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Filling in those lines

New injectable skin treatments are picking up where Botox and collagen shots left off.

August 25, 2003|Shari Roan | Times Staff Writer

Botox was just the beginning. The popularity of the injectable toxin overwhelmingly proved that people wanted wrinkle cures without surgery.

So as hundreds of thousands of Americans rushed to get the muscle-paralyzing treatment -- even those who had never before sought cosmetic procedures -- plastic surgeons and drug manufacturers were working to come up with other simple tricks to smooth aging skin. They seem to have succeeded.

A new generation of injectable substances -- used to treat facial lines, scars and depressions -- has begun hitting the market. The products, which actually fill in deep wrinkles and small imperfections, are expected to lure the sizable Botox crowd even farther down the path toward eternally youthful skin. Two fillers have recently been approved by the Food and Drug Administration, and several more are awaiting approval. They work in slightly different ways, but all are an improvement over bovine collagen, the filler of choice for the past decade, doctors say.

Not only do the new fillers last longer than traditional collagen injections -- some are even permanent -- they don't pose the risk of headaches the way Botox injections do."Botox has drawn a lot of people into the cosmetic dermatologist's office who hadn't come in before, and I think the new fillers will draw even more people in," says Dr. Leslie Baumann, a Miami dermatologist who has investigated several of the new fillers. "People who are used to paying $500 for Botox won't have sticker shock."

The botulinum toxin -- Botox for short -- is used primarily to prevent expression lines from forming during facial movement, such as the smile lines around the mouth and those that form between the eyebrows. Fillers actually plump up deeper lines (at least temporarily), most notably the folds that run from nose to mouth and mouth to chin.

Fillers also are used for lip augmentation and to fill acne scars and sunken areas of the face, such as under the eyes. Neither they nor Botox are generally used to treat fine lines and wrinkles, such as those around the eyes.

Soft implants can also be used to fill in deep lines and folds, but those products require surgery and are costly. Injectable fillers require no surgery, little recovery time and they're significantly cheaper.

Although studies haven't been completed on all of the substances -- and some doctors are wary of the permanent fillers -- most appear to pose little risk. Moreover, many of the new fillers are synthetic and, like Botox, don't require allergy testing in advance of treatment. Bovine collagen required one or more allergy tests six weeks before treatment.

"Sales of collagen in the late '90s became relatively flat," says Dr. Douglas Hamilton, a dermatologist and assistant clinical professor at UCLA. "Consumers became increasingly disillusioned that you had to keep going back and redoing the treatment. Consumers started to really push for something more permanent. There was nothing, up until now, in the American market, and the pent-up demand is tremendous."

Now the sheer range of new products demands that savvy consumers spend some time considering their options -- not only which product to choose, but where to get it.

Some people already have obtained the fillers, even those not yet approved by the FDA, through clinical trials, off-label use and illegal use.

They're often smuggled from other places in which they've been used for years, such as Europe, Canada and Latin America, Baumann says. "We see a lot of illegal fillers in Miami," she adds, "and I know it's going to continue to be a problem."

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Tough to detect illegal ones

People who are receiving illegal fillers have no way of knowing the purity of the product and how it has been stored (high temperatures will change the chemical composition of some fillers), she says. In addition, U.S. studies on many of the products haven't been completed, which should make consumers think carefully about possible unknown risks before opting to have an experimental treatment.

Also, the popularity of the new dermal fillers could trigger problems similar to those surrounding Botox, such as shots being given by untrained practitioners and outside medical offices. In March, the American Society for Dermatologic Surgery announced plans to form a task force to develop guidelines for using facial fillers and cautioned that the treatments should only be administered by trained doctors.

"It's not something people should approach cavalierly," Hamilton says. "Botox you can turn over to a registered nurse who has been well-trained and not have problems. But only doctors, he added, should be injecting the permanent wrinkle fillers. Some doctors may rely on nurses, however, to administer the temporary ones. The new fillers differ in composition and durability. Two approved by the FDA in March, CosmoDerm and CosmoPlast, are made of collagen derived from human cells. Doctors say they last slightly longer than bovine collagen.

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