedure may take from 10 to 30 minutes. You may notice that the areas treated are slightly overcorrected immediately following the procedure. A cold compress will be applied to the areas treated. This helps soothe the skin and constrict blood vessels so you can apply make-up afterwards. You may resume your normal daily responsibilities immediately after the procedure but are advised to avoid strenuous exercise, extensive sun and/or heat exposure, and alcoholic beverages for 24 hours following the injection. This type of exposure can cause temporary redness, swelling, and/or itching at or near the injection site.

Follow-Up Visit
Priscila will schedule your follow-up visit with her depending on the filler used.

Risks
The risk of infection is always present with any injection and it is possible to experience a reaction to the process itself, such as mild bruising at the injection site. This is more likely if you are using drugs to reduce coagulation such as aspirin or non-steroidal anti-inflammatory drugs. Occasionally, injected collagen has been reported to be visible in the skin in the form of a small raised or white area at the treatment site, which may persist for weeks or months.

At the time of your initial consultation, you will be provided with the complete safety summary of the product.