Restylane, a form of hyaluronic acid, was developed in Sweden as a replacement for collagen. The material is injected into lips, wrinkles and skin folds to smooth out surface contour irregularities, and to provide temporary "fill." The injections can be done easily under no or local anesthesia. Because Restylane does not contain materials that might cause allergy, pre-testing is not required.

Typically, the area treated does not become bruised after treatment, but simply swells during the first 2 to 3 days following treatment, and reaches its optimal form after about 3 days.

Although it has only been available for a relatively short time, Restylane has become very popular, and results, which may last 6 months or even up to a year, seem to be very gratifying.

Collagen in cream-based skin-care products is of absolutely no value. As a large protein molecule, it cannot penetrate down into the upper layers of the skin.

Purified collagen protein has been injected into fine and medium wrinkles for about twenty years. A simple office visit is required, and the injection takes only a few minutes. However, a skin test for allergy to the collagen is absolutely required before treatments. It takes several days to see the results of the test, and many doctors feel a second skin test is worthwhile to prevent allergic reactions to the injected collagen.

Collagen treatments are moderately effective but the effects are temporary, lasting only 3 to 6 months. Most patients want more extensive and longer-lasting improvement than collagen offers, and are better off waiting until they are prepared to undergo more definitive treatment.

Collagen is not a form of regular "replacement therapy" as it is made from animal collagen, and is broken down in human skin once injected. In fact, your own collagen is in a balance, constantly being made and broken down.

Artecoll is another injectable product for the skin that has recently become available, however, it is made up of acrylic micro-spheres in a collagen base. Once the microspheres are injected, they would be difficult to remove. While this offers a hope of permanent change, it makes any problems arising difficult to treat and a less permanent injectable product may be a more useful product.

Fat injections have limited benefit in the treatment of fine and medium wrinkles, but recent research has shown that part of aging involves the gradual loss of fat from the face, resulting in a loss of fullness of the face. In a short operation lasting less than an hour, fat is injected where it is needed in the face, filling out contours and plumping up the skin. The fat used for these injections is taken by liposuction from another part of the body.

Botox is a relatively new therapy for wrinkles of the brows and around the eyes. Botox is made from the same toxin that causes botulism poisoning, but is used in much lower doses. This material has been used successfully for years to "fine tune" the results of eye squint surgery, and has recently been applied to cosmetic uses, where it is usually used for frown lines and crow's foot lines. However, it has no effect on longstanding, established wrinkles where the skin has been deeply creased. Injection results in temporary (3 to 6 months) paralysis of the injected muscles.

Benjamin Gelfant, MD, 
in association with the MediResource Clinical Team