Collagen and Other Injectables
Collagen is a nice way to begin the "appearance medicine" journey.
|
By Kimberly A. Henry, MD and Penny S. Heckaman
WebMD Medical Reference from "The Plastic Surgery Sourcebook"
Collagen is a nice way to begin the "appearance medicine" journey. Many people are frightened by the idea of plastic surgery. With collagen, those who are scared can experience the joy following elimination of bothersome wrinkles and improvement of long-time acne scars.
WHAT IS COLLAGEN?
Collagen is a natural protein that is found throughout the body in the skin, muscles, tendons, and bones in all of us. As we age, the collagen fibers, which are woven together like threads in fabric (forming a framework in which new cells can grow), starts to weaken. Our bodies' collagen provides natural texture, resiliency, and shape. As we grow older, we also start to lose collagen.
Cosmetic collagen was developed in the 1970s by physicians at Stanford University from bovine collagen. They were researching alternatives to skin grafting when they stumbled on collagen. Collagen was first used medically in 1976, and, to date, over 500,000 people have been treated with it. The Collagen Corporation, based in Palo Alto, California, has been the main supplier of synthetic injectable collagen for years. The newer products, Zyplast and Zyderm, have been used to increase the size of small lips; eliminate the line around the borders of the lips of smokers, the wrinkles of those with heavy sun exposure, acne scarring and acne pits; and treat fine lines around the eyes and between the eyebrows (see Fig. 19-1).
HOW DO THE COLLAGENS WORK?
When a physician injects a small amount of collagen directly into areas where the body's own collagen has been weakened, depressions can be raised to the level of the surrounding skin. Therefore, lines and scars can be minimized and texture improved, and the skin has a softer and more even tone. Zyderm collagen was formulated especially for people with small or superficial contour problems. Zyderm can be particularly effective in smoothing delicate frown and smile lines as well as fine creases that develop at the corners of the eyes and above and below the lips. It is also good for correcting certain kinds of shallow scars.
Zyplast collagen was designed to treat depressions requiring a stronger material. It is used for more pronounced contour problems, such as deeper scars, lines, and furrows, and for areas on which more force is exerted, such as the corners of the mouth. Your surgeon will determine the potential benefits of each material in the appropriate course of treatment.
"Ice pick" scars cannot usually be helped by collagen, but occasionally, fat injections and scoring underneath the scar can help minimize these particular types of scars.
Collagen comes in 1-cc or 2 1/2-cc syringes. Most patients opt for at least 1 to 2 ccs during each period of injection.
Before you begin collagen therapy, it's necessary to have a skin test prior to the full correction of a line or acne scar. This test consists of injecting a small amount of collagen underneath the skin of your arm and watching for a period of three weeks to see if you have a reaction to the collagen. Most people who are allergic to beef will have some type of reaction to the collagen. A red bump at the site or a rash is a positive reaction against the collagen. Your surgeon or dermatologist needs to be notified right away of any type of reaction or problem.
If your skin test is negative, your surgeon or doctor can proceed with the collagen injection. Usually 1 to 3 ccs of collagen is injected. Each syringe costs anywhere from $350 to $500 per cc injected.
Following the injection, you will be swollen and a bit bruised. When I inject lips to augment them, I usually use the bulkier, more robust Zyplast collagen. This is cross linked (strands of collagen hooked together) to fill the line or depression. It will also last longer, anywhere from four to six months. Sometimes, after several injections, a patient will develop so much scar tissue in the area that scar buildup will further improve the look in addition to the collagen.
There has been some suggestion that patients may develop autoimmune disease following the use of collagen. This is currently under investigation. If you are concerned, refer to the collagen pamphlet which is provided before the procedure and thoroughly discuss this with your surgeon.
OTHER INJECTABLES
Other injectables include autologous fat (a patient's own fat), silicone (uncommon and illegal in the United States), and Fibril products. Sidney Coleman, M.D., and some doctors in Sweden have developed beautiful techniques using a patient's own fat. Fat is removed from another part of the body and injected into areas of the face to help lessen the effects of aging. As we age, our bodies and faces start to lose fat, specifically around the eyes and the cheek areas, causing the face to droop and sag. The injection of a person's own fat in these areas helps rejuvenate the face.
Before 1992, silicone gel injections were used exclusively to augment the face. At this point, they are currently banned by the FDA due to frequent complications. The silicone was known to migrate to different parts of the face, causing it to look very lumpy.
The areas where a fat injection can most effectively be used include the cheek area, the jawline areas, the chin, and the lips. In addition, fat injections to the hands are also quite helpful in rejuvenating their overall appearance.
Usually a surgeon will overcorrect the fat injections in the cheek area approximately 20 to 30 percent and in the lip area 10 to 20 percent; occasionally the lips have to be redone at a second stage.
Fat Injections for the Hands
When I first heard about the technique of fat injections to the hand region, I was a little skeptical. My skepticism lessened somewhat when I discussed the technique with one of my colleagues who had performed a hand procedure. I then learned the technique and began to perform the procedure on my patients. I am now convinced that it works consistently well and produces beautiful results. There are some surgeons, though, who will not do this procedure.
As we age we lose fat in our hands, the tendons on the back sides of our hands become more visible, and our hands begin to "look old." If fat is borrowed from, say, your stomach area, inner thigh area, or buttock area, approximately 10 to 20 ccs or a couple of teaspoons of fat are injected into the backside of your hand, you will see a dramatic improvement. It's very important that you stay on antibiotics just prior to the procedure as well as after.
The hands may be puffy and bruised for up to two to three weeks postoperatively as the tissues heal. The procedure may need to be repeated again, as fat has a tendency to be reabsorbed by the body.
Collagenesis, Inc., one of the most prominent companies in the new biomaterials industry, developed a patented technology named the Human Tissue Matrix System (HTM). Using this system, Collagenesis separates cellular material from human dermal tissue material matrix, and, using its patented process, an injectable form of the tissue results. As part of its Soft Tissue Augmentation Program, this company introduced Autologen in 1992 for use as an injectable dermal implant to treat facial contour defects, and more recently, Dermalogen, another natural alternative to animal and synthetic implants. These new injectables offer a practical solution for patients wanting aesthetic treatments.
Even more recently, in 1997, Collagenesis instituted its BioBank, a holding service for patients who may store their tissue from cosmetic surgery procedures for future processing into Autologen. This Massachusetts-based company provides its products and services to over four hundred physicians in eleven countries, including my practice. We store tissue at Collagenesis for our patients who request this service after a face-lift or tummy tuck. The tissue is resynthesized and converted into injectable syringes of the patient's own collagen. Patients essentially pay rent on the application and use of the collagen.
We had a patient who underwent a breast reconstruction, and the remaining tissue from her abdominal incision was sent back in special containers and is currently being resynthesized into syringes of her own collagen. The expense is a bit higher for the standard collagen. Standard collagen is anywhere from $350 to $500 per syringe cc. Resynthesized collagen is anywhere from $500 to $1,500 per syringe cc. Ultimately, it will be worth it if one's own resynthesized collagen lasts longer than the regular collagen from bovine tissue. Also, there is less of a chance of sensitivity when you use your own tissue.
ALLODERM
Another type of cosmetic material on the horizon is injectable Alloderm. Initially, Alloderm was developed as skin graft in order to treat patients with burn injuries. The Alloderm tissue is actual cadaver tissue that is treated, and all the cells are removed. The HIV and hepatitis viruses are also removed during this process.
In my practice, I am currently using Alloderm for lip augmentation, which is human tissue specifically treated and freeze-dried. In the near future, Alloderm will be useful in injecting small defects or increasing lip tissue or removing and erasing facial lines.
Every type of injectable may cause infection. Every type of injectable may reabsorb, requiring repeat injections in the future. For most people, this technique is worth it.
SHOULD INJECTABLE COLLAGEN TAKE THE PLACE OF SURGICAL PROCEDURES SUCH AS FACE-LIFTS AND DERMABRASION?
The face-lift and dermabrasion have their place, as does collagen. Often doctors will use Zyderm or Zyplast in conjunction with surgery to fill in depressions not amenable to surgery. Moisturizers work only on the skin's surface; collagen works deeper and helps restore contour problems. If you have a personal history of autoimmune disease, which includes but is not limited to rheumatoid arthritis, scleroderma, systemic or discoid lupus, or pyomyositis; a dietary allergy to beef; or you've recently been on steroids or immunosuppressant therapy, you may have a sensitivity to collagen. In my practice, I require that all patients have a skin test prior to being treated.
Occasionally, after a collagen injection, you may develop symptoms such as redness and swelling or bruising. If this should happen, contact your physician. Bruising and a little swelling is normal. Prolonged redness needs to be discussed with your plastic surgeon or dermatologist.
Some physicians have reported the occurrence of connective tissue disorders such as rheumatoid arthritis, systemic lupus, pyomyositis, and dermatomyositis subsequent to collagen injections in patients with no previous history of these disorders.
Conflicting studies have been published in scientific journals regarding the association between injectable collagen and these disorders. Currently, there is no substantial evidence connecting the two.
DOES THE CORRECTION LAST FOREVER?
Touch-up injections are usually needed to maintain maximum correction, especially when Zyderm rather than Zyplast is used. I wholeheartedly recommend using Zyplast as much as possible, as this is a much bulkier collagen. Most patients seek repeat injections within three to twelve months after the initial treatment series. Some patients go two or three years until they finally come back and say, "I'm ready for my collagen again."
|
additional news >>
|
|
|
Local Specialists near Ashburn, VA
- Healthydermis, Inc.
Oakton, VA (11.69 miles)
More Info | Phone # | Map
- Impressions MediSpa
Vienna, VA (12.39 miles)
More Info | Phone # | Map
- The Dermatology Center and Rockledge MedSpa
Bethesda, MD (16.98 miles)
More Info | Phone # | Map
- Millennium Medical Spa
Chevy Chase, MD (20.66 miles)
More Info | Phone # | Map
- Serenity Zone Medical Spa
Olney, MD (22.61 miles)
More Info | Phone # | Map
- About Face Aesthetic Centers, LLC
Alexandria, VA (26.74 miles)
More Info | Phone # | Map
- Metamorphosis Plastic Surgery
Ellicott City, MD (36.54 miles)
More Info | Phone # | Map
- Allure Med Spa
Stafford, VA (38.68 miles)
More Info | Phone # | Map
- Toscana Medispa
Baltimore, MD (49.54 miles)
More Info | Phone # | Map
|
