Injecting the Fountain of Youth
Excerpt By Collette Bouchez, HealthDay

Move over Botox. Collagen injections, step to the side.

The road to the fountain of youth is about to be repaved, as a host of new injectable, antiaging treatments sit poised to return your weathered, baby-boomer face to a kinder, gentler time.

Among the most promising: Treatments known as "volume fillers" -- compounds that promise to replace those laugh lines and angry wrinkles with smiles.

"These are various compounds that are injected just under the skin and work to fill out the indentations that appear as age lines and wrinkles," says Dr. Neil Sadick, professor of dermatology at Weill Medical Center of Cornell University in New York City.

Unlike Botox injections, which get rid of wrinkles by paralyzing the tiny muscles that help form the line, the new volume fillers work more like the original bovine collagen shots first popularized more than 20 years ago. They simply plump up the tissue that lies just under the surface of the wrinkle.

The big difference between then and now? The new compounds are longer lasting and, many dermatologists say, safer for a greater number of people.

Some dermatologists, however, warn the new treatments may pose potential risks.

"One to two percent of people have an allergy to bovine collagen -- you don't see that with these newer treatments," says Sadick. In addition, most last twice as long as collagen, which is good for about three months, and some even longer than that.

Some of the new volume-filler treatments generating the loudest "beauty buzz" are Artecoll, Restylane, Radiance and Hylaform. Although none is currently approved for cosmetic use in the United States, they're likely to be available soon. The clinical trials conducted here, combined with approved use in Europe and Canada, have some doctors excited about their potential.

"I'm extremely impressed with both the result and the safety profile of Restylane. It works extremely well," says Dr. Robin Ashinoff, an associate professor of dermatology at New York University Medical Center.

A gentle treatment derived from hyaluronic acid -- a fluid found naturally in human joints -- it's essentially non-toxic with virtually no risk of allergic reaction, so no pre-testing is needed, Ashinoff says.

"It also gives longer-lasting results -- from seven months to a year," says Ashinoff, who conducted some of the clinical trials for Restylane.

Hylaform is a slightly different form of hyaluronic acid. And it's derived from rooster combs. It also has an excellent safety profile, with results that last longer than collagen -- from three to six months or more, Sadick says.

"Agents such as hyaluronic acid represent a major advance because patients can have treatments with increased safety and greater longevity," says Sadick, who worked on clinical trials of Hylaform.

Because it's an animal byproduct, the American Society of Plastic Surgeons (ASPS) warns that the risk of allergic reaction to Hylaform is slightly greater than for Restylane. But the risk is still considered low.

Radiance is another volume filler, but it's comprised of tiny particles derived from calcium. Currently, the FDA has approved its use for treating vocal cord paralysis and some types of incontinence. However, "off-label" use -- prescribing a drug for a reason other than what it was originally approved -- means it's available to any doctor to use as an antiaging treatment.

On the plus side, Radiance treatments are reported by dermatologists to last anywhere from two to five years, with the potential for allergic reaction very small. On the down side -- a small but significant risk of "granuloma," a localized skin reaction to a foreign body that can result in hardened, sometimes itchy bumps just under the skin. And, the problem can last months or even years, studies show.

The lumps can also migrate to other parts of the body with a potential for complications that doctors know little about, according to the American Society of Plastic Surgeons.

Still one more volume-filling option is Artecoll, an injection that combines 75 percent collagen with 25 percent micro beads made of a synthetic material similar to Plexiglas.

The big plus here: Permanent wrinkle removal because it works on a slightly different principal than other volume fillers.

"The collagen gives you the immediate fill and the micro beads help initiate a body response that gives you the permanent fill," says Ashinoff.

The micro beads settle in just below the surface of the wrinkle, kicking off the body's natural inflammatory response. This, in turn, initiates the production of a kind of scar tissue to grow around the bead. It's this tissue that ultimately forms the permanent filling for the wrinkle or line, explains Ashinoff.

While results are said to be remarkable, studies also show a risk of granuloma, which can be permanent.

Artecoll's manufacturer says the body does not absorb the micro beads. But the American Society of Plastic Surgeons cautions that, like Radiance, the beads in Artecoll can migrate to other areas of the body -- and there's almost no information on what consequences, if any, this might cause.

Some American doctors are calling for more safety studies on Artecoll before the U.S.Food and Drug Administration (FDA) gives it its blessing. This spring, however, an FDA advisory panel voted to recommend that Artecoll get that approval now -- which could mean it might be available for use in the United States as early as September. Restylane, Radiance and Hyalaform are under similar consideration.

As intriguing as the new options are, some doctors continue to believe the tried-and-true bovine collagen injections remain the gold standard for antiaging care.

"Collagen has a safety profile that goes back more than 20 years," says Dr. Tewodros Gedebou, director of Plastic and Reconstructive Surgery/Trauma at Cedars-Sinai Medical Center in Los Angeles.

"And with the proper pre-treatment testing to rule out allergic reactions, it offers both predictable results and few, if any, complications. And I don't think we can say that about these newer treatments," he says.

More information

To learn more about the new injectables, visit The American Society of Plastic Surgeons. For more information on a variety of antiaging treatments, check out The American Academy of Dermatology's AgingSkin Net.

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