Injectibles Causing Collagen Formation: Yes or No ?

I am having injectibles to my chin, Perlane I ml, is is really true that after repeated injections, scar tissue (so called collagen formation), fills out the area, if so, how many injections would it take to achieve this, does it mean I can stop having injectibles or at least less amounts ?

Doctor Answers 5

Limited Studies Do Document Collagen Formation After Soft Tissue Filler Injection

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are some studies to suggest that soft tissue fillers result in collagen formation. I know this has been evaluated for Restylane and Radiesse. It has not been evaluated for Perlane or Juvéderm. But since Perlane is made of the same hyaluronic acid gel that Restylane is, one can infer that a similar response is likely.

Berlin et. al. published a study (Dermatologic Surgery, June 2008; 34:S1: S64-S67) to characterize the expression of collagen I response to injected calcium hydroxylapatite (CaHA; Radiesse) filler material. Six months following injection, biopsies of the treated area behind the ear were evaluated microscopically using conventional, special, and immunohistochemical stains. At six months after injection, conventional H&E staining demonstrated deposition of collagen around, and infiltrating into, the CaHA microspheres, as well as a fibroblastic tissue response. Special staining with picrosirius red confirmed collagen deposition, and polarized yellow-orange and green birefringence, documented the presence of type I and type III collagen respectively. Immunohistochemical staining with anti-collagen antibodies revealed strong staining for type I collagen around the CaHA microspheres. Similar collagen formation was also demonstrated by electron microscopy in a different and unrelated study. The conclusion was that the Radiesse filler stimulated new collagen deposition at six months, and that this may contribute to the overall appearance of the lines and wrinkles.

Wang et. al. published a study (Archives of Dermatology, 2007; 14:155-163) which showed that Restylane injections stimulated de novo production of type I collagen. In an initial study, the investigators demonstrated that a single hyaluronic acid (HA, Restylane) injection into photo-damaged forearm skin resulted in increased collagen deposition around the filler at 4 and 13 weeks after treatment (p<0.05). To further investigate the potential mechanisms underlying collagen induction following HA injections, gene expression was measured. The investigators found that types I and III pro-collagen, as well as several pro-fibrotic growth factors, were up-regulated at 4 and 13 weeks compared with controls (p<0.05). Fibroblasts in filler-injected skin demonstrated a mechanically stretched appearance and a biosynthetic phenotype.
The authors concluded that injection of Restylane stimulates collagen synthesis, partially restoring dermal matrix components. They hypothesize that this stimulatory effect may be induced by mechanical stretching of the dermis, which in turn leads to stretching and activation of dermal fibroblasts. The authors then surmised that multiple Restylane injections placed in a specific area of skin over time may result in collagen accumulation at that location and may produce more long-lasting aesthetic effects.

These studies obviously have their limitations – small sample size, the studies were not performed on skin from the face, and some of the conclusions are based upon the skin’s biologic response but that was not correlated with the clinical appearance.

This collagen formation does occur after only one injection. More than one injection may stimulate more collagen formation but that was not evaluated. This collagen formation does not last forever and will eventually undergo degradation with time. If you like the results of your injections you will need to continue them at some interval.

The key to a good and long-lasting result with any soft tissue filler is to provide “complete correction” (as I have mentioned in some of my previous answers to questions here) at the initial fill(s). And then to maintain that correction with maintenance treatments that build upon remaining product (i.e. re-treat before all the product from the previous treatment has been metabolized). Following this course will result in the use of less product, and better longer-lasting results will be achieved.

I hope this is helpful. Best wishes, Ken Dembny

Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

Fillers do stimulate collagen

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hyaluronic acid fillers (Perlane, Restylane, Juvederm) are biocompatible polysaccharides which are naturally found in skin tissue and have been shown to stimulate collagen after repeated injections.  Radiesse and Sculptra have shown greater biostimulatory effects i.e collagen stimulation on skin.  With any category of filler, collagen stimulation is a nice bonus, but proper placement and amounts are essential for good cosmetic results.  For the chin area, Perlane is a nice choice. 

Daniel Levy, MD
Bellevue Dermatologic Surgeon
4.9 out of 5 stars 43 reviews

Injectibles Causing Collagen Formation: Yes or No ?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 While is has been reported that fillers like Perlane cause some collagen formation...this will not amount to enough augmentation to equal the volume placed with Perlane injections.   Even with repeated treatments, the amount of augmentation obtained by having the filler injected will always far outweigh any collagen formation IMHO.  Permanent solutions remain Cheek or Chin Implants IMO.  be sure the MD, you select for facial augmentation with fillers understands and follows the proper aesthetics of facial beauty for the creation of a naturally more attractive face.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Fillers and collagen production

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are some studies suggesting some collagen formation after fillers, but to me it is not impressive.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

That Perlane will provide volume in your chin for years.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

WIll it stimulate collagen.  There is a very weak study that suggests this and is often touted to support this story.  However, the study is singularly unimpressive.  So I would tell you that the product you are getting is fantastic and can provide very nice long term help.  However eventually the volume will disappear.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.