Over the last several years, a number of new soft-tissue fillers including Restylane, Perlane and Juvederm have been introduced to the U.S. For physicians, deciding what to inject is an extremely important decision, as some fillers are safe for essentially all patients, while others can have troubling and even disfiguring side effects. The first filler that gained widespread acceptance is bovine collagen. However, that product tended not to last very long and also required a skin test prior to treatment. Human-sourced collagen products were then developed, but they had the stigma of being derived from the tissue of human cadavers. Also, the results did not last much longer than those from bovine collagen.
Injectable hyaluronic acid (Restylane, Perlane, Juvederm) is produced in culture instead of being taken from an animal or human source, which eliminates many of the concerns associated with injectable collagen products. Hyaluronic acid has many of the qualities of the ideal filler: it is safe and affordable, it produces natural-looking results, and it is extremely effective for most patients. In our plastic surgery practice and medical spa, we have seen a much higher rate of patient satisfaction when using hyaluronic acid products than with collagen products.
The enhancements produced by hyaluronic acid products tend to last six months on average, but in some patients, results can be seen for as long as 10 to 12 months. Hyaluronic acid injectables have advantages above and beyond the long duration of results seen in most patients. In three years of experience using this material, we have never encountered an adverse reaction, such as infection, inflammation, migration, allergy, or scarring.
There are many injectables currently available that carry a significant risk of one or more of the above complications, which points out the importance of choosing an injectable agent that is not only effective but also safe.
Evolence is a new Dermal Filler derived from Porcine (Pig) Collagen. There have been reports of nodule formation following lip injection.
For permanent wrinkle elimination, I perform facial fat grafting. Fat grafting can also be used to enhance the lips, cheeks, chin, under eye hollows and hollow aging brows.
