Cosmetic Surgery Guide 2003

Beyond Botox

Fill ’Er Up
So you want Radiance, Artefill, Restylane. Before you tend to those wrinkles, you might want to know the facts first.

Injectable fillers that erase wrinkles are suddenly the bread and butter of every cosmetic dermatologist’s practice, and it seems a new one is being introduced every week. But are they safe? Here’s a crib sheet to the most popular—and controversial—cosmetic substances currently being pumped into New Yorkers.

Silicone
What it is: A carbon-based polymer, derived from glass.
How it’s used: It’s injected in micro-droplets into fine lines, acne scars, and skin depressions, and used to enhance lips. In breast reconstruction, a new generation of silicone implants is being used on a limited basis.
Where it’s used: Popular in South America; less widely used in Europe; less widely used still in America.
FDA status: Silicone has been approved only for correcting detached retinas, not for any cosmetic purpose; it’s being used off-label as a filler while undergoing clinical trials. ln the late eighties, silicone was the breast implant of choice for many women and doctors, but because of thousands of lawsuits charging that the implants leaked and caused autoimmune diseases, it was taken off the market. The new implants are in FDA clinical trials and can be used only by doctors participating in the trials.
Pros: Results are permanent.
Cons: Results are permanent. Injected silicone can migrate to unwanted places or produce persistent nodules or bumps under the skin and are difficult to remove.

Artefill
What it is: Tiny beads of polymethyl methacrylate (PMMA), an acrylic substance, suspended in a bovine-collagen solution.
How it’s used: As a wrinkle-filler and lip-enhancer.
Where it’s used: Started in Germany, now widespread in Europe.
FDA status: Recommended for approval by an advisory panel to the agency. Drug is now under consideration by the FDA.
Pros: The bovine collagen provides immediate benefits to the skin. Meanwhile, the PMMA beads are said to permanently boost your skin’s natural collagen production.
Cons: Granulomas, or hardened scar tissue, can appear six months to two years after injection; requires allergy testing since it’s derived from nonhuman collagen. No one knows what effect the beads will ultimately have on the body.

Radiance
What it is: Microscopic calcium particles (hydroxylapatite) found in bone and teeth, suspended in gel.
How it’s used: As a wrinkle-filler and lip-enhancer.
Where it’s used: In the United States.
FDA status: Not approved for cosmetic use, but approved by the agency for such uses as treating incontinence (by beefing up bladder walls).
Pros: Long-lasting results (from two to five years).
Cons: Patients have reported developing bonelike deposits in places where Radiance was injected. Because it’s a calcium derivative, it can obstruct certain facial and dental X-rays.

Restylane
What it is: Hyaluronic acid (a natural sugar present in the skin).
How it’s used: As a wrinkle-filler and lip-enhancer.
Where it’s used: In France and Canada.
FDA status: Hyaluronic acid was approved for use in ophthalmologic and orthopedic surgery ten years ago, but it is not yet approved for cosmetic use.
Pros: Lasts six months to a year (twice as long as collagen fillers).
Cons: Slightly more painful than other fillers; associated with more bruising and swelling at time of injection (especially lip injections).

CosmoPlast
What it is: Human collagen purified from human fibroblast cells grown in a lab; it’s a new, improved collagen.
How it’s used: Wrinkle-filler and lip-enhancer.
Where it’s used: In Europe, South America, and the United States.
FDA status: Approved for cosmetic use.
Pros: Allows for single-visit, same-day treatment.
Cons: Like collagen, it dissipates quickly, sometimes in as little as three months.