Re Fillers
There is an enormous interest in "fillers" in cosmetic surgery today. Many of the newer ones in "world wide " are not available in the USA. I will attempt an overview from a clinicians standpoint.
Collagen: Derived from cowhides (tons of the stuff from one cowhide} When it was first introduced the detail people told us "It was permanent", later "It would last 5years", later "we were not injecting it correctly." Effect probably last less than three months. Interestingly it got thru the FDA not as "drug", but as a "device." Requires skin testing pre use. Indication is for injection into the deep dermis. Collagen is being replaced by Restyline.
Restyline {here after R} ; Is a hyaluronidase which there are many varieties which I know little about. Currently Restyline is the only one I've used. These chemicals are hydroscopic agents which means they bind water. The duration of R is probably a little longer than Collagen not dramatically so. R does not require skin testing and can be used in places where collagen does not work as well. Its certainly possible the stretch accompanying R induces some collagen formation, I think it highly unlikely the amount would be clinically significant.
Artefil: is a newly approved filler which uses bovine collagen as a bulking agent which contains small (methyl methacrylate I think} plastic beads which are about the size of red blood cells. The company is recomending this as a perminent filler for "smile lines." Plastic surgeons may not take to the idea of a perminent solution.
There are a whole array of other fillers which are in use in other countries awaiting FDA nod. The problem with most fillers is they are expensive on a volume basis. Restyline comes in 1cc pre packaged syringe and retails in Boston avg. probably 600$. Which brings us to the real story which is micro fat grafting.
Recent improvements in the cannulaes we use to extract fat for auto grafting will soon sky rocket facial augmentation by fat grafting to the forefront as treatment for facial aging. Fat grafting shares some commonality to skin gafting in that a portion of the fat takes on a blood supply and survives. Nb there may be other surgeons who would argue this point (of course I would be willing to debate). The new cannulae have intake ports about 1mm in diameter which are considerably smaller than most surgeons would have guessed fat could be sucked thru. The harvested fat comes thru in an almost creamy smooth consistancy that can be injected anywhere in the face including the eyelids without fear of lumps. I frequently inject over 30ccs in one setting. If this were R this would be 18,000$ worth. Honestly.....the fat is better and easier to control.
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