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A guide to wrinkle fillers - the alternatives to collagen

Collagen has many rivals these days, this article tells you what's what

Author: Theodore R. Corwin November 23 2008

woman lying down getting injection in lip

In the late 1980s plastic surgeons and the public were introduced to a new concept, filling in wrinkles with collagen. Collagen came from cows and was treated to make it inert so that it could be safely injected into humans.

It worked, but had several significant drawbacks. Since it was an animal protein, there was the risk of an immune response. Anyone who desired collagen injections was skin tested and waited weeks to make sure they didn’t react to the treated protein. In addition, collagen was expensive and only lasted up to several months. For many years this was all that was available to the plastic surgeon in the realm of fillers.

However in recent times several new fillers have come onto the market, and it can be difficult for patients to know which product is best for their needs. Here is a run down on the most popular fillers:

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  1. Hyaluronic acid based fillers (Restylane, Perlane, Juvaderm, Elevess)
  2. Calcium hydroxlyapatite fillers (Radiesse)
  3. Human and animal based collagen (Cosmoderm, Cosmoplast, Artefil)
  4. Others (Sculptra, Silicone)


Restylane was introduced for use around the mouth after FDA approval in 2003. It was innovative in that it didn’t require a skin test for allergies like the old bovine collagen fillers. This hyaluronic acid gel is based on the same hyaluronic acid in the human body, thus reducing the risk of side effects. Youthful skin has lots of hyaluronic acid which helps plump up the skin, but we lose it as we age. Restylane helps restore that volume. It can be injected into the fine lines or deep folds of the face, as well as the lips. With over 1.4 million people who have already received this treatment, it is popular because there’s minimal down time and the results can be seen immediately. Although it has been proven clinically safe to use, those with severe allergies should avoid the use of Restylane. It normally lasts between six months to one year.


Perlane entered the market in May of 2007. Also a hyaluronic preparation, Perlane is similar to Restylane, but slightly thicker. It is intended for injection into the deeper layers of the skin. The FDA approved of its use for mild to moderate lines around the mouth. Although clinical studies of Perlane have shown no allergic reactions, it should not be used by anyone who has had previous severe allergies. Pregnant or nursing women should also avoid use of Perlane. It lasts approximately eight months to one year.


Juvaderm Ultra and Juvaderm Ultra Plus are also hyaluronic acid fillers that are FDA approved for cosmetic purposes. Ultra is used on very fine lines, while Ultra Plus, dense and thicker in consistency, is made for the deeper lines and folds of the face. The duration for both is about eight months to one year.


Elevess is a relative newcomer to the field of hyaluronic acid fillers, but it comes in a higher concentration, which adds to its durability. It also contains lidocaine, a local anesthetic that improves patient comfort during injection. Elevess was created to be injected in the mid to deep layers of the skin, thereby alleviating the moderate to severe folds and lines, such as those around the nose and cheeks. Patients with severe allergies should not use Elevess.


This water-based gel with suspended calcium particles is made of a chemical called hydroxylapatite, which is compatible with the bioidentical substance in our bodies. It does not require a skin test. Perfect for facial contouring and for plumping the deep folds of the skin, Radiesse will usually remain in place for ten to fourteen months. Because Radiesse is white in color, it cannot be used in the lips or for fine lines that require injections close to the skin surface. The white color would show through the skin layers.

Cosmoderm and Cosmoplast

Made from purified human based collagen, these fillers are FDA approved and can be injected without a skin test. They come mixed with a local anesthetic, and therefore are less painful to inject. Both fillers are very pliable, which leaves a natural looking result. Cosmoderm works best on the fine lines around the eyes and the vertical lines above the lips. Cosmoplast, a more dense filler, works in the deeper lines of the face and the furrows between the eyes. Although Cosmoderm and Cosmoplast are less expensive than the other fillers, they don't last as long. The collagen is absorbed and wrinkles can return within three to six months.


Collagen is the main protein found in connective tissue, but Artefil comes from bovine collagen, which requires skin testing before it can be injected. The advantage to Artefil is that it contains microscopic spheres that develop a matrix for your own body’s collagen to grow on. Unlike the other fillers that are reabsorbed into the body, this filler is permanent. That’s both the good news and bad news. If you like your result, it’s permanent. If you don’t like your result, it’s still permanent. Artefil is also more expensive than the other fillers.


Different than all the other fillers is Sculptra, made of poly-L-lactic acid. It was created not to fill in wrinkles, but to increase volume in hollow cheeks, sunken eyes and facial folds. Approved by the FDA for medical use, it is most often used in AIDS patients who lose facial contour due to loss of facial fat. This synthetic material lasts up to 2 years, but needs initial maintenance to get an outcome that is satisfactory.


The FDA does not condone Silicone injection for the treatment of facial lines and defects. There is a silicone preparation available to ophthalmologists to be used in the treatment of eye disease, but some doctors use this preparation for treatment of facial lines contrary to the recommendations of the FDA.


Facial fillers have been around for a relatively short period of time. Their biggest drawback right now is their temporary nature. I believe we will see many changes and enhancements in the future. I expect that in the next several years longer lasting, or even permanent fillers will be developed.

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About the Author

Dr. Corwin has been practicing Plastic and Reconstructive Surgery in the Conejo Valley since 1977 and specializes in cosmetic surgery

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Posted on 28/01/09 08:55 by: Scarlett Hara

The new wrinkle fillers are taking the latest of modern science, and creating a smoother, more natural appearance, and help to wipe away the years without surgery. I heard that all new fillers are devoid of any anaesthetic, which is why they can be painful. Is it so?
Posted on 15/04/09 17:13 by: glenn

I had restylene to repair a badly scarred lip. All I can say is that if you are trusting a doctor with your face, you had better make sure that they are also an artist! Mine was not!!
Posted on 02/09/09 18:52 by: Theodore R. Corwin, MD

Answering a couple of questions about my article on fillers. At this time the only filler that comes with a local anesthetic in it is Hydrelle. Juvaderm is talking about adding a local anesthetic to their product. It is possible for the physician to mix a local into the product prior to injecting it.

The other alternative is to give the patient a local antesthetic in the area to be injected. This can be done by injection in the area or by nerve block such as the dentist uses before working on your tooth. As for choosing an injector who is an artist, this is of course an excellent idea.

Injectable fillers are not permanent; if you get a good result this is a bad thing, but if you get a bad result this is a good thing. Seeing a board certified plastic surgeon who deals with aesthetics every day gives you your best chance at a good result.


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