Anti-Ageing:Your essential fillers guide

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Written by Elise Eggleton

With so many dermal fillers on the market, it's easy to get confused.

Despite being an inevitable part of growing older it seems that when it comes to wrinkles, most of us would trade just about anything to get rid of them. The school of thought that wrinkles add character and reflect someone's life experiences seems to be quickly diminishing. People are living longer and a smooth, youthful visage is increasingly sought after. That is not to say everyone wants to look 21 forever, and nor is it negating the beauty and wisdom of age - it's about looking as young as you feel on the inside.

By definition, a wrinkle is a line, furrow, crease or depression in the skin's surface. Wrinkles generally form due to a number of factors - sun damage, habitual facial expressions (smiling, frowning, squinting), smoking, genetic disposition, lifestyle and as part of the natural ageing process.

There are two types of wrinkles: dynamic and static. Dynamic wrinkles are formed by repeated muscle contraction involved in facial movement. Static wrinkles are formed during the normal ageing process due to the gradual loss of the skin's elasticity and fat volume, the pull of gravity and the breakdown of collagen. In visible wrinkles, the thickness of the skin is diminished to approximately one third of the surrounding skin.

Australians are particularly susceptible to wrinkles, due to the increased potential for photoageing by the sun. Photoageing refers to the premature ageing of the skin caused by exposure to sunlight. Some studies have estimated that photoageing may contribute up to 80 percent of the damaging effects to the skin. Daily radiation from the sun breaks down collagen and gradually destroys the elastin network.

Elastin is not naturally replenished by the body and when it is damaged the skin often assumes an uneven texture. Cosmetic processes such as dermabrasion can help with new elastin growth, giving the skin a smoother appearance.

Collagen is one of the strongest natural proteins and gives the skin its durability and resilience, and also helps the skin to heal. The latest light-based technologies not only rejuvenate the skin but also help stimulate the formation of new collagen post treatment.Today there is a plethora of products and minimally invasive procedures available to help restore a more youthful appearance. One of the most popular is dermal fillers.

Wrinkle treatments

Botox

Botulinium type-A toxin is injected in minute quantities to soften dynamic facial lines by blocking muscle contraction. Botox is most commonly used to treat crow's feet around the eyes, the central frown lines between the eyebrows (glabellar lines), chin creases, neckbands and the worry lines across the forehead. Common side effects are restricted to minor and temporary redness, swelling or bruising at the injection site. The cosmetic effect of Botox usually becomes apparent after three to four days, reaching its full action by one week. On average, Botox lasts three to four months but sometimes up to six months or longer.

Ipsen

Dysport was recently approved by the Therapeutic Goods Administration for use in Australia, and has been used in Europe and New Zealand for over 12 years. It is a protein extracted from the bacterium Clostridium botulin. Clinically Dysport should be the same as Botox but because it is a biological product and is produced by a different manufacturer it may have different effects on different patients and therefore may be better suited for certain patients. Dysport tends to be as long lasting as Botox.

Non-permanent fillers

Collagen

One of the original dermal fillers, Collagen remains a popular injectable today. Allergy testing is required four weeks prior to treatment. Generally, 97 percent of people can be treated. Once approved, treatment consists of simple injections to smooth lines, wrinkles and scars, and to define the lip border. An immediate result is visible, with results lasting between one to six months, although in some people one implant may be sufficient for up to two years.

Hylaform

Made from a highly purified form of hyaluronic acid (HA), this mimics the effects of natural hyaluronic acid. It is used to add volume, smoothing unwanted lines and wrinkles. Because it is very soft it is the best product for highly mobile areas such as the red part of the lips. Its softness also makes it ideal for patients who want to try a dermal filler. Usually lasting from four to six months, it is also effective for the nasolabial folds and marionette lines.

Hylaform Plus

This is a hyaluronic-based soft-tissue filler used to plump moderate to severe facial wrinkles and folds. It is a clear, colourless product with larger hyaluronic gel acid particles than in Hylaform, so it is designed to last longer and work effectively for the deepest facial wrinkles.

Radiesse

Ideal for filling in smile lines, frown lines and skin depressions such as acne scars, this product is 100 percent biocompatible and biodegradable, and is composed of synthetic calcium hydroxylapatite (CaHA). Once injected into fibrous tissue, the consistent, smooth and spherical CaHA particles form scaffolding for natural tissue infiltration through which the body's own collagen grows to maintain the filler in place. The gel carrier is gradually absorbed and replaced by the surrounding soft-tissue. Radiesse is also generally longer lasting than other types of dermal fillers - lasting somewhere between 18 and 24 months.

Restylane

A non-animal stabilised hyaluronic acid that combines with the body's own HA, Restylane is completely biodegradable and biocompatible. It is commonly used to treat glabellar lines, the nasolabial folds, smoker's lines and the lips. Restylane is injected into the skin and is slowly absorbed by the body. Treatments usually last for up to six months. No pre-testing is required.

Restylane SubQ

This is an instant aesthetic treatment for shaping the facial contours, such as the cheeks and the chin. It can also be used for restoring volume lost through ageing and can be used as an alternative or a complement to traditional facelifts. The gel is based on a biotechnologically produced version of hyaluronic acid, a tissue-friendly substance that occurs naturally in the body. Effect should last between six and 12 months when used for smoothing lines and around six months for augmenting lips.

Sculptra

This is a long-lasting filler, with results sometimes lasting for up to 18 months. It is a synthetic product, biocompatible, immunologically inactive and without toxicity. It is made from poly-L-lactic acid, which has been used for more than 20 years in dental implantology, surgical suturing and tissue reconstruction. Sculptra is suitable for increasing the volume of depressed areas, particularly skin depressions such as in skin creases, wrinkles, folds, scars and eye rings.

Zyderm and Zyplast

These are injectable collagen implants that help to smooth lines, wrinkles and scars, and to define the lip border. They are produced in various formulations, each appropriate for different facial areas and conditions. The collagen is of bovine origin so patients need a pre-treatment skin test. No other injectable collagen implants currently on the market have undergone such extensive research.

Permanent fillers

Aquamid

Aquamid is a permanent filler commonly used to treat forehead frowns, marionette lines and depressed corners of the mouth. It can also be used for lip, chin and cheek augmentation and nasal correction. Aquamid has been proven to remain in place unchanged for up to 10 years.
Aquamid is a transparent, injectable implant in hydrogel form. The hydrogel is composed of 97.5 percent sterile water bound to 2.5 percent cross-linked polymers. These have been used safely in biomedicine for decades. acsm

Common wrinkles

Frown creases

As a result of voluntary and involuntary frowning, horizontal creases can form across the forehead, glabellar lines between the eyebrows and horizontal lines across the bridge of the nose.

Eyelid droop

Gravity forces the brow down, causing heavy upper eyelids, often exacerbated by loose skin.

Eye bags

Blinking, rubbing and squinting tends to make lines show up around the eyes. The skin is thinner and more susceptible to creasing. As the orbital septum weakens, the fat will bulge more around the eyes, creating sags and bags.

Crow's feet

Smiling, laughing and squinting cause muscle contractions that result in lines etched at the corners of the eyes.

Smile lines

The nasolabial folds from the nose to the corners of the mouth become more deeply etched as the skin over the cheeks loosens, causing it to sag downwards.

Lip grooves

Smoker's lines (not necessarily as a result of smoking) can form around the outer boarders and at the corners of the mouth due to the loss of skin elasticity, volume and weakening muscles.