Relaxers and Fillers
Joseph B. O'Connell, M.D.
Sponsored By Plastic Surgery of Southern Connecticut, L.L.C.
208 Post Rd. West | Westport, CT 06880 | 203 454-0044
New Fillers:
Artefill®, the only FDA approved "permanent" filler, has been re-launched in the United States by Suneva Medical, Inc. Artefill® consists of 20% (by implant volume) PMMA (polymethylmethacrylate) microspheres, 80% purified bovine collagen plus 0.3% lidocaine. The PMMA microspheres create what the manufacturer calls a "support matrix" for new collagen in-growth and enduring wrinkle correction.
Polidocanol, marketed under the name Asclera, has recently been approved by the FDA for injecting small spider and varicose veins in the lower extremities - this procedure is known as "sclerotherapy." This product has been used in Europe for many years and will likely represent a new treatment option for these common conditions in the U.S.
There has been recent discussion of Platelet-Rich-Plasma-Fibrin Filler, also known as PRP, which utilizes the patient's own blood and platelets to create an injectable filler. This is also known as the "vampire facelift" or "Dracula facelift", however it's important to realize that this procedure is not a surgical facelift and it does not create the same effect as a facelift. The procedure involves taking a small amount of the patient's whole blood and separating the platelets from the remaining blood elements. One technology that is used is known as "Selphyl®", however a search of the FDA web site was silent on this search term on November 28, 2010. It is claimed that these platelets contain growth factors that in turn stimulate cells in the tissues being treated to rejuvenate the skin. While this technology may have future use in plastic surgery, there is currently a paucity of evidence to support use of this product as an injectable filler.
Juvederm® VOLUMA® is an injectible hyaluronic volumiser that is pending approval by the US FDA. The product is used to recontour areas of the face such as the cheeks, cheekbones and jawline that have become hollow or thin because of age-related volume loss or weight loss. The correction has been shown to last up to 18 months. The product is advertised in Europe, not as a wrinkle filler, but as a large scale volumiser.
Belotero® is a monophasic double crosslinked NASHA hyaluronic acid filler distributed by Merz Aesthetics, Inc. that is not as yet US FDA approved. The manufacturer claims that Belotero is effective from 6-9+ months and suggest that two treatments per year are sufficient. The product utilizes a cohesive polydensified matrix technology and their FDA application requested approval for injection into the mid-to-deep dermis for correction of moderate to severe wrinkles and folds. The product is approved for use in Germany, UK, Italy, Russia, Austria and Switzerland.
Restylane® Received FDA Approval for Lip Augmentation. On October 11, 2011 the FDA provided approval for Restylane for aesthetic lip augmentation. Previously, lip augmentation was considered an "off-label" use for the product.
Restylane is a transparent hyaluronic acid gel that can be injected into a patient's lips to temporarily increase their size. In the clinical study referenced by the FDA patients needed one or two injections to obtain optimal lip fullness. The effects of the injection last about six months.
Restylane was approved in 2005 for injection into facial tissue to smooth moderate to severe wrinkles and folds, especially the nasolabial folds.
Dr. O'Connell believes that lip augmentation should not simply be a diffuse "plumping" but rather should be an artistic enhancement of the natural contours of the lips. The upper and lower lips have natural areas of fullness that fit together like a hand-in-glove and if this is not preserved, an unnatural appearance will result similar to many of the overly augmented lips seen in the media. Dr. O'Connell also commonly highlights the "white roll" at the margin of the lips to help create definition of the vermillion (red) portion of the lips from the white portion. Sometimes, the philtral pillars are also highlighted. In most cases, only one syringe of Restylane is necessary for lip augmentation in his practice and he is critical of the overly done, duck-like lips that are sometimes seen. Dr. O'Connell believes that the longevity of hyaluronic acid products for lip augmentation as well as wrinkle effacement is in part related to motion of the tissues.
Before and After lip augmentation with Restylane
Before and after Restylane for tear-trough augmentation
Joseph B. O'Connell, M.D.
208 Post Rd. West
Westport, CT 06880
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203 454-0044
Designed for Dr. Joseph B. O'Connell by the American Society of Plastic Surgeons