Welcome Back Collagen?
April 28th, 2009
Allure magazine has just reported the availability of a new injection material, Evolence. Manufactured by Ortho-McNeil-Janssen Pharmaceuticals, Inc., it received FDA approved almost a year ag0. Now available in the US, it gives another choice to patients requesting injectable wrinkle treatments. Other injection materials include hyaluronic acid (Restylane ®, Juvéderm ®), hydroxyapitite (Radiesse ®), autologous fat (fat from your own body), and other collagen products (Zyderm ®, Zyplast ®, Hylaform ®, Cosmoplast ®).
The Evolence collagen is sourced from porcine (pig) tendons. It is crosslinked using a patented technology using D-Ribose a natural sugar. Due to the genetic similarity between pig and human collagen and the crosslinking process, dermal allergy pre-testing is not necessary.
The search for the ideal injection material to improve facial wrinkles, augment facial bones, and enlarge lips has endured over a century long pursuit for plastic surgeons. The first material tried in the 19th century was paraffin or wax. The chemical induced inflammation and ruled out this material out of the question very early on. Interestingly, I recently saw a patient from Asia who had received such an injection in the 1990’s!
Women searching for larger breasts in the 1940’s and 1950’s received silicone injections. The reactions were so serious, it was banned in the US. Unfortunately, silicone breast injections continued elsewhere in the world for some time. In 1994, the FDA approved injectable silicone for detached retina treatment. The off-label (not approved) injection into the face has continued since that time. Sadly this practice has migrated outside the standards and medical protocol of physician’s offices. It can be found in home parties and offered at hotels where it is being injected by individuals without medical training. Poor results are common.
Collagen injections were first approved by the FDA in 1981. Since that time there has been a string of new collagen products, each trying to improve on the last. Problems including allergic reactions, visible material under the skin, and skin loss (necrosis) have plagued these products. Only widespread clinical use of Evolence will be able to confirm the reported risks and benefits for this product.
Surgical Revisions
April 16th, 2009
There is a saying among surgeons, “If you don’t operate, you will not have complications.” The same can be said of surgical results. On occasion, the results of surgery do not go according to plan. All surgeons have surgical results which sometimes disappoint them. Occasionally the result requires secondary surgery to improve on the outcome.
The causes of less than optimum results are complex. Complications such as unwanted bleeding or infection may occur. Sometimes patients do not follow after care instructions as carefully as they could. Pre-existing medical conditions may also interfere with healing and scarring. The surgical design may just not work out for a particular patient. Generally, the final outcome is a combination of some or all of these. It really is a shared responsibility and must be remembered as such.
Revision surgery is difficult. Not only must the surgeon contend with previous surgical scarring but must also deal with changes in anatomy. Feelings of disappointment and possible mistrust by the patient are not to be over-looked. Expectations of perfection may present the burden of unrealistic results.
Results are rarely perfect. The decision to have revision surgery is usually based on the likelihood of possible improvement weighed against the risk of making things worse.
Finally, often small improvements are always the most difficult to achieve. I know this sounds counter intuitive, but I find that to be true.
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