The use of injectable fillers for anti-aging purposes has become ubiquitous as it is a quick, safe and low downtime procedure in experienced hands. Understanding of anatomy and process of natural aging are keys to proper filler technique to produce natural and beautiful results.
As part of the aging process, the skin’s collagen breaks down, both fat and bone resorb resulting in the loss of facial volume. Loss of skin elasticity results in wrinkles and fine lines whilst loss of facial volume causes hollowness of the mid face and jowls to form in the lower face. Besides facial rejuvenation, fillers can also be injected to the neck to improve lines and hands for volume restoration.
Fillers can be classified into two main groups, hyaluronic acid based fillers and collagen stimulators. Collagen stimulators include Radiesse (Calcium Hydroxyapatite) and Ellanse (Polycaprolactone).
Hyaluronic acid (HA) is a natural molecule found in our skin and joints. When HA is injected into the face, neck or hands, it absorbs and holds on to water molecules, therefore providing volume replacement and hydration at the same time. Depending on the “stiffness” (i.e. cross-linking) of the HA filler, it can last anywhere from 3 months to 1.5 years.
Common side effects include swelling 1-2 days after injection and this is due to the water absorbing property of the filler. Therefore, it is prudent for injectors to undertreat when using HA fillers to prevent too much swelling and over volumisation. An advantage of HA fillers is that the enzyme hyaluronidase (Hyalase) can be used to dissolve the product in case of any adverse event after treatment, or if patient requests to remove the filler.
Another disadvantage besides post-treatment swelling is that HA fillers do not stimulate as much collagen production as compared to collagen stimulators. Therefore, more frequent repeated injections might be needed to maintain the results produced by HA fillers as compared to longer lasting effects produced by collagen stimulators.
Collagen stimulators/ biostimulators are newer cosmetic fillers. As the name suggests, these products stimulate the underlying tissues to produce collagen, thereby restoring volume, skin elasticity and also provide a subtle lift of the face.
These provide tissue collagen stimulation that develops from 2.5 to 3 months post-injection. They can provide maximum results that develop subtly and naturally over time without an over filled appearance.
How do Collagen Stimulators work?
Collagen is one of the main structural proteins of the skin and is responsible for giving the skin its firmness and smoothness associated with a more youthful appearance. As we age, the body’s production of collagen decreases, resulting in thinner skin, fine lines and a loss of volume and elasticity.
Unlike HA fillers which provide volume replacement via absorbing water molecules, collagen stimulators restore volume to the face via tissue rejuvenation which occurs gradually from 2.5 to 3 months. In general, most patients see results after 3 months with final results lasting 1.5 to 2.5 years. The skin gradually regains collagen and elastin and as a result, leads to gradual restructuring of the skin from within for natural rejuvenation.
The collagen stimulation property also makes it ideal for treating larger areas of the skin that need rejuvenation but which would not be easily improved using HA fillers. For example, collagen stimulators can be used to treat atrophic scars and the back of the hands which experience loss of tissue volume with aging.
In Singapore, two types of collagen stimulators (Ellanse and Radiesse) are HSA and FDA approved. When done by an experienced medical practitioner, they are safe to be injected for face, neck and hands rejuvenation.
Ellanse consists of the biostimulator called polycaprolactone (PCL) suspended in the aqueous gel carrier of carboxymethylcellulose (CMC).
When Ellanse is injected into the skin, the CMC provides an immediate lift to volume deficient areas. PCL provides collagen stimulation in the skin while CMC is reabsorbed. The collagen will therefore occupy the space that was initially taken up by the CMC gel, from 3 months post-injection. Results from collagen stimulation using Ellanse can last up to 2 to 2.5 years post treatment.
Repeated Ellanse treatments over time will result in stacking of more and more collagen resulting in continuous improvement of the patient’s facial age and may allow for less frequent maintenance treatments.
From my experience, Ellanse is one of the most powerful fillers for lifting and stimulating collagen production due to its higher G’ property as compared to most HA fillers. Therefore, it provides very good lifting ability and projection over the cheeks, temples, forehead and chin. Compared to HA fillers, it has also less water retention.
Similar to Ellanse, Radiesse is also a collagen stimulator. The difference is that it consists of Calcium Hydroxyapatite (CaHA) instead of PCL (Ellanse) but suspended in the same CMC gel carrier. Like Ellanse, when Radiesse is injected, the CMC component immediately provides volume to deficient areas and contour facial features. Over 3 months, the CMC gel is fully absorbed and collagen stimulation from the CaHA microspheres occurs resulting in improvement of facial volume and skin elasticity. Collagen stimulation occurs at 3 months with results lasting up to 1.5 years.
Areas that Radiesse are suitable for contouring include the cheeks, temples, forehead, jawline and chin. It is also excellent as an anti-aging treatment of hands.
A unique property of Radiesse is that it can be used as a skin rejuvenator for skin tightening and pore size reduction. This is via hyper-dilution to increase the volume of the product and at the same time decrease its density to allow it to be injected more superficially.
Optimum and natural results require a skilful and experienced injector with a keen aesthetic eye. Collagen stimulators must be placed precisely in the skin’s dermis and subcutaneous layers, where fibroblasts are found for maximum results. Fibroblasts are the cells which generate collagen.
Also, if collagen stimulators are injected too superficially, they will cause lumpiness and nodules which are almost irreversible. Therefore for both cost-effective results and safety reasons, it is imperative to consult an experienced injector who has performed a high volume of such injectable treatments.
Similar to HA fillers, prospective patients who have bleeding disorders or who are consuming blood-thinning medications or supplements should consult a doctor first before embarking on such treatments as the risk of bruising from the procedure will be increased. Patients who are nursing, pregnant or trying to become pregnant should not have this procedure performed. As always, consult your doctor before embarking on any aesthetic procedures for your safety.
After assessing and ensuring that you are a suitable candidate for collagen stimulator treatment, anaesthetic in the form of topical or injection may be instituted by your practitioner to minimise discomfort. A fine needle will then be used to gently prick the skin to create a tiny entry point before a cannula is introduced to carefully deposit the product under the skin in thin threads. As the cannula is blunt-tip, most patients experience minimal discomfort throughout the procedure. The area is then massaged to distribute the product evenly. There may be some swelling and bruising post-treatment, but it will resolve in a couple of days. In my practice, my patients have no to minimal swelling and often no bruising post procedure.
The benefits of collagen stimulators over HA fillers can be summarised as follows:
However, it is imperative to note that injecting collagen stimulators requires expertise and should only be done by a medical practitioner who has accumulated much experience and is skilled in injecting these products. This is to ensure optimum and natural results without any complications.
Consult us today to find out more about collagen stimulators as an anti-aging treatment!
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Disclaimer: The material contained in this is for informational purposes only and do not constitute medical advice. The content is not intended to be a substitute for doctor's advice, diagnosis, or treatment.