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Implants, also called injectable fillers, are becoming a common means of erasing wrinkles and folds. Several materials are being used for deep wrinkles, depressions under the eyes, lip enhancements, and acne scars.
After being banned from the market in 1992, silicone is making a comeback in research settings as a potential permanent wrinkle eraser. Scientists are looking into a new microdroplet technique (the use of very small drops) combined with purified silicone as a way to eliminate any danger. The past problems with silicone occurred when it was mixed with a foreign substance, such as mineral oil, or when it was injected in large doses.
The U.S. Food and Drug Administration (FDA) approved the Juvederm product line in June 2006. Juvederm is an injectable treatment for moderate-to-severe facial wrinkles and folds. Juvederm products are gels made from hyaluronic acid. They are injected into the face. Doctors report good results after a single treatment with Juvederm, and the results last for at least 6 months.
Most implants to date are not completely satisfactory. Collagen implants and biologic fillers from animal, bacterial, or human sources do not provide long-lasting benefits. Synthetic fillers are permanent but may cause an allergic reaction, which can lead to chronic problems. Such reactions are rare, but they can be painful and unattractive. In 2008, the FDA recommended that women be informed of the health risks from cosmetic fillers such as Restylane, Juvederm, Artefill, and Perlane. These risks can include allergic reactions, swelling, pain, blisters, and cysts.
|Name and Material Used||Procedure||Specific Areas Affected||Benefits||Drawbacks|
Collagen implants. Collagen is the protein that forms the structures in the body (such as skin, bones, or cartilage).
The implant procedure has typically used bovine (cow) collagen. A form of human collagen (CosmoDerm, CosmoPlast) has been approved.
Injected into target wrinkles with needle and syringe. Several weeks after injection, cow collagen breaks down and is replaced by newly created human collagen.
Wrinkles around the eyes and mouth. It is used to give lips greater fullness.
Very simple, with faster recovery than many other implant techniques.
Wrinkles form again, and require repeat treatments 3 - 12 months later. Rarely, severe allergic reactions occur. Should not be used by children, pregnant women, and people with a history of autoimmune disease.
Microlipoinjection. Fat tissue from the patient's own thigh or abdomen.
Injected into target wrinkles with needle and syringe.
Deep wrinkles around the nose and mouth, folds in the forehead, and wrinkles on the hands.
No allergic or immune reaction because substance is patient's own fat.
Body eventually absorbs the fat, resulting in a need for multiple injections. Some studies suggest that 70% of the fat may still be in place after at least a year.
Gore-Tex. Highly porous (full of tiny holes) and inert (not chemically active) synthetic material.
Requires some surgery. Tiny patches are inserted under the skin to fill out wrinkles. Skin cells and blood vessels pass through the porous material easily, reducing the risk of severe irritation.
Material does not break down.
Possible scarring from surgical procedure. Allergic reactions are rare but can occur even with chemically inactive materials.
Artecoll. Contains PMMA, or polymethylmethacrylate, an inert substance, enclosed in tiny droplets of natural collagen.
Material is injected. Body absorbs collagen. PMMA remains and stimulates new collagen growth.
Although part of the implant is a natural collagen implant, it does not degrade as quickly as a full collagen implant.
Repeat treatments may still be needed. Possible allergic reaction.
Hyaluronic acid. Natural (non-animal) substance acts like a molecular sponge to absorb water. Treatments include Restylane, Captiva, Hylaform-Plus, Hylaform, and Juvederm.
Gel is injected under the skin.
Low risk for allergic reaction. May last longer than cow collagen.
Repeat treatments needed.
Poly-L-lactic acid. Synthetic polymer. Approved in U.S. as Sculpta. Approved in other countries as New-Fill.
Material is injected under the skin.
Approved in U.S. only for patients with facial fat loss due to HIV. Approved in other countries for wrinkles.
Low risk of allergies. Treatment effects can last 18 - 24 months.
Doctors require special training.
The popularity of Botox injections has skyrocketed in the United States. Botulinum, the deadly toxin found in uncooked foods, is also a powerful muscle-relaxant. Tiny amounts of a purified form (Botox) are injected into wrinkles to relax the surrounding muscles. Botox may help with forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. Botox is also useful for treating involuntary muscle movements that can occur after a face-lift.
The injections need to be repeated every few months, because the effects wear off. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. When used for areas around the eyes, it produces a rounder appearance, which patients should be aware of before they undertake the procedure.
The drug does not cross the blood-brain barrier, and, to date, the only side effects reported have been temporary muscle weakness near the injection site. However, the FDA has warned that in rare cases, the toxin can spread beyond the injection site and cause potentially fatal side effects. Most of the adverse reactions involved patients taking Botox for therapeutic, rather than cosmetic reasons.
Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also causes headaches in about 1% of cases. In some cases, the headaches can be very severe and long lasting (from 8 days to a month). Some researchers suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.
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