Truth or Hype: Do Fillers like Restylane, Juvederm, and Radiesse Really Increase Collagen Production?
In early 2007, the Archives of Dermatology published a report saying that injection of cross- linked hyaluronic acid fillers, like Restylane and Juvederm, stimulated new collagen production. Since that time many dermatologists and others who work primarily with fillers have used this report to increasingly tout their philosophies. They claim that lifting procedures may not be necessary because fillers can increase collagen production and tighten skin. This contention has always been dubious at best since the amount of collagen production necessary to lift sagging facial skin would have to be a lot.
However, the study findings need to be re- examined in more depth because a new study looking at injection of Radiesse (calcium hydroxylapatite) found no increase in collagen production.
We decided to review both papers to see if we could find the source of the discrepancy, and we think we may have. It seems that those who cite the original Restylane paper may not have noticed that, in the study, volunteers had an entire syringe of Restylane injected in one small area identified on the forearm. One to three separate sites were injected this way and then samples were taken that showed increased collagen production. Why is this important?
Simply put, this study does not make a lot of sense for at least 2 reasons. First, and most important, no one injects an entire syringe of Restylane into one designated area. It is generally used in the face to fill in wrinkles distributed over some distance. Since the doctors propose that mechanical stretch is the reason they think new collagen production is induced, we now can discern that it would take a whole lot of Restylane to be injected into any one area of the face to allow for collagen production. Not only would this likely be cost prohibitive, but it would also counter normal aesthetics. Second, the study used the forearm of participants to examine the effects, and we know that skin from different areas of the body respond differently to injection of these fillers.
This also explains why, in the more recent finding, new collagen production did not occur when Radiesse was injected. One would suspect that if the mechanism was simply mechanical stretch that it would not matter which of the fillers was injected, but the study found no new collagen on examination. Why is the second study likely more reliable?
- They used a crease behind the ear as the site of injection. One would reason that this skin is more like the rest of the skin in the face than is forearm skin.
- They injected only 0.1 ml into the area. This is closer to the amount that is normally injected into any one wrinkle area.
So, while fillers work well for temporary improvement of wrinkles, the evidence that they have any real effects on collagen production is lacking.1 comment
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