Dermal fillers: new face lift?


Fillers are face lift alternative By her early 50s, Dorene Polcyn was growing weary of her battle against Father Time. Every six weeks, she would drive to her dermatologist's office and plop down $375 for an injection of collagen to fill in and smooth away wrinkles on her face.

"The collagen didn't last that long. And I was tired of the expense," she says.

Then, in 1998, Polcyn entered a clinical trial for a long-lasting wrinkle-filler called ArteFill. The difference was striking. Eight years later, she's only recently had to return to her doctor for fresh treatment - and then just to fill in new wrinkles that have cropped up in the meantime.

"It seems like we stopped the clock," says the 60-year-old resident of Woodland Hills, Calif. "I love it. I have so many friends who want it."

Dermal fillers - injected substances that plump up crevasses, wrinkles and depressions in the skin - have already been encroaching on the venerable face-lift's turf. Now a new generation of longer-acting fillers may turn the temporary fixer-upper, collagen, into a cosmetic dinosaur.

With the Food and Drug Administration set to decide this summer whether to approve ArteFill, the first so-called permanent dermal filler, consumers may shortly have the cosmetic fix of their dreams: a treatment that fills a wrinkle and keeps it filled - for years.

If approved, ArteFill will join several other longer-lasting wrinkle eradicators, such as Radiesse, a "semi-permanent" filler that is approved for use in vocal cord defects and is already being used off-label by doctors to fill wrinkles.

Now its maker is seeking FDA approval to market the injectable substance for cosmetic use. Sculptra, another long-lasting filler made of synthetic materials, is also being used off-label for treating wrinkles.

And Juvederm - a filler made of hyaluronic acid - was approved last month for use. Unlike previous hyaluronic acid fillers, which last about six months, Juvederm is said to last at least six months and up to a year.

The appeal of these remedies is obvious. "For many patients, permanent is what they're looking for," says Dr. Douglas Hamilton, a Los Angeles area dermatologist who participated in the early clinical trials of ArteFill. "They don't want to keep coming back."

The rise of long-lasting dermal fillers could further energize a market that has already superbly captured America's anti-aging obsession. Demand for shorter-term fillers has skyrocketed in the past few years, despite the cost and inconvenience.

The number of injections for the most popular type, hyaluronic acid, soared 35 percent from 2004 to 2005, according to the American Society for Aesthetic Plastic Surgery. It is now the third most popular nonsurgical cosmetic procedure in the United States.

Long-lasting fillers may also hasten the trend away from face-lifts, which declined in popularity for the first time in 2005, according to the society.

The new dermal fillers fulfill several needs: They last much longer - at least one year compared with three to six months for the earlier generation of fillers. That ends up being more cost-effective for consumers watching their wallets. And they can be used for deeper facial lines and depressions and to add volume to sunken cheeks or smooth a bumpy nose.

But the expanded uses and addition of long-lasting fillers have raised concerns among some doctors. They say that the marketplace is rife with inexperienced practitioners, injection "parties" in nonmedical settings and counterfeit products - all of which could lead to botched work including long-lasting, ugly results such as lumpiness or lopsidedness.

Even when injected properly, long-lasting fillers are not easy to remedy should the consumer suffer a bad reaction or dislike the result. Moreover, no one really knows how long-lasting fillers will look years later as the face continues to age.

"The field is expanding and is getting more complex," says Dr. V. Leroy Young, a St. Louis plastic surgeon and chairman of the nonsurgical procedures committee for the American Society for Aesthetic Plastic Surgery. "People have to be very sure when they sign up that they understand the risks and benefits and what the alternatives are and how they all compare."

Dermal fillers can consist of human fat, human collagen, bovine collagen, hyaluronic acid (found naturally in the body's connective tissue), synthetic substances or combinations of those materials.

The older, short-acting fillers are made of natural products such as collagen and fat that are quickly absorbed by the body. The new long-acting fillers mostly rely on synthetic materials for that extra durability.

ArteFill, for example, consists of tiny synthetic spheres made from polymethylmethacrylate, a substance used in some types of medical implants, suspended in a bovine collagen gel.

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