A client has hand rejuvenation using Radiesse. This painless 5 minute procedure lasts approximately one year. Dr. Berkowitz has perfected tis procedure and combines it with Mixto fractional resurfacing.
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As the popularity of injectable dermal fillers continues to rise, more and more women look in the mirror and slump at the sight of their deep lines and wrinkles. Social acceptance and therefore availability of fillers has certainly increased, but should we be concerned about the safety of this relatively new cosmetic treatment?
Benefits versus safety
Injectable dermal fillers have gained popularity in recent months – almost as much as Botox – and lip plumping seems to be all the rage. When administered properly, they generally offer a safe means of winding back the clock and revealing a younger you. By injecting hyaluronic acid (HA) or collagen based fillers into the skin, deep lines and folds in the skin can be smoothed and the natural collagen structures in the skin can be protected from deteriorating too quickly.
At birth a person’s natural HA concentration is around three per cent, which drops to around 0.007 per cent when that person turns 45. Therefore whilst dermal fillers will not stop time, they can recover the damage already done by boosting natural HA levels.
However as with any cosmetic treatment, fillers are not without risks and on rare occasions, adverse reactions can develop. They are several key points to note when questioning the safety of this anti aging treatment. The first is to realise that there are two kinds openly available on the UK market: biodegradable dermal fillers (non-permanent) and permanent fillers, which both offer effective wrinkle treatment.
Permanent dermal fillers can contain Polyacrylamide and Polyalkylamide and have featured heavily recently in the media as these are where most of the problems lie. Permanent and non-permanent fillers are both based on the natural substances collagen or hyaluronic acid, and these can be broken down and reabsorbed by the human body. However permanent fillers also contain synthetic substances that are non-biodegradable and therefore become a permanent fixture of the body. This poses post-treatment problems because as the skin starts to sag, the permanent fillers remain intact, creating a rather unnatural, distorted look as the face continues to change shape.
At SkinGenesis, our patients receive non-permanent biodegradable dermal fillers, which includes the hyaluronic acid based filler, Restylane, and Radiesse, which contains calcium hydroxyapatite. Of course, due to constant innovation, SkinGenesis doctors may also use other products that they consider to be the best on the market. Clients are required to visit us more regularly with non-permanent fillers, however if unwanted effects do occur, they are at least short-lived as the substance is reabsorbed by the body.
Restylane smoothes out wrinkles on the hands and face, lasts around six months and offers reduced risk of allergic reaction because it is made from non-animal sources. Radiesse has the same effects, which can last for 12 to 18 months.
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The second consideration is to be aware that UK regulation of this industry is comparatively lax when considered alongside the USA. There are currently 100 types of dermal fillers available in the UK, compared to six FDA-approved types (US Food and Drug Administration) in the USA. This is because in the States, new cosmetic treatments are rigorously tested over long periods of time and only when a product receives FDA approval will it be widely available on the market. Both Restylane and Radiesse are FDA-approved brands.
Which? Magazine has previously suggested that the UK is even the ‘guinea pig’ for the industry as there is currently no FDA equivalent in the UK to manage what is and what is not available on our market. The Department of Health and the Healthcare Commission looked into tightening the restrictions in the UK, however they ultimately declared responsibility to the private health industry’s body, the Independent Healthcare Advisory Services (IHAS), which in turn said that there is little that can be done unless another agency, the Medicines and Healthcare products Regulatory Agency (MHRA), classifies fillers as medicines. This would mean they would be regulated, like Botox, under they Medicines Act and would only be administered by licensed medical practitioners. With little regulation, this means that anyone in the beauty industry can certify themselves to administer the treatments to unsuspecting patients.
Caution is key to successful treatment
Patients should be extra vigilant when deciding where to have dermal fillers. The reluctance of the Government to tighten regulation of the industry has created a ‘buyer-beware’ culture. SkinGenesis’ dermal fillers are administered by qualified doctors and we are a registered member of the Healthcare Commission.
More than 1,500,000 treatments have been conducted around the world, with very few yielding adverse reactions to the ingredients. As an industry we expect around one in every 2000 patients to experience adverse reactions, and even then this depends on each individual person’s health.
Other minor side effects can occur, including swelling, redness, discomfort and itchiness. Immediate reactions, such as transient erythema, oedema and ecchymosis should be treated with ice and antihistamines, whilst sub-acute reactions like infections, bluish discolouration and necrosis will require medical attention.
As a general guide, patients should book treatments with a qualified, experienced doctor two to three weeks before a social engagement, to allow for the possibility of an adverse reaction. Minor side effects usually clear up within two to four days and dermal fillers should also be avoided in the following circumstances.
If you are:
o Are pregnant or breast feeding
o Are currently taking anticoagulants or aspirin
o Have a history of anaphylaxis or intolerance to previous dermal fillers
o Have a skin infection or inflammatory disease (acne herpes)
o Have permanent implants
o Have had laser skin resurfacing or skin peels within last 6 weeks
o Have been using Roaccutane within past 12 months
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As we age, the backs of the hands are one place where time really affects our appearance. The muscles and fat gradually waste away, producing some hollowing-out of the back of hand between the bones. The skin sags there and can be pulled up with a pinch. When this kind of process occurs in the face, one thing that can be done is a face-lift to tighten the skin. This does not fix the depressions and hollowings but does take away the sagging. In the hands, however, no face-lift procedure is available. As in the face, however, a material that can “fill in” the hollowed areas under the skin is what can restore the youthful shape of the hands.
Although it is possible to do this with a hyaluronic acid filler, such as Juvederm or Restylane, which are popular in the face, a longer-lasting filler, such as Radiesse or Radiance, is a more popular choice in the hands. Radiesse is composed of a gel of calcium hydroxyapatite. It is injected under the skin and smoothed out into the hollowed areas. It elevates the depressed areas and gives the hands a smoother, more youthful texture. Although it is not permanent, it is expected to last an average of 18 months. Over time, the calcium hydroxapatite is converted to the body’s own collagen and gradually dissipates. It is common to use a syringe per hand.
During the treatment, the gel is mixed together with a local anesthetic, such as lidocaine. Pain is minimal with this technique but ice may also be applied to minimize pain and bruising. The gel is massaged out into the areas that need filling. Swelling may develop and progress over the following 1-2 weeks and is treated with hand elevation and icing. Arnica may also be taken to help with bruising.
The cost of an injection of a syringe of Radiesse varies from clinic to clinic, but ranges from $600-1000. Injection must be carried out by medical personnel and must be supervised by a physician.
One of the most common facial areas that bothers many patients is the development of the nasolabial folds, also referred to as the lip-cheek groove, or in a recent television commercial known as the parentheses. You can argue whether it is a fold or a groove but it is probably closer to a fold. It develops as the cheek tissue from above ages and begins to sag….falling over its border with the upper lip. The upper lip is ‘fixed’ so the overhanging cheek tissue creates the appearance of a deepening fold. With time, aging, and the anatomy of one’s face, this nasolabial fold extends south past the corner of the mouth and sometimes nearing the lower border of the jaw in extreme cases of skin laxity.This area is commonly treated by injectable fillers and in my practice as many patients wants their nasolabial folds treated as they want their lips enlarged.
The most common method for nasolabial fold reduction is with injectable fillers. Like all filling procedures by injection, the results from nasolabial fold reduction is quick, easy to do, and the results are immediate. I usually perform them under a local anesthetic block so the treatment is as comfortable as possible. While all of the injectable fillers will work, I think some are better for this area than others. And the ones that I think are best are those that last the longest and have the greatest ‘push’.
While all of the hyaluronic acid fillers such as Restylane or Juvaderm will work, they do not last as long as any of the particulated injectable fillers. Currently Radiesse (ceramic beads) and Artefill (plastic beads) are the only two particulated fillers currently available. The evidence is clear, not surprisingly because of their solid bead component, that they consistently last longer than any of the hyaluronic acid fillers. While beaded injections can cause lumpiness and irregularities, this is not a significant cosmetic issue (nor can it usually be seen) in the forgiving area of the nasolabial fold. Conversely, in the lips this is a different matter. Also, because the bead composition makes the injectable material more thick and viscous, I think it provides more push as it goes in resulting in a better cosmetic effect and having to use less injectable filler. Because of particulated fillers longevity and thicker volume, it is my preferred injectable approach to the nasolabial folds. This injectable treatment will give a 9 to 12 month result.
There are other treatment options for the nasolabial fold as well. The best way to eliminate them is the one way which is almost never done….cut them out. That gets rid of the fold immediately but also leaves a fine line scar which may only be acceptable in an older patient. The other more commonly done alternative is to use an implant. I specifically use an Advanta implant for those patients that want a permanent volume solution. A very small incision is made in the nose crease and at the end of the lower fold line. The implant is slide into place from one end to the other. This is a procedure that can be done in the office under local anesthesia. An implant approach to the nasolabial fold is a good solution for someone who no longer wants to do injections, doesn’t mind the concept of an implant in their face, or has very deep nasolabial folds which would take a lot of injectable filler volume. My experience with an implant in this area has been quite good but it is not a first line approach for most patients.
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