Temporary

Collagen serves to provide structural support for bones, skin, tendons, and blood vessels and lends stability to the body’s tissues. With age, the body’s collagen weakens and loses its elasticity, leading to, among other effects, the various signs of aging. The main sources of collagen for this purpose are bovine, porcine, and human. Bovine collagen is very similar to the human molecule, with specific differences only in the end peptides (telopeptides). These regions can be removed in processing, leaving a core protein similar to that of a humans [9] (Table 6.3).

Table 6.3. Temporary fillers   Implants   Indications   Treatment   Complications and potential adverse reactions   Zyderm Bovine dermal alcollagen dispersed in phosphate-buffered conphysiological saline containing 0.3% lidocaine   FDA-approved for the cor rection of facial rhytids, scars, and lip augmentation [10, 17]. The low-concentration filler is used to treat fine lines, rhytids, shallow scars, and thin-skinned areas, and the high-concentration filler is used to treat moderate lines, rhytids, and scars [15]   Injected intradermally. Infiltrated into the superficial papillary dermis. Requires second skin test on the contralateral arm [15]. Topical anesthesia may be required. Overcorrection is mandatory because water in the suspension is reabsorbed within 24 h after injection [10]. The average longevity of both fillers is 3–6 months [10, 18]   Bovine collagen may induce an allergic reaction [10]   Zyplast Bovine collagen cross-linked with glutaraldehyde and suspended in saline and 3 mg/ml lidocaine   FDA-approved for the correction of facial rhytids, scars, and lip augmentation [10, 17]. Often, this filler is used as a foundation in the nasolabial folds or oral commissure with non-cross-linked bovine collagen is also used to enhance the vermilion border, but it should be avoided in treatment of fine lines or in the glabella [18]   Placed into the midreticular or deep reticular dermis at the dermal subcutaneous interface. Requires second skin test on the contralateral arm. Topical anesthesia may be required. Overcorrectionis mandatory because water in the suspension is reabsor bed within 24 h after injection [10]   Bovine collagen may induce an allergic reaction [10]   CosmoDerm Human-based collagen isolated from human fibroblas tcell cultures   Used for superficial skin defects [4]. FDA-approved for rhytids and scars [17]   May require pretreating with topical anesthetic cream [9]. Allergy test not required. Longevity is generally 3–6 months   Short-term complications may include mild swelling, erythema, bruising, and rarely, palpable lumps [9]   CosmoPlast Human-based collagen cross-linked with glutaraldehyde   Reserved for deeper lines but can be used off-label for the lips. FDA-approved for rhytids and scars [17]   May require pretreating with topical anesthetic cream [9]. Because of the low incidence of sensitivity, an allergy test is not required. Longevity is generally 3–6 months   Short-term complications may include mild swelling, erythema, bruising, and rarely, palpable lumps [9]   Restylane Hyaluronic acid derived from bacterial biofermentation process   Perlane: 20 mg/ml stabilized hyaluronic acid with approximately 10,000 gel particles/ml is recommended for nasolabial folds and lips (fullness and pouting)   Perlane: Injected into the deep layer of the dermis and/or surface layer of the subcutis   Temporary skin reactions [23], including redness, swelling, localized granulomatous reactions, bacterial infection, acneiform, and cystic lesions. Hypersensitivity, although declining after introduction of more purified hyaluronic acid raw material [24].However, no long-range problems [9]       Restylane: 20 mg/ml stabilized hyaluronic acid with approximately 100,000 gel particles/ ml is recommended for rhytids such as glabellar, oral commissures. Lips: fullness, pouting, and vermilion border   Restylane: Injected into the mid part of the dermis         Restylane fine lines: 20 mg/ml stabilized hyaluronic acid with approximately 200,000 gel particles/ml is recommended for thin superficial lines, such as worry lines, periorbital lines, perioral lines   Restylane fine lines: Injected into upper part of the dermis         FDA-approved [9]   None of the three should be overcorrected.Various injection techniques apply, depending on the type of correction and product used. These techniques include linear threading, serial puncture, fanning, and cross-hatching [23]     Juvederm [18, 24, 30] Viscoelastic, includnonanimal hyaluronic acid gel   18 mg/g, designed for the superficial dermis, specifically for fine lines and rhytids 24 mg/g, designed for the mid dermis, specifically for deeper rhytids 30 mg/g, designed for the mid to deep dermis, specifically for deeper furrows such as nasolabials and for lip and cheek augmentation. Not available in the USA. Outside the USA, approved for a wide range of facial applications, from lip augmentation and superficial lines to frown lines and deep rhytids [25]   The first is designed for injection in the superficial dermis, the second is designed for injection in the mid dermis, and the third is designed for injec tion in the mid to deep dermis. Not permanent. Eventually absorbs into the body; typical Hypersensitivly last 3–6 months.   Temporary skin reactions [23] including redness, swelling, localized granulomatous reactions, bacterial infection, acneiform, and cystic lesions. Hypersensitivity, although declining after introduction of more purified hyaluronic acid raw material [24].However, no long-range problems [9]   Hylaform Viscoelastic hyaluronic acid gel from rooster combs   FDA-approved for cosmetic use   May require local anesthetic or a regional block for pain. May require skin testing because of avian source. Immediate results, effect lasts 2–3 months [17]   Delayed inflammatory skin reactions have been reported [23]   Sculptra/New-Fill Poly-L-lactic acid   FDA-approved for use in absorbable suture material and treatment of HIV-associated lipoatrophy. FDA approval pending for the treatment of fine lines, rhytids, and more marked furrows or creases, as well as for the augmentation of the tissue volume in certain areas of the face (cheek bones, cheek depressions, chin, etc.) [17]   Correct placement in the deep dermal and/or deep dermal subcutaneous plane is important; too shallow and visible nodules and/or blanching of the skin occurs [26]. Takes effect in 4–6 weeks, lasts 12–18 weeks [17]   Infection, allergic reaction, and inflammatory granulomas [27]   Poly-L-lactic acid           Injection site reactions. Rare, nonvisible nodules [17]