Dermatologic & Cosmetic Surgery

Dermatologic Treatments

Collagen and Restylane

To correct wrinkles, scars by temporarily plumping of filling out the skin depression. Conditions that respond well to collagen include Marionette lines, frown lines, lines around the mouth, worry lines, crows feet, smile lines and facial scarring from acne or injury.

Restylane is one of the most recently FDA approved facial fillers. It is injected into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds, such as nasolabial folds and marrionette lines. It is also an excellent choice for lip enhancement.

HISTORY OF FILLERS
Bovine collagen (derived from cow) was the only available filler for years. To use the product you need to get two patch tests to check for allergy so the waiting period was 6 weeks before you could proceed with the treatment. It lasted about 3 months on average. In March of 2003 the FDA then approved the bioengineered HUMAN, NONcadaverous collagen fillers Cosmoderm and Cosmoplast. The need for a test patch was eliminated, but results still last on average about 2-4 months. It is an excellent product and at our center is used alone or in combination with Restylane depending on the patient and the area of the correction.

BENEFITS OF COLLAGEN
Soft tissue augmentation involves injecting a substance into the skin to correct wrinkles, depressions and scarring.

DISADVANTAGES
Only temporary

WHAT IS INJECTABLE COLLAGEN?
Collagen is a naturally occurring protein that gives support and structure to skin, bones, ligaments and other body parts. Injectable collagen is like the natural protein found in humans, but is make from purified bovine (cow) collagen. There are two types of collagen with the brand names of Zyderm and Zyplast. They are generally used to treat wrinkles, facial lines, and scarring.

HOW IS COLLAGEN USED FOR SOFT TISSUE AUGMENTATION?
Collagen is injected beneath the surface of the skin into the dermis, the second layer of skin, where it corrects the wrinkle or scar by temporarily plumping or filling out the skin depression. Conditions that respond well to collagen treatment include frown lines, lines around the mouth, worry lines, crows feet, smile lines, and facial scarring from acne or injury.

HOW IS THE PROCEDURE PERFORMED?
The procedure is performed in an outpatient setting where your Dr. Lawrence injects the collagen just below the surface of the skin with a very fine needle. A local anesthetic contained in the collagen mixture can help to reduce discomfort. A topical anesthetic cream may also be used. During a series of treatment sessions, a person received the amount of collagen necessary to "fill out" the lines and wrinkles or raise the scar depression up to the level of the surrounding skin.

DOES IT HURT?
A local anesthetic is usually not used but a topical anesthetic can be used. (Emla)

WHAT ARE THE RISKS ASSOCIATED WITH COLLAGEN TREATMENTS?
Although all medical procedures carry risks, collagen therapy is quite safe for the treatment of facial wrinkles, scars and contour irregularities. In fact, it received marketing approval by the Food and Drug Administration in 1981. The chief risk associated with the procedure is an allergic reaction to the injected collagen. Therefore, before beginning collagen replacement therapy, two skin tests are administered to evaluate whether you have an existing allergy to the collagen. The skin tests are usually performed 2 to 4 weeks apart. Provided the skin tests were negative and a sufficient time has elapsed, treatment can proceed.

WHAT SHOULD BE EXPECTED AFTER TREATMENT?
There may be some swelling or minor bruising at the injection site. This usually fades in a matter of hours to days, revealing a new, smoother appearance to the skin.

HOW LONG WILL THE IMPROVEMENT LAST?
The length of time the correction lasts depends on many factors. Typically, 3 to 4 months may go by before touch-up or maintenance treatments are required. Occasionally, treatments may need to be done sooner or more often. In come people the collagen injections seem to stimulate the body's own production of collagen, and improvement can last more than a year. Correction of acne scarring tends to last longer.

BENEFITS OF RESTYLANE

• Restlane is a hyaluronic acid. This acid is found in all living organisms. The type of hyalouronic acid in restylane is NASHA™. It is FDA approved.
• NASHA™ is a patented NON-ANIMAL stabilized hyalouronic acid in clear gel form which is produced biosynthetically.
• NASHA™ is the first stable, biodegradable non-animal form of hyaluronic acid.
• NASHA™ is not derived from humans, but produced in a lab by a fermentation process.
• NASHA™ is not derived from “rooster combs” like the newly approved hylaform. It too is a hyaluronic acid but is contradicted in patients with a known hypersensitivity to avian (bird/egg) proteins.
• NASHA™ is non-animal based so it eliminates any risk of animal disease transmission or allergic reaction.
• Restylane has been safely used by dermatologists and plastic surgeons worldwide since 1996.

RESTYLANE VS HUMAN COLLAGEN (Cosmoderm / Cosmoplast)
Restylane requires less frequent treatments and a smaller volume to achieve a similar cosmetic result than human collagen. In addition, restylane lasts longer. It has been reported to last on average 6-8 months. Each individual is different. Human collagen on average 3 months. Treatments are typically scheduled twice a year.

Restylane can be used in conjunction with human based collagen to fill in superficial fine lines and to help flatten a crease. Restylane binds significant amounts of water allowing a more durable cosmetic improvement with little or no early loss of correction. Results are simple, convenient and practically instantaneous.

RESTYLANE VS PERMANENT FILLERS (Silicone, Radiance)
Restylane is naturally broken down by the body’s own mechanism for degrading hyaluronic acid. It’s unlike permanent fillers, which can cause clumping, lumping, granulomatous reaction and microsphere redistribution to other parts of the body. As we age, our faces change, so if you fill an area now with a permanent filler, it may not be the look you want 10-20 years from now. Restylane lasts longer than most soft tissue fillers but disappears over time. You can get restylane every year to suit the needs of your changing face.

RESTYLANE VS BOTOX
Restylane is a filler. It is used in creases that are caused by loss of skin fullness as we get such as nasolabial folds and marionette lines. Botox is a drug that blocks nerve transmission and relaxes the underlying muscles. It is used for wrinkles caused by muscle movement such as frown lines and crows feet. They are often used together.

ADMINISTERING RESTYLANE
Restylane requires no pretesting, but you should avoid using aspirin, non-steroidial anti-inflammatory medications. St. John’s Wort, Ginkgo Biloba, and high doses of Vitamin E should be avoided prior to treatment to decrease the incidence of bruising or bleeding at the injection site. If you suffer from cold sores on your face, the injection could stimulate a breakout. In this case you are given an oral medication to prevent a breakout before the injection. Ultrafine needles and topical anesthesia are used resulting in minimal discomfort.

POST PROCEDURE EXPECTATIONS
Redness and swelling at injection sites, typically resolve within 2 days. Injection into the lip can result in swelling for 3-5 days. Bruising may occur. Cold compresses may be used immediately after treatments to reduce swelling.

PRE & POST OPERATIVE PHOTOS

PRE-COLLAGEN TREATMENT	POST-COLLAGEN TREATMENT

To make an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.