Cosmetic Fillers and Wrinkles

Wrinkles may be proof of wisdom. But do you ever wish you didn't have to look quite so wise?

Cosmetic fillers are materials injected underneath the skin to make it fuller. After an injection, the plumper skin shows fewer wrinkles and looks younger.

Injectable cosmetic fillers have been around for decades. In recent years, medical advances have brought new versions of this wrinkle treatment to the marketplace. Newer cosmetic fillers are longer lasting, even permanent -- but do your homework before heading to the cosmetic surgeon.

The Birth of a Wrinkle

Skin is held tight and smooth by three critical components: collagen, hyaluronic acid, and elastin. These chemicals combine to create a firm, spongy meshwork under the skin surface. This elastic structure keeps the skin surface smooth and firm.

We slowly lose the integrity of the meshwork as we age. With weakness in the underlying support structure, the skin's surface loses its perfect baby-skin smoothness.

Injecting cosmetic fillers helps fill the thinned-out meshwork. They plump up the tissue underneath skin, shrinking wrinkles. The skin becomes firmer, smoother, and younger-looking.

Collagen is the oldest and best-known cosmetic filler. Newer natural and synthetic products are available, each with its own advantages and disadvantages.

Bovine Collagen Fillers

Bovine collagen is processed from the skin of cows. Approved in the 1980s as a wrinkle treatment, bovine collagen is still in wide use as a cosmetic filler.

Bovine collagen is effective and less expensive than other treatments. It can cause allergic reactions, so allergy skin testing is generally done before beginning the injections.

Collagen injections are broken down naturally by the body. Injections need to be repeated two to four times per year to maintain results.

Human Collagen Fillers

Human collagen, mass-produced from cultures of human cells, became available in 2002. Human collagen causes dramatically fewer allergic reactions, so skin testing is usually not needed. It is more expensive than bovine collagen, and injections also need to be repeated every three to six months.

Hyaluronic Acid Fillers

Hyaluronic acid is a naturally occurring polysaccharide (chain of sugars). It's a normal part of the support structure under the skin. Age depletes hyaluronic acid in the skin, but injections can replace it.

Various natural and synthetic hyaluronic acid (HA) products are available. In the newest products, the HA molecule is modified to break down more slowly. Cosmetic results can last nine months or longer. Allergic reactions are very rare.

Fat Injection Fillers

Ever wish you could move that fat from your thighs to somewhere it might look a little better? Fat injections involve removing small amounts of fat from the thighs, belly, or buttocks and injecting it under the skin of the face. The fat expands the skin, shrinking wrinkles. Because it is the patient's own tissue, there can be no allergic reaction. Results are variable, and are sometimes permanent.

Poly-L lactic Acid (Sculptra) Fillers

When injected under the skin, poly-L lactic acid (PLLA) stimulates skin cells to make collagen. Poly-L lactic acid is nontoxic, and has been widely used as a component of suture material for years.

PLLA is FDA-approved for cosmetic treatment of certain skin conditions in HIV patients. It is often legally used "off-label" to treat wrinkles in otherwise healthy people. It's considered "semi-permanent," meaning results can last for months to years.

Calcium Hydroxyapatite (Radiesse) Fillers

In 2006, the FDA approved calcium hydroxyapatite for cosmetic injection. This cosmetic filler is made of the minerals that give bone its strength and texture. These minerals are ground into tiny particles and suspended in water solution, which is injected under the skin.

In the trial that led to its approval, calcium hydroxyapatite worked significantly better and lasted longer than collagen injections to reduce severe wrinkles.

Polymethyl methacrylate (PMMA) Fillers

Polymethyl methacrylate is a new, permanent cosmetic filler. PMMA has been used for decades as a cement for bone surgery, and was recently FDA-approved as an injectable cosmetic filler.

You heard right -- we said "cement." Polymethyl methacrylate is a non-biodegradable chemical. Unlike biological products, PMMA produces permanent cosmetic results.