Collagen for Facial Enhancement

Many techniques are now available for the improvement of acne scars, removal of wrinkles, correction of other imperfections, and lip augmentation. A plethora of filler materials saturates the marketplace, each of whose makers claims to offer the best method.

Of the many fillers available, bovine collagen is the most commonly used agent. It was approved by the FDA in 1982, has an excellent safety record, and is the gold standard to which all new fillers are compared today.

Collagen is a protein building block of the skin. Collagen injections are effective for superficial defects, while deeper defects may be better treated with implants of fat or synthetic products.

Types of Collagen

Collagen may be derived from either human or bovine sources. A review of the numerous materials now available would comprise a small book; please see emedicine.com for details on these. Briefly, however:

Bovine collagens include Zyderm I and II, Zyplast, and Resoplast.

Zyderm I’s relatively rapid reabsorption led to the development of Zyderm II, which contains a higher concentration of collagen and lasts longer (4-5 months, compared to 1-3 months for Zyderm I). Zyderm is useful for superficial wrinkles, including crow’s feet.

Zyplast contains a different type of collagen than Zyderm, one that is less likely to cause immune responses, and may last up to a year. Zyplast is used for lip augmentation, deeper wrinkles, and many scars.

Human collagens include Autologen, Dermalogen, and others.

Autologen is harvested from the patient’s own skin. After a skin sample is obtained, it is processed into an Autologen solution, which may be kept for 6 months before use. At least 3 injections are needed to treat skin defects, because much of the solution is reabsorbed. Autologen injections are more painful than bovine collagen injections, and therefore additional anesthesia is required. Since there is no risk for disease transmission or allergic reaction, skin testing is not necessary before Autologen injections. Results may last a year or more.
Dermalogen is prepared from cadaveric tissue that has been screened for viral and bacterial infection. Treatment is similar to Autologen in that it requires 2 or more repetitions, and like Autologen, they are relatively painful compared to bovine alternatives. Dermalogen has caused no allergic reactions to date, however, and skin testing is not required. Results may last 1- 2 years.

How is Collagen Used?

Pre-treatment Skin Tests

Prior to injection with bovine collagen, two skin tests are performed to ensure that no allergy to collagen will cause a reaction. About 3% of the general population is allergic to bovine collagen. About 1% of patients develop a hypersensitivity reaction after injection despite negative skin test results.

Treatment

Collagen is injected into the skin through a very fine needle. This may be done in one injection, or it may be done as a series of beads of collagen, one next to another, along the length of an area to be augmented. The collagen solution contains some anesthetic, but topical anesthesia may also be applied to reduce discomfort.

After injection, the area is molded in place. Ice packs or cool compresses may be used to reduce swelling. Physicians generally “overcorrect,” as the collagen mixture will undergo some reabsorption within a day.