Restylane, Perlane, Hyalaform, Juvederm, and Captique
The early 2000s saw the race for a better wrinkle filler. Half a dozen companies waged a furious battle to gain early market share for what they hoped would be the next blockbuster cosmetic drug—the next Botox.
Restylane was approved in Europe in 1996 and in the United States in 2003. It is made of hyaluronic acid, created by bacteria through the wonders of genetic engineering. Because no animals are used to create this product, there is no chance of contracting infectious disease. And because this sugar-like substance is already normally present in our bodies, skin testing for allergy is not required. Although the FDA says that Restylane is comparable to Zyplast collagen at six months, many physicians find it to be superior. Under the microscope, this material is seen to last nine months. Bruising, swelling, and pain on injection are common and depend on the skills of the doctor.
Restylane fills wrinkles nicely and clinically lasts between six and twelve months, although this duration is not guaranteed. Some patients need a second touch-up injection a few weeks after the first because swelling occurs immediately, making precise injections impossible.
Restylane is not destroyed by the body. It simply diffuses into the skin, like a drop of ink diffusing into a glass of water. Gradually it settles into the skin, and the wrinkles are exposed again.
The company that produces Restylane also produces lower- and higher- viscosity (thickness) products. Perlane is Restylane’s thicker cousin. It will be used to correct deep folds and to plump lips. Restylane Fine Line is a thinner material that will be used in fine wrinkles, and Restylane SubQ uses larger particle sizes to fill deeper folds and to build up the cheekbones and the chin. These products will serve to confuse physicians and consumers since their indications overlap.
Juvederm, approved in 2006, is Allergan’s answer to hyaluronic acid. Juvederm comes in three different viscosities. Like the Restylane products, the thicker materials are used for deeper folds; the thinner fillers are used for more superficial wrinkles. Juvederm claims to have the highest concentration of cross-linked hyaluronic acid, allowing the chemical to stay in the body longer than competing products. Because Allergan also makes Botox, the co-marketing of these two substances will propel Juvederm’s popularity.
Restylane is today’s ‘‘injectable of choice.’’ It has caught on rapidly. Not only is it used for fine wrinkles, but creative uses keep being described. It fills folds, scars, and various depressions. It is being used to plump up the eyebrows, giving a lifting effect. Used in the lower eyelid, it pushes up the lid, shaping it and filling in the ‘‘tear trough.’’ It can highlight the bones in the upper eyelid and increase the size of lips. It has even been injected into sun-damaged cleavages!
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