Skin wrinkles and blemishes
Description
An in-depth report on the treatment and prevention of skin wrinkles and blemishes.
Alternative Names
Liver spots; Pupura; Seborrheic keratoses; Cosmetic surgery; Plastic surgery
Implant Procedures
Implants, also called injectable fillers, are becoming a common means of erasing wrinkles and folds. Several materials are being used for deep wrinkles, depression under the eyes, lip enhancements, and acne scars. In 2005, more than 3 million Botox injections and more than 1 million hyaluronic acid injections were given.
After being banned from the market in 1992, silicone is making a comeback in research settings as a potential permanent wrinkle eraser. Scientists are looking into a new microdroplet technique (the use of very small drops) combined with purified silicone as a way to eliminate any danger. The past problems with silicone occurred when it was mixed with a foreign substance, like mineral oil, or when it was injected in large doses.
Most implants to date, however, are not completely satisfactory. Collagen implants and biologic fillers from animal, bacterial, or human sources do not provide long-lasting benefits. Synthetic fillers are permanent but may cause an allergic reaction, which can lead to chronic problems. Such reactions are rare, but they can be painful and unattractive.
The U.S. Food and Drug Administration (FDA) approved the Juvéderm product line on June 2, 2006. Juvéderm is an injectable treatment of moderate-to-severe facial wrinkles and folds. Juvéderm products are gels made from hyaluronic acid. They are injected into the face. Doctors report good results after a single treatment with Juvéderm, and the results last for at least 6 months.
Implant Procedure and Material Used
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Procedure
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Specific Areas Affected
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Benefits
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Drawbacks
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Collagen implants. Collagen is the protein that forms the structures in the body (e.g., skin, bones, cartilage).
The implant procedure has typically used bovine (cow) collagen. A form of human collagen (CosmoDerm, CosmoPlast) has now been approved.
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Injected into target wrinkles with needle and syringe. Several weeks after injection, cow collagen breaks down and is replaced by newly created human collagen.
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Wrinkles around the eyes and mouth. It is used to give lips greater fullness.
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Very simple with faster recovery than many other implant techniques.
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Wrinkles form again, and require repeat treatments 3 - 12 months later. Rarely, severe allergic reactions occur. Should not be used by children, pregnant women, and people with a history of autoimmune disease.
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Microlipoinjection. Fat tissue from the patient's own thigh or abdomen.
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Injected into target wrinkles with needle and syringe.
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Deep wrinkles around the nose and mouth, folds in the forehead, and wrinkles on the hands.
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No allergic or immune reaction because substance is patient's own fat.
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Body eventually absorbs the fat, resulting in a need for multiple injections. Some studies suggest that 70% of the fat may still be in place after at least a year.
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Gore-Tex. Highly porous (full of tiny holes) and inert (not chemically active) synthetic material.
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Requires some surgery. Tiny patches are inserted under the skin to fill out wrinkles. Skin cells and blood vessels pass through the porous material easily, reducing the risk of severe irritation.
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Deep wrinkles.
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Material does not break down.
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Possible scarring from surgical procedure. Allergic reactions are rare but can occur even with chemically inactive materials.
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Artecoll. Contains PMMA, or polymethylmethacrylate, an inert substance, enclosed in tiny droplets of natural collagen.
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Material is injected. Body absorbs collagen. PMMA remains and stimulates new collagen growth.
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Deep wrinkles.
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Although part of the implant is a natural collagen implant, it does not degrade as quickly as a full collagen implant.
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Repeat treatments may still be needed. Possible allergic reaction.
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Hyaluronic acid. Natural (non-animal) substance acts like a molecular sponge to absorb water. The FDA approved Restylane in 2003, Captiva, Hylaform-Plus, and Hylaform in 2004, and Juvéderm in 2006.
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Gel is injected under the skin.
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Moderate-to-severe wrinkles.
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Low risk for allergic reaction. May last longer than cow collagen.
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Repeat treatments needed.
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Poly-L-lactic acid. Synthetic polymer. Approved in US as Sculpta. Approved in other countries as New-Fill.
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Material is injected under the skin.
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Approved in US only for patients with facial fat loss due to HIV. Approved in other countries for wrinkles.
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Low risk of allergies. Treatment effects can last 18 - 24 months.
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Doctors require special training.
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Botulinum (Botox)
The popularity of Botox injections has skyrocketed in the United States. Between 2004 and 2005, the number of procedures performed jumped 16 percent. Botox injection was the number one non-surgical cosmetic procedure in 2005, with more than 3.2 million injections. Botulinum, the deadly toxin found in uncooked foods, is also a powerful muscle-relaxant. Tiny amounts of a purified form (Botox) are injected into wrinkles to relax the surrounding muscles. It may benefit forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. It is also useful for treating involuntary muscle movements that can occur after a face-lift.
The injections need to be repeated every few months, since the effects wear off. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. When used for areas around eyes, it produces a rounder appearance afterward, which patients should be aware of before they undertake the procedure.
The drug does not cross the blood-brain barrier, and, to date, the only side effects are temporary muscle weakness near the injection site. Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also
causes
headaches in about 1% of cases. In some cases, the headaches can be very severe and long lasting (from 8 days to a month). Some experts suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.
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Review Date: 9/3/2006
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Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
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