July 29, 2004 (New York) -- Wrinkle fillers that erase the signs of aging are getting better all the time, say experts speaking at the annual meeting of the American Academy of Dermatology.
Along with collagen and the recently FDA-approved fillers including Hylaform and Restylane, a slew of new fillers -- some which last years instead of months -- are being investigated both here and abroad, says Leslie Baumann, MD, an associate professor clinical dermatology ay the University of Miami in Florida.
Wrinkles result from the loss of three skin components: collagen, hyaluronic acid, and elastin, she explains. "Today, we can replace two of these components [collagen and hyaluronic acid] that are lost as skin ages," she says. "While there are no elastin fillers, some products are being developed that may stimulate elastin."
One thing is for certain, "we have a lot more paints on our palates," she says.
The Pipeline Is Bursting
Called Juvederm in Europe, one new filler is a long-lasting gel that, once injected into the skin with an ultrafine needle, lifts and adds volume. Like Restylane and Hylaform, this gel is made from hyaluronic acid. It is unclear what the product will be named if it is approved in the U.S.
According to preliminary studies, this filler causes less tissue injury, less inflammation, and fewer damaging free radicals when compared with other fillers. Free radicals break down hyaluronic acid, so the results of Juvederm may last longer, she explains.
Baumann says European dermatologists have said it can last up to 15 months. Trials have just begun in the U.S., she adds.
Slow and Steady Wins the Race?
Another type of filler, called Sculptra, is known as a dermal stimulator because it stimulates the skin's dermis layer to make more collagen.
An advisory panel to the FDA has recommended approval of this product for use as an injectable filler to reconstruct HIV patients suffering from loss of facial fat that makes them appear ill. This is a common side effect of some medications used to treat HIV.
Sculptra does not offer immediate gratification, Baumann says. "It provides a slow correction as it is injected and gets the skin's fibroblast cells to make more collagen," she explains.
"There is no immediate difference. You have to wait for the product to work, and it can take about a week," she says. Currently, people receive this treatment once a month for four months, and the results can last up to two years.
"If you use it in combination with hyaluronic acid and collagen fillers, it would solve the problem of no immediate gratification," she says.
"The Europeans feel it's really effective for cosmetic benefit as well as facial wasting in AIDS patients," says Bruce E. Katz, MD, the medical director of the JUVA Skin and Laser Center in New York. Katz spoke on the future of wrinkle fillers at the meeting.
"I have seen impressive results, but it does require a series of treatments and it takes time for results to be seen," he says.
Another filler coming down the pike is Artecoll. It is made from a mixture of small microspheres of a chemical called polymethymethacrylate, or PMMA, and collagen. It augments the tissue under the upper layers of skin, giving a smooth appearance to wrinkles. "It is actually approved in Canada," Katz says. "It is supposed to last three or four years, but a lot of colleagues have seen reactions." Reactions can include long-lasting granulomas, a solid group of inflammatory cells that sometimes form a visible lump under the skin.
"A lot of us feel it should not be approved until we know what is going on with it," Katz says.
It is approved for treating vocal chord paralysis, but it is also used as a wrinkle filler, he says. It can last anywhere from two to five years, research suggests.
Looking to the future of wrinkle fillers, Katz says that "the ideal filler is one that doesn't need skin testing and is long lasting, but not permanent," he says.
"You wouldn't want one that lasts longer than three to five years because as people age, our skin thins out and features change, so you would see lumps and bumps and mounds of tissues," he says.
"If someone has huge cheekbones and their face shrinks, they look distorted," Katz says. "Semi-permanent is the way to go."
Baumann adds that "these fillers work great alone, but the trend seems to be to use them in combination."