Injectable treatments for wrinkles go hand in hand with laser treatments and we continue our coverage of this field as it is of interest to all aesthetic physicians offering laser treatments.
Dysport is an acetylcholine release inhibitor and a neuromuscular blocking agent, approved by the U.S. Food and Drug Administration (FDA) in late April 2009. Dysport has similar properties as the popular BOTOX Cosmetic®, which has been used in the U.S. since 2001. Dysport is approved for the temporary improvement in the appearance of moderate to severe glabellar lines (vertical lines between the eyebrows) in adults younger than 65 years of age.
The active substance in Dysport is a botulinum neurotoxin type A complex, which acts at the level of the neuromuscular junction in the targeted muscle. Dysport is a neuromuscular blocking toxin which acts to block acetylcholine release at motor nerve ends and reduces muscular spasm. As our skin becomes less elastic over time, repeated frowning creates visible lines and wrinkles. Dysport and BOTOX that relax the muscles by blocking nerve impulses. Once the muscles are at rest, the skin becomes smoother, creating a more natural and relaxed appearance.
Although only recently approved for use in the United States, Dysport has been used in patient care in the United Kingdom since 1991, and has marketing authorizations in 27 countries for aesthetic use.
According to the American Society for Aesthetic Plastic Surgery, over 10 million cosmetic procedures were performed in the U.S. in 2008, 83% of which represented nonsurgical procedures. Injections of botulinum toxin type A have been the number one nonsurgical cosmetic procedure for the past five years, with over 2.4 million total procedures in 2008 alone.
It is still unclear whether Dysport is better than Botox. The major advantage of Dysport may be the price. Botox is not cheap: about $500. Dysport is about 20 percent less expensive than Botox, and that could be a potential savings for some people of over $100 a treatment.
Doctors warned both Botox and Dysport do have risks and should be only be used in healthy patients, who are not pregnant or breastfeeding. Potential complications include temporary eyelid drooping, headache and resistance to the medication.
Both products are not perfect when it comes to meeting the most desired feature of a dream cure: neither Botox nor Dysport last long.
Learn how dermal fillers administered by aesthetic physicians can plump your skin and add volume to your face. Watch this educational interview to find out your options, risks, and costs and consult your skin doctor.
Temporary or permanent? A new survey by the British Association of Aesthetic Plastic Surgeons suggests that patients who choose permanent fillers experience more complications than those who select other types of fillers.
Complications? Distorted or malformed appearance of the patient’s skin.
In fact, one in four UK surgeons has seen patients with complications from permanent fillers. And one in five saw a patient who needed surgery to correct the problem.
The UK doctors surveyed said the reason for complications was unqualified practitioners administering fillers incorrectly, and studies by the U.S. FDA confirm that U.S. patients who experienced adverse events are mainly the result of injection by an unqualified provider.
Doctors advise patients to accept only approved fillers, from injections prescribed by a physician. And, they urge consumers to ask the provider to be very specific about his or her qualifications.
Watch this video covering the report.
Fillers have become a mainstay in cosmetic and rejuvenation treatments in aesthetic medicine today. A recent study demonstrates that a novel tissue-engineered filler, developed using a combination of adipose stem cells (ASC) and micronized acellular dermal matrix (Alloderm), is showing promise for many cosmetic and medical indications. Its developers claim it offers a softer, more natural appearance and may raise the bar in terms of aesthetic outcomes in procedures utilizing dermal fillers.
Various filling methods such as fat injection and grafts, as well as popular collagen and hyaluronic acid fillers, are used for cosmetic and medical indications for the treatment of rhytids, loss of subcutaneous tissue secondary to congenital malformation, trauma and extirpation. However, many of these approaches have several limitations including donor-site morbidity and deformity, unsatisfactory and unpredictable results and may have related issues of potential allergy associated with complications and subsequent toxicity to the filler.
“In using this unique approach with ASCs and micronized Alloderm, we hoped to circumvent many of the common problems encountered with other filler approaches used in plastic surgery,” says Jin Soo Lim, M.D., of the Department of Plastic Surgery at The Catholic University of Korea, Seoul, Korea. “It appears that ASCs are an ideal autologous cell source for adipose tissue engineering, and its combination with Alloderm can result in a softer, more natural injectable soft tissue filler.”
Dr. Lim and his team aimed to develop a unique soft tissue filler using the combined strengths of adipose tissue equivalents (which were constructed using ASCs) and micronized Alloderm. In the study, cultured human ASCs were first labeled with fluorescent green protein (to determine whether adipose formation in complexes originated from seeded cells or from surrounding perivascular tissue) and then attached to micronized Alloderm (5×105 cells/1mg). These ASC-Alloderm complexes were subsequently cultured in adipogenic differentiation media for two weeks, and then injected subcutaneously into the dorsal cranial region of nude male mice. Of the eight mice used in the study, four control mice were injected only with micronized Alloderm, and four were injected with ASC-Alloderm complex. The viabilities of the ASCs in micronized Alloderm were determined at 1, 4, 7 and 14 days, and the complexes, which had been cultured for 14 days and implanted in vivo for two months, were histologically evaluated by light, confocal and scanning electron microscopy (SEM).
Results showed that the ASCs in the micronized Alloderm were alive during all time points in the culture period. Light microscopy and SEM evaluations showed that the ASC-Alloderm complexes cultured for 14 days contained round cells with large lipid vesicles and many spherical cells thought to be adipocytes, respectively. Histologic evaluation showed that the ASCs in implanted ASC-Alloderm complexes, which were harvested from mice at two months post-injection, differentiated into adipocytes which had the green fluorescent dye. The H&E evaluation in the control mice which had only received micronized Alloderm showed that some fibroblast-like cells and small capillaries had infiltrated the micronized dermal matrix, whereas in the mice that had received ASC-Alloderm complexes, markedly increased numbers of large signet-ring cells and large capillaries were observed.
“Micronized Alloderm can potentially be a useful medium in which human ASCs can grow and differentiate and serves as a good scaffold for human ASCs when constructing fat tissue for filling and plastic reconstruction purposes,” Dr. Lim says. “This newly grown fat tissue can be used in many medical and cosmetic three-dimensional soft tissue filling scenarios and may ultimately prove to be more advantageous than other currently available filler procedures and modalities.”
Alloderm can be injected alone as a filler but in order to achieve long-lasting cosmetic results, cell in-growth and revascularization of the micronized Alloderm is necessary — but according to Dr. Lim, this does not occur in all patients. Sufficient amounts of ASCs have the ability of high proliferation and a strong differentiation to adipocytes and endothelial cells, and mixing the Alloderm with ASCs can potentially improve the aesthetic results of this tissue-engineered filler. Dr. Lim says that, due to the natural approach of this novel soft tissue filler, common unwanted adverse events as sometimes seen with other filling modalities can be avoided.
“The differentiated adipocytes from the ASCs mixed in the micronized Alloderm medium make the injected micronized Alloderm a more acceptable soft tissue substitute, and the differentiated endothelial cells enhance the implantation of the injected soft tissue constructs,” Dr. Lim adds.
The choice of stem cells and scaffolding used in tissue engineering plays a central role in the degree of success of adipose tissue engineering. According to Dr. Lim, injectable scaffolds can widen the scope of engineered adipose tissue and Alloderm used on its own has been successfully implemented in soft tissue augmentation for the treatment of wrinkles and scars.
Its developers allow that the ASC-Alloderm complex approach is a more complex and time-consuming procedure than using off-the-shelf dermal fillers. Nevertheless, they say, it can result in a viable injectable soft tissue filler with enduring aesthetic benefits.
Yoo G, Lim JS. Tissue engineering of injectable soft tissue filler: using adipose stem cells and micronized acellular dermal matrix. J Korean Med Sci. 2009;24:104-109. Epub 2009 Feb 28.
Botox and dermal fillers are household terms these days and people are no longer shy to talk about it. In fact, according to survey statistics released today by the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 9 out of 10 respondents (87 percent) openly discuss their dermal filler treatments with others, and 7 out of 10 (70 percent) receive support from the people they told.
This trend shows that aesthetic injectable treatments continue to evolve into mainstream and widely accepted options for the everyday use. Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent).
In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ’surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used,” says Laurie Casas, MD involved in the survey.
Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. The most common injectable dermal fillers are Restylane, Juvederm, Sculptra, Zyderm and Zyplast, and Bio-Alcamid.
Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.
Several classes of dermal fillers are marketed in the United States today. They include:
New promising dermal fillers are in development that will offer superior capabilities in the future.
Autologous (your own) fat is also used as a dermal filler. Your surgeon can take fat from one area (where you do not want it) and inject it into another (where you want it, such as facial wrinkles, or any other area with a loss of volume). This procedure is called lipoinjection or lipografting.
Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. Some mild burning and stinging is normal and quickly resolves.
The results can last from three months to five years, depending on the filler being used. Collagen provides the shortest duration with effects lasting anywhere from three to six months. Restylane tends to last a bit longer with effects lasting from six months to one year. Radiesse can provide results that last greater than 3 years.
These two are very compatible. In fact, if your aesthetic physician is trained and has lasers, he or she can enhance your results dramatically by doing a combination treatment, which may stimulate the growth of new collagen and improve the skin texture. Typically IPL or laser photo rejuvenation (photo facial) is done as a separate procedure. An advanced aesthetic clinic will be able to offer a dermal filler-laser treatment combination in one seating.
Bad economy continues to cause growth in aesthetic medicine: the use of Botox and anti-wrinkle dermal fillers is on the rise, and physicians are looking for extra income by offering non-invasive treatments. Many patients are looking for inexpensive alternatives to cosmetic surgeries and good deals. But cheap may not work in this field.
We hear from many aesthetic physicians that diluting Botox vials and dermal fillers to save costs has become a wide spread practice among non-medical providers advertising prices below the actual cost. This is a bad way to save money for patients and an extremely dangerous way for providers to cut costs.
Bad treatments and improper use of botulinum toxin (Botox, BTXA, Dysport, Myobloc, Neurobloc and Xeomin) and dermal fillers, such as Restylane, Juvederm, Sculptra, Zyderm and Zyplast, Bio-Alcamid, etc., can lead to exaggerated or droopy arches, uneven brows, drop of the lip, impaired speech, drooling or worse. A Botox party or a deep discount at a spa may cost double or triple to repair a cheap injection.
Watch this news report from Texas about the dangers of dermal fillers.
Treating colored skin poses difficulties, as many practitioners have experienced. Dr Mukta Sachdev says good technique hinges on good pre-, intra- and post-operative care and choice of patient.
Colored skin has the tendency to hyperpigment following trauma, so in the wake of procedures such as lasers, chemical peels or microdermabrasion, there is a chance that hyperpigmentation will occur at the treatment site. This post-inflammatory hyperpigmentation is a common adverse event in darker skin. According to one expert, maximising the success of an aesthetic procedure can be better achieved if the proper pre-, intra- and post-operative precautions are taken. Dr Mukta Sachdev, a consultant dermatologist at the Manipal Hospital in Bangalore, India, says that treating coloured skin can be particularly challenging, even for the most experienced cosmetic physician. “In India we have found that the patients do not use sunscreens as much as they should, as compared with the West, and Indian people are simply not aware of the benefits of these creams. The cosmetic implications—especially in darker skin—is that following a procedure, such as laser or microdermabrasion, the risks of hyperpigmentation will increase,” Dr Sachdev says.
According to Dr Sachdev, the use of sunscreens is mandatory before cosmetic procedures, and the patient should get into the habit of using these two to three times a day, at least 14 days prior to procedures. This gets the patient into the habit of using them, and they help in preventing unwanted hyperpigmentation post-procedure. Dermal filler procedures are also a common cause of post-inflammatory hyperpigmentation. Dr Sachdev says that perhaps a normal Caucasian skin might tolerate a Restylane or Perlane filler very well in terms of decreased risk of developing a post-procedural hyperpigmentation. However, in a darker skin, skin types IV to VI, patients can frequently have a pigmentation of the injection puncture wound where the filler was introduced into the skin.