For many years doctors have been seeking methods to deal with small scars and aging lines that are not severe enough to require surgery. A number of injectable fillers have been developed for this purpose. In our practice, we primarily offer two options: Restylane® and microdroplet injectable silicone.
A number of new fillers are currently in the process of FDA approval. All of them claim to be either more effective or less expensive than Restylane®. However, in spite of manufacturer’s claims or glowing testimonials made by doctors who are supported by the manufacturer, it takes years before these products can be adequately evaluated. Therefore, we are reluctant to utilize these new products until they have been more thoroughly evaluated over a period of time.
Of course, if proven, we will begin to offer any products that we feel can provide a significant advantage over the ones with which we have experience.
At our Center, Restylane® is primarily used to treat fine lines of the face and to fill small defects such as grooves between the cheek and upper lip. It is also useful to correct defects beneath the lower eyelid.
Usually 1 to 4 c.c.s of the material will be utilized at each treatment session, which takes approximately thirty minutes. Anesthesia is not required although some patients will have a topical skin anesthetic applied. Restylane® has a local anesthetic mixed with the hyaluronic acid which tends to numb the injection site. Patients may return to normal activity when leaving the office. Make-up may be applied three hours after implantation. Injections can be carried out at our Center or during one of our out-of-town visits.
Inevitably, more than one injection session is requested, but patients may choose when they wish to resume the treatment after seeing the results. Results typically seem to last around six to eight months, but this is quite variable. Although not permanent, Restylane® can be effective for the treatment of many fine lines and depressions of the face, especially when the problem is treated early or not of sufficient magnitude to warrant consideration of surgery or laser resurfacing.
MICRO-DROPLET SILICONE INJECTION
In past years, tiny amounts of liquid silicone were commonly injected as a filler with a high degree of success. Because of problems related to injection of larger amounts of silicone, the FDA banned the procedure. This was unfortunate, because when used properly, silicone was probably the safest and most effective soft tissue filler available.
Recently, the FDA approved the use of injectable silicone for certain cases of retinal detachment. This approval has paved the way for the renewal of micro-droplet silicone injection therapy as an off label use of an approved device. This allows patients and their physicians to use their discretion in the use of the device for a purpose not intended by the manufacturer.
Tiny amounts are injected on a monthly basis until the desired results are obtained. Usually four to eight treatments are required. It is not really the silicone that leads to the enlargement. What happens is this: Each micro-droplet of silicone that is injected stimulates the development of collagen that surrounds the silicone droplet. Much as a grain of sand in an oyster leads to the formation of a pearl, the silicone induced collagen production is what leads to the filling or enlargement. For this reason, it is essential to wait several weeks between each injection session since it is hard to predict the exact amount of collagen formation that will take place. A full treatment program can take from three to twelve months.
In our practice, silicone has primarily been used for lip augmentation, but it can be used to fill depressed scars, lines, crevices or post surgical depressions. While treatment is slow, the results are permanent, and when used properly, in our opinion, it offers a very high degree of safety and effectiveness. •