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Temporary Volume Fillers
Zyderm and Zyplast are made by the Allergan Corporation and are composed of highly purified bovine dermal collagen that has been used to correct facial imperfections since the 1980’s. The bovine collagen is processed to create a product that is similar to human collagen. Bovine collagen was the first legally approved product for soft tissue augmentation in the United States, and it remains the criterion standard against which all other dermal implants are measured. Bovine collagen is still the least expensive treatment option available. Zyderm and Zyplast are available in 0.5- to 2-mL syringes, and all three types of bovine collagen dermal fillers available contain 95% type I bovine collagen and 5% type III bovine collagen.
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There are three forms of Bovine Collagen available:
An allergy test is needed for this product because it is made from cows. As many as 5% of all patients tested for bovine collagen can experience some sort of hypersensitivity to this injectable. For this reason, skin testing is required before treatment. Two skin tests performed 2 weeks apart, with the last test at least 4 weeks before treatment, is now standard. The skin test is administered in the forearm to determine if there is any reaction to the implant material. Positive test result is defined with redness, swelling, hardness, or tenderness that persists for more than 6 hours after implantation. Three percent of people tested may have sensitivities. Collagen is most commonly used to fill out superficial wrinkles, skin depressions and some scars. It has been largely replaced by newer substances including human collagen and hyaluronic acid gel. Bovine collagen has fallen out of favor because of the short term effects with this. The longevity can last from just a couple of weeks to possibly 3 months.
Zyderm I was approved for treatment by the FDA in 1981. Zyderm I contains 95-98% type I collagen, and the remainder is type III collagen. It also contains 0.3% lidocaine, so it make the injections less painful. Zyderm is 3.5% bovine dermal collagen by weight suspended in physiologic phosphate-buffered sodium chloride solution. It comes packaged as a single-use syringe with 30-gauge needle. Zyderm is indicated for the treatment of superficial wrinkles, including those around the eyes, lips, and glabellar region. Zyderm is injected into uppermost layer of the dermis. It is commonly used in acne scars and also lip augmentation. Overcorrection by approximately 100% is required due to secondary absorption.
Images courtesy of Zyderm
Zyderm II was FDA approved in 1983. Zyderm II is identical to the chemical makeup to Zyderm I. The only exception is that Zyderm II has 6.5% bovine dermal collagen by weight compared to Zyderm I - 3.5 % bovine collagen. It comes packaged as a single-use syringe with 30-gauge needle. Zyderm II is for injection into the shallow reticular layer of the dermis - which consists of dense irregular connective tissue. Reticular dermis differs from the papillary layer which is made up of mainly loose connective tissue. The reticular layer of the dermis is important in giving the skin it overall strength and elasticity, as well as housing other important epithelial derived structures such as glands and hair follicles. Zyderm II indications are for course wrinkles as well as acne scars and lip augmentation. Less overcorrection (approximately 50%) is required than Zyderm I because of a higher concentration of collagen and slower re-absorption. Zyderm lasts longer than Zyderm I because of the larger collagen weight.
Syringe of Zyderm II
Images courtesy of Zyderm
Zyplast was FDA approved in 1983, at the same time as Zyderm II. Zyplast is 3.5% bovine dermal collagen cross-linked to form a latticework and a more viscous compound. Zyplast is less immunogenic than Zyderm I or Zyderm II, and it is more resistant to degradation. It comes packaged as a single-use syringe with 30-gauge needle. Zyplast is injected into the mid to deep reticular dermis for treatment of deeper wrinkles or rhytides and contour defects, including nasolabial folds, marionette lines and significant lip augmentation. No overcorrection required. Zyplast should not be used in the glabellar region because of possible local tissue necrosis. It is often layered with Zyderm I or Zyderm II for more dramatic, longer-lasting results.
ADVANTAGES AND DISADVANTAGES OF BOVINE COLLAGEN Bovine collagen is still the least expensive treatment option available, cheaper than any other filler that is offered. One of the biggest disadvantages of bovine collagen is that it is very short lived, lasting a few short weeks or months. The other inconvenient factor of bovine collagen is that because it is different from human collagen – allergy is possible, two separate sensitivity tests must be performed weeks ahead of the first treatment. Injection of Zyplast into the glabellar region is not recommended because of the risk of skin necrosis.
Although collagen fillers changed the face of beauty when they entered the marketplace in the 1980’s, they quickly fell out of favor when longer lasting hyaluronic acid was introduced. However, many doctors still use collagen for plumping the lips and filling in “smoker’s lines” around the mouth. Collagen type products are still being used by many doctors for particular facial lines. Collagen is a softer fill and avoids the bumps or lumps seen with hyaluronic acid and also avoids the “drop in the eyebrow” seen with BOTOX sometimes. Another advantage of collagen is that it is great for recreating “structure”. Collagen’s biggest strength is its structural effect. It can be used along the side of a drooping or disappearing lip line to help hold the entire lip up. It’s downside however, is that most Collagen products are very short lived, and will last a couple of weeks to maybe 3 months maximum. CosmoDerm I, CosmoDerm II and CosmoPlast are FDA-approved fillers consisting of natural human collagen grown under controlled laboratory conditions. CosmoDerm and CosmoPlast are made by Allergan Corporation. Pre-treatment skin tests are not necessary so you are able to get the filler the day of your first appointment. These materials that go into CosmoDerm and CosmoPlast are screened extensively for purity from a single fibroblast cell culture. Human-Based Collagen is manufactured from human tissue which has been grown in a controlled laboratory environment.
Images courtesy of CosmoDerm and CosmoPlast
Before and After CosmoDerm
Images courtesy of CosmoDerm and CosmoPlast
Pros: Instant results Cons: Short lived effects How long it last: Manufacturer states 2-3 months Cost of Procedure: The cost for a Cosmoderm ranges from $400 - $700 per cc – depending on your geographical location.
ADVANTAGES AND DISADVANTAGES OF COSMODERM AND COSMOPLAST A couple of the advantages of both CosmoDerm and CosmoPlast are that they both have the least potential for post injection swelling – and no allergy or skin testing needed like Zyplast or Zyderm. Has a longer longevity rate than bovine collagen. The disadvantages of CosmoDerm and CosmoPlast are that they do not last as long as some of the other hyaluronic acid fillers.
Collagen makes up to 70% to 80% of the skin’s dermis – and is known for being an abundant building block that provides structure, strength, and support. As we age, our natural occurring collagen starts depleting; leaving the aftermath of new wrinkles and folds. Also factors such as sun exposure, genetics, hormonal changes and smoking all contribute to collagen diminishing. With the FDA approval of Evolence, collagen is getting attention again. Evolence is a new dermal filler that replaces lost collagen with a new collagen that will last several months. Doctors who have used the porcine (pig-derived) collagen are optimistic about Evolence, saying that it’s easy to inject and it causes less bruising and swelling than the hyaluronic acids. Some studies are showing that Evolence can last up to nine months, which is a significant improvement from the other collagen products available. Evolence is approved for the nasolabial folds, however Evolence can be used “off label” for other wrinkles and facial folds. Evolence will also have a higher formulation that is suitable for fine lines and lip augmentation – called Evolence Breeze available soon. Because Evolence is porcine and not bovine (cow) collagen, there is no need for an allergy test. Evolence has a unique technology called glycomatrix. It is this technology that adds to the longevity of Evolence. This process purifies the collagen somewhat like what occurs in the human body. The collagen strands are linked with ribose, which is a naturally occurring sugar. Evolence is made in a process using natural enzymes (pepsin) – which will result in a collagen that is so natural which will then actually integrate itself into the bodies own collagen matrix. Blood vessels and cells grow into the Evolence after it is injected. Evolence is marketed in the United States by the Aesthetics Group of OrthoNeutrogena, a division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., and part of the Johnson & Johnson family of companies. This innovative collagen structural dermal filler was developed by ColBar Life Science, Ltd., a biotechnology company specializing in reconstructive medicine and tissue engineering. This comes packaged as a sterile non-pyrogenic gel in a 1.0 ml syringe with a 27 gauge needle.
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ADVANTAGES AND DISADVANTAGES OF EVOLENCE Fillers can cause some minor swelling based on the fact that water is absorbed by these fillers. Water absorption adds to the fillers longevity. There is no water absorption with Evolence; therefore the swelling is minimal after injection. In addition, collagen is a natural hemostatic agent, meaning it will minimize any bleeding that occurs after injection. This means there is less bruising with Evolence as well. A lot of physicians refer to Evolence as the “event filler”, because of this fact you can have this treatment done with minimal bruising, redness or swelling. However, if this product is not injected properly it can cause lumps or areas of hardness.You might see the tiny injection holes from the needle after the treatment of Evolence, but that is about it. Makeup can be used fairly quickly after injection if necessary. Evolence tends to be a firmer and stiffer compound than some of the other soft tissue fillers, such as Juvederm, etc. Evolence is not indicated for lip enhancement; however the new formulation Evolence Breeze will be and should be approved within the next 3 to 6 months. Evolence Breeze is also great in fine lines and wrinkles. On November 3, 2009, Ortho-McNeil announced their intention to discontinue the manufacture and marketing of EVOLENCE® products.
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