Anyone remember the movie First Wives Club? Or, more to the point, the image of Goldie Hawn after having collagen injected into her lips? She really did a pretty good imitation of a duck billed platypus with swollen lips to the max. Truly this was a parody of the earlier days of injectable fillers, but we’ve come a long way since then. Let’s have a look back.
In The Beginning
First came Zyderm and Zplast (this is what Goldie got). This was actually first used in the late 1970’s. It is collagen from a bovine origin (you know, beef, what’s for dinner). The products were the first widely used and well tolerated products to be used as fillers. However, since they were a foreign protein (foreign to the human body, that is) you needed a skin test to make sure you weren’t allergic. And they did have a lot of swelling associated with them. Also, they didn’t last all that long.
A Big Advance
The next advance didn’t come until 2003, when Inamed (what McGhan became before they were acquired by Allergan) developed a human form of collagen, Cosmoplast and Cosmoderm. These were great products and a real advance over the bovine collagen because no skin test was required. Although these are not used as much these days, they still are very good fillers. They just don’t last as long as we would like.
The Game Changer
Enter Hyaluronic acid. This is a natural polysaccharide that is a part of our bodies. Hyaluronic acid fillers are produced in the lab and are compatible with all of us. No skin testing is needed, and it lasts longer than collagen. Much longer. Medicis corporation was the first kid on the block in this country with Restylane which debuted in 2003. It became pretty big in a hurry because of it’s longevity when compared to collagen.
Allergan was once again heavily in the game with the introduction of Juvederm in 2007. Juvederm, like other hyaluronic acid (HA) fillers, is available in different thicknesses to work better in certain areas and perhaps last a little longer (i.e. Juvederm Ultra, Juvederm Ultra Plus).
Currently we are using several different HA fillers as some are better in some areas for some people. The latest improvement on this has been to add lidocaine, or a local anesthetic to the filler, as in Juvederm XC. This happened in 2010 and has made the whole process easier.
A Different Kind Of Filler For Certain Areas
There is also another class of fillers which are considered semi-synthetic. These contain synthetic (non-organic) materials mixed with an organic matrix. We use Radiesse, which contains micro sphere of hydroxyapatite in a gel carrier. Radiesse has the advantage of lasting longer than the HA’s. However, it is thicker and must be used in areas where the tissue is thicker (never the lips). Semi-synthetic fillers are not for everyone, in the right places they’re great.
*Read note below.
Another Big (and Recent) Advance
One of the greatest advances with fillers in terms of both safety and comfort has had nothing to do with the injected product, but what we inject it through. Formerly we all used needles. However, there has been a move to use blunt flexible cannulas because they are safer, and we have found them to be much more comfortable and to have less bruising. Yes, they may cost a bit more but, boy, are they worth it.
What comes next? Don’t really know. But the products that we now have are quite good and quite easy to access. Anything that will receive as wide acceptance as these will need to be as easily used and as easily accessed. We’ll keep our eyes open and let you know what we come across.
All the best,
Dr. David Reath
*Note: Since this post was written back in 2012 a new filler has come on the market which we are using instead of Radiesse. It’s called Juvederm Voluma and we have a special page on our website dedicated to it.