These are temporary substances that can be injected to fill in areas of tissue loss or deeper folds in the face. Collagen is mostly used in the middle and lower third of the face like the nasolabial fold, marionette lines, and wrinkles around the lips, forehead, and eyes that fail Botox treatment.
Before and after injection of the nasolabial fold
History
Soft tissue filler have been around for over 100 years. Initially blocks of fat were taken from the arms and used for sunken facial defects. Later bovine collagen was invented and was the most popular filler until 2003 when hyaluronic acid fillers like Restylane became available.
FDA approved collagen products
The most popular collagen products include the Zyderm family from a bovine (cow) source and the Cosmoderm family from a human source. The Zyderm family includes Zyderm I, Zyderm II, and Zyplast. Zyderm I is the thinnest form and is used for superficial wrinkles or to layer over a thicker filler. Because much of Zyderm I is salt water which diffuses out of the area, more of this filler must be injected to overcorrect the area as it will flatten out later. Zyderm II is thicker and more concentrated and is used for deeper folds or wrinkles. It also should be injected to overcorrection. Zyplast has the longest effect, 3 months longer than the other products. It is placed deeper in the skin to treat deep folds. No overcorrection is necessary. Allergic reaction can be avoided by performing a skin test, looking for abnormal swelling, redness, itching, and tenderness at the site. If the first skin test is negative, then a second test is done 2 weeks later. If the second test is negative, then treatment can be done 2 weeks after that.
The human collagen formulations need no skin testing. Cosmoderm I, Cosmoderm II, and Cosmoplast are used in the same way as Zyderm I, Zyderm II, and Zyplast.
Patient Selection
The kind of defect, its size, depth, and location, and the health of the surrounding tissue must be taken into consideration. The patient should be aware of other treatment options such as plastic surgery, laser resurfacing, and Botox. The procedures benefits and risks of each option should be understood. Patients especially need to be aware that collagen filler injection is temporary and will need to be repeated to maintain the effect.
Treatment guidelines
Patients should avoid any blood thinning medication for 1-2 weeks before treatment, to avoid bruising. Treatment areas should be photographed. Then areas should be cleaned with an antiseptic. Anesthesia can be given as a cream that is left on for 20-30 minutes, then removed, or as an injected nerve block. Patients should be sitting up so that gravity will make their folds more prominent. The filler is then injected, the area massaged and ice applied to decrease swelling and bruising. Patients can then reapply make up and resume normal activities.
Indications
Crow’s feet, (the wrinkles radiating out from the outer corners of the eyes), and lipstick lines, (wrinkles spreading from the lips), can be treated with Zyderm I or Cosmoderm I. Lines on the brow and forehead can be treated with Zyderm I or II or Cosmoderm I or II. The mouth corners, lip borders, and nasolabial folds need the thicker products like Zyplast or Cosmoplast. Soft scars from injection or acne can get any type of collagen. However the thickest fillers Zyplast and Cosmoplast must not be used in the glabellar area (between the eyebrows). This can lead to blood vessel blockage and necrosis of the skin.
Skin necrosis
Scars
Fillers can be used for nonice pick shallow scars, 1-2 mm deep. For thin skin Zyderm or Cosmoderm can be used. For males with thick skin, Zyplast or Cosmoplast is needed.
Lip augmentation
Lip enhancement is one of the most frequent uses for fillers. Patients may complain of thinning lips, lipstick or smoker’s lines, and drooping mouth corners. Patients with recurrent herpes infections will require antiviral medications to prevent herpes reactivation that can occur with filler injection. The thickest collagen is used for adding definition to the lip border, and bolstering the angles of the mouth. For adding volume to the lips and treating lipstick lines, thinner fillers like Zyderm I and II or Cosmoderm I or II are used.
The Nasolabial fold
Smile lines, folds that run from the nose to the mouth corners, are often addressed by fillers. Thicker substances like Zyplast or Cosmoplast are used.
Before and after treatment of the nasolabial fold and the melomental folds
Soft tissue filler have been around for over 100 years. Initially blocks of fat were taken from the arms and used for sunken facial defects. Later bovine collagen was invented and was the most popular filler until 2003 when hyaluronic acid fillers like Restylane became available.
FDA approved collagen products
The most popular collagen products include the Zyderm family from a bovine (cow) source and the Cosmoderm family from a human source. The Zyderm family includes Zyderm I, Zyderm II, and Zyplast. Zyderm I is the thinnest form and is used for superficial wrinkles or to layer over a thicker filler. Because much of Zyderm I is salt water which diffuses out of the area, more of this filler must be injected to overcorrect the area as it will flatten out later. Zyderm II is thicker and more concentrated and is used for deeper folds or wrinkles. It also should be injected to overcorrection. Zyplast has the longest effect, 3 months longer than the other products. It is placed deeper in the skin to treat deep folds. No overcorrection is necessary. Allergic reaction can be avoided by performing a skin test, looking for abnormal swelling, redness, itching, and tenderness at the site. If the first skin test is negative, then a second test is done 2 weeks later. If the second test is negative, then treatment can be done 2 weeks after that.
The human collagen formulations need no skin testing. Cosmoderm I, Cosmoderm II, and Cosmoplast are used in the same way as Zyderm I, Zyderm II, and Zyplast.
Patient Selection
The kind of defect, its size, depth, and location, and the health of the surrounding tissue must be taken into consideration. The patient should be aware of other treatment options such as plastic surgery, laser resurfacing, and Botox. The procedures benefits and risks of each option should be understood. Patients especially need to be aware that collagen filler injection is temporary and will need to be repeated to maintain the effect.
Treatment guidelines
Patients should avoid any blood thinning medication for 1-2 weeks before treatment, to avoid bruising. Treatment areas should be photographed. Then areas should be cleaned with an antiseptic. Anesthesia can be given as a cream that is left on for 20-30 minutes, then removed, or as an injected nerve block. Patients should be sitting up so that gravity will make their folds more prominent. The filler is then injected, the area massaged and ice applied to decrease swelling and bruising. Patients can then reapply make up and resume normal activities.
Indications
Crow’s feet, (the wrinkles radiating out from the outer corners of the eyes), and lipstick lines, (wrinkles spreading from the lips), can be treated with Zyderm I or Cosmoderm I. Lines on the brow and forehead can be treated with Zyderm I or II or Cosmoderm I or II. The mouth corners, lip borders, and nasolabial folds need the thicker products like Zyplast or Cosmoplast. Soft scars from injection or acne can get any type of collagen. However the thickest fillers Zyplast and Cosmoplast must not be used in the glabellar area (between the eyebrows). This can lead to blood vessel blockage and necrosis of the skin.
Skin necrosis
Scars
Fillers can be used for nonice pick shallow scars, 1-2 mm deep. For thin skin Zyderm or Cosmoderm can be used. For males with thick skin, Zyplast or Cosmoplast is needed.
Lip augmentation
Lip enhancement is one of the most frequent uses for fillers. Patients may complain of thinning lips, lipstick or smoker’s lines, and drooping mouth corners. Patients with recurrent herpes infections will require antiviral medications to prevent herpes reactivation that can occur with filler injection. The thickest collagen is used for adding definition to the lip border, and bolstering the angles of the mouth. For adding volume to the lips and treating lipstick lines, thinner fillers like Zyderm I and II or Cosmoderm I or II are used.
The Nasolabial fold
Smile lines, folds that run from the nose to the mouth corners, are often addressed by fillers. Thicker substances like Zyplast or Cosmoplast are used.
Before and after treatment of the nasolabial fold and the melomental folds
Periocular lines
Many of the wrinkles around the eyes are etched in lines from constant folding of the skin by underlying muscle. Therefore, Botox is usually the first treatment to stop or freeze these movements. But any of the wrinkles that persist can be addressed with the thinnest fillers like Zyderm I or Cosmoderm I. Often after Botox treatment wrinkles may persist in the area between the eyebrows. Zyderm I and Cosmoderm I may be used, but Zyplast and Cosmoplast can absolutely not be used here.
Complications
In general, improvements with fillers last about 3-6 months. Allergic reactions can occur. Bruising can occur. If the filler is placed too superficially, lumps or nodules can occur. Placing fillers too deep could result in blocking a blood vessel leading to skin tissue damage. When a filler is injected into a blood vessel, the skin may whiten and generate sharp pain. Heat and nitroglycerin paste can help open up the blood vessels and salvage some skin.
Even after negative skin tests, there is a 1% chance of developing an allergic type reactions after collagen injection. There may be a swollen nodule formation that would take a year to resolve. Nonsteroidal anti-inflammatories, steroids, and other immunologic medicines can help. Sterile abscesses can also form and are treated with drainage, steroid injections, and antibiotics. Scarring can occur.
Many of the wrinkles around the eyes are etched in lines from constant folding of the skin by underlying muscle. Therefore, Botox is usually the first treatment to stop or freeze these movements. But any of the wrinkles that persist can be addressed with the thinnest fillers like Zyderm I or Cosmoderm I. Often after Botox treatment wrinkles may persist in the area between the eyebrows. Zyderm I and Cosmoderm I may be used, but Zyplast and Cosmoplast can absolutely not be used here.
Complications
In general, improvements with fillers last about 3-6 months. Allergic reactions can occur. Bruising can occur. If the filler is placed too superficially, lumps or nodules can occur. Placing fillers too deep could result in blocking a blood vessel leading to skin tissue damage. When a filler is injected into a blood vessel, the skin may whiten and generate sharp pain. Heat and nitroglycerin paste can help open up the blood vessels and salvage some skin.
Even after negative skin tests, there is a 1% chance of developing an allergic type reactions after collagen injection. There may be a swollen nodule formation that would take a year to resolve. Nonsteroidal anti-inflammatories, steroids, and other immunologic medicines can help. Sterile abscesses can also form and are treated with drainage, steroid injections, and antibiotics. Scarring can occur.
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