For years, women, and – to a lesser extent – men also, have sought a means to treat facial lines and surface depressions with a non-surgical technique. The many products available serve as testimony to the fact that the perfect solution has yet to be discovered.
First, we must differentiate between the surface lines that result of aging or degeneration of the skin from those that result from skin laxity. In the latter case, face lifting remains the treatment of choice. Just the same, fillers are being used more and more with varying reports of success.
FACIAL LINES AND FAT REPLACEMENT
The current rage for deep filling to replace subcutaneous tissue lost due to aging requires the injection of the patient’s own fat. Attempts at fat grafting over the years have failed to demonstrate a great deal of long term success. But the advent of liposuction renewed interest in this technique, since the fat was being removed anyhow.
Small amounts of fat, extracted with liposuction techniques, are reinjected into the subcutaneous tissues to plump up the skin. Proponents claim that the procedure is very technique sensitive. But there is no single technique that is universally recommended. Even the most optimistic reports admit to significant absorption with the need for repeated treatment. Nonetheless, the procedure has gained popularity over the past few years.
Our experience at the Facial Plastic & Cosmetic Surgical Center shows us that most of the transplanted fat is absorbed over a period of time. Still, we still have requests for the procedure.
Zyderm Introduced in Mid ’70s
Zyderm®, a form of injectable collagen derived from cowhide, enjoyed wide popularity after its introduction in the mid-1970s. While admittedly temporary, Zyderm® boasts a very high safety record. The product, which has a reputation for being easy-to-use, also has little patient discomfort. Some patients are allergic to the material. But they can quite effectively be screened out if two successive skin tests are carried out prior to treatment. The manufacturer’s claim of 6 months’ duration seems overly optimistic. But just the same, many patients choose this form of treatment.
Some patients experience allergic symptoms. To reduce allergy and increase the effective duration of treatment, makers introduced a host of alternative injectables over the years. Included in the list: Artecoll®, Hylaform®, Restylane®, and Dermalogen®, to mention only a few. Many of these products are still not approved by the Food and Drug Administration. Accordingly, they are not generally available in the United States. None have been widely accepted.
Silicone Microdroplet Injection Therapy
Some problems have resulted from injection of large amounts of liquid silicone when used as a tissue filler for facial lines. But the injection of small amounts in a controlled fashion proved to be a very successful and permanent filler. The procedure is technique sensitive and must be used carefully. Still, years of experience, including our own, have resulted in excellent results with minimal problems. It is very well suited to lip augmentation and soft tissue filling. Small nasal defects can be corrected. This often does away with the need for secondary surgery following less-than-ideal rhinoplasty results.
In 1992, the FDA banned the use of injectable silicone when it stopped the use of silicone gel filled breast implants. Patients requesting treatment besieged surgeons who had been using the material with good results. Recently, the FDA approved the use of injectable silicone for certain cases of retinal detachment. This stimulated renewal of microdroplet silicone injection therapy as an off-label use of an approved device. Patients and their physicians use their discretion in applying the device for a purpose not intended by the manufacturer.
One of the most popular uses of silicone microdroplet injections is for lip enlargement. Tiny amounts are injected on a monthly basis until the desired results are obtained. Usually four to eight treatments are required. For additional information see our article on lip augmentation.
Botox® For Facial Lines
Injections of Botox® remain popular for the treatment of expressive lines. Like silicone, this represents an off-label use of a drug that has been approved for spasmodic facial contractions. While excellent for expressive lines, it does not treat lines that are present at rest. Accordingly, it answers quite different conditions than those treated by fillers. Botox® injections are commonly used around the eyes, in the forehead, between the eyes (for frown lines), and, less commonly, for lip lines and neck bands.
Alloderm® for Facial Lines
Alloderm®, a material processed from human skin, is rendered immunologically inert by removing the antigenic targets that can lead to rejection. The material is made inert. But it retains the properties of human dermis. Unlike fat injections or Collagen, both of which are largely absorbed, AlloDerm® appears to remain intact to a significant degree when implanted in the body. While there is some absorption, much of the material persists. Unlike other fillers, Alloderm® is not injected but must be surgically implanted. For additional information see our article on lip augmentation.
Resurfacing – Laser and Other Techniques
Fillers offer the prospect of reducing facial lines without major surgery. But their use is limited, as discussed above. Resurfacing with laser treatment remains an excellent choice for those seeking more and longer-lasting improvement. As we have gained experience with the use of the carbon dioxide laser, risks are minimized. Patients heal well, usually within eight to ten days. Furthermore, the combination of facelifting with laser resurfacing allows us to address all the features of aging with a single combined procedure.
Lighter techniques of resurfacing, such as light peels, microdermabrasion, and newer less invasive laser techniques, work for facial line treatment. But they generally offer only temporary improvement. The carbon dioxide laser remains the gold standard for permanent resurfacing.