Stopping the Clock

Face lifts are outdated. A new generation of permanent dermal fillers8212;which make use of biology and synthetics8212;may turn collagen into a cosmetic dinosaur

By her early 50s, Dorene Polcyn was growing weary of her battle against Father Time. Every six weeks, she would drive to her dermatologist8217;s office and plop down 375 for an injection of collagen to fill in and smooth away wrinkles on her face. 8216;8216;The collagen didn8217;t last that long. And I was tired of the expense,8217;8217; says the Los Angeles woman, now 60. Then, in 1998, Polcyn entered a clinical trial for a long-lasting wrinkle-filler called ArteFill. The difference was striking. Eight years on, she8217;s only recently had to return to her doctor for fresh treatment8212;and then just to fill in new wrinkles that have cropped up in the meantime. 8216;8216;It seems like we stopped the clock,8217;8217; she says. 8216;8216;I love it. I have so many friends who want it.8217;8217;

Dermal fillers8212;injected substances that plump up crevasses, wrinkles and depressions in the skin8212;already have been encroaching on the venerable face-lift8217;s turf. Now a new generation of longer-acting fillers may turn the temporary fixer-upper, collagen, into a cosmetic dinosaur. With the Food and Drug Administration set to decide this summer whether to approve ArteFill, the first so-called permanent dermal filler, consumers may shortly have the cosmetic fix of their dreams: a treatment that fills a wrinkle and keeps it filled 8212; for years.

If approved, ArteFill will join several other longer-lasting wrinkle eradicators, such as Radiesse, a 8216;8216;semi-permanent8217;8217; filler that is approved for use in vocal cord defects and is already being used off-label by doctors to fill wrinkles. Sculptra, another long-lasting filler made of synthetic materials, is also being used off-label for treating wrinkles. And Juvederm8212;a filler made of hyaluronic acid8212;was recently approved for use. Unlike previous hyaluronic acid fillers, which last about six months, Juvederm is touted to last at least six months and up to a year. The appeal of these remedies is obvious. 8216;8216;For many patients, permanent is what they8217;re looking for,8217;8217; says Dr Douglas Hamilton, a Los Angeles area dermatologist who participated in the early clinical trials of ArteFill.

The new dermal fillers last much longer and they can be used for deeper facial lines and depressions and to add volume to sunken cheeks or smooth a bumpy nose. But the expanded uses and addition of long-lasting fillers have raised concerns among some doctors. They say that the marketplace is rife with inexperienced practitioners, injection 8216;8216;parties8217;8217; in nonmedical settings and counterfeit products8212;all of which could lead to botched work including long-lasting, ugly results such as lumpiness or lopsidedness.

Dermal fillers can consist of human fat, human collagen, bovine collagen, hyaluronic acid found naturally in the body8217;s connective tissue, synthetic substances or combinations of those materials. The older, short-acting fillers are made of natural products such as collagen and fat that are quickly absorbed by the body. The new long-acting fillers mostly rely on synthetic materials for that extra durability. ArteFill, for example, consists of tiny synthetic spheres made from polymethylmethacrylate, a substance used in some types of medical implants, suspended in a bovine collagen gel. While no one is quite sure how it works, most experts believe that the microspheres settle in the injected site they cannot be broken down by the body. The bovine collagen gradually disintegrates and is replaced by a permanent scaffold of human collagen growing around the microspheres. Radiesse consists of smooth particles of calcium that, after injection, also form a scaffold that is slowly filled with human collagen. Sculptra, which is approved for lipoatrophy, the facial wasting associated with HIV infection, consists of a synthetic substance called polylactic acid that has long been used in medical products such as dissolvable stitches. It adds volume to skin and lasts about two years.

Doctors recommend that patients exercise caution to maximize the chance that treatment with long-lasting fillers will go well. The first order of business is to check the injector8217;s experience. 8216;8216;Technique is a big issue here,8217;8217; Young says. And the key to successful ArteFill, Sculptra and Radiesse injections will be for the physician to tread lightly, experts say. Major problems could occur if the doctor injects too much, injects at the wrong depth or injects in areas of the face that it shouldn8217;t be used in. For example, in the case of ArteFill, Over time, the human collagen will grow in and plump out the wrinkle, so overfilling could lead to bumps.

To be cautious, Young says, patients could try a temporary filler to see if they like the outcome, then use the ArteFill or another long-lasting filler later. Consumers should also be careful about using any filler off-label or in an area of the face that it is not specifically approved for8212;such as with facial shaping. 8216;8216;When you get it right, it works well,8217;8217; says Young. But, he adds, 8216;8216;The use of these things on the nose is on the riskier side of things. If you get a problem you8217;re going to live with it for a long time.8221; 8212;Shari Roan