Collagen injections have been used for many years to improve facial lines and acne scars. Because three percent of the population manifests an allergic reaction to collagen, it is necessary to pre-test a patient with collagen beforehand. This is performed by injecting a small amount, 0.1 ml, into the skin of the undersurface of the forearm, and observing the patient at intervals of seventy-two hours and four weeks later.

If no inflammation is seen at the implantation site, it is recommend that a second collagen test be administered at the end of four weeks, and that test site observed two weeks later. At that time, if there is no reaction, collagen can then be administered into facial lines. Like any other allergy producing substance, collagen can induce a reaction in patients who have tolerated it before, although it is unlikely.

As with other procedures, it is always important to discuss your complete medical history with your physician. It is especially important for your physician to know whether there is any history of connective tissue disease, or any pregnancy planned in the very near future. Collagen is available in a long-lasting form called Zyplast, in intermediate lasting form called Zyderm II, and a short-acting form called Zyderm I. The techniques of injecting the various forms differ. Collagen injections, properly administered, produce extremely gratifying results. However, collagen becomes absorbed within four to six months, and the injections need to be repeated at intervals, adding to the cost and the inconvenience of this procedure.

One solution to the transient nature of collagen has been offered through the use of Softform and Gortex inserts along facial lines. These can be placed into the fold between the nose and the mouth, or around the liplines, and when left in place will permanently correct the depression. However, both Gortex and Softform implants have been associated with an approximately five percent rate of inflammation, infection or rejection, necessitating removal of the implant from the skin. Moreover, these implants are not suitable for lines on the forehead and in the glabella region, the lower forehead area between the eyes. Only Zyderm should be used in these areas, since the use of the longer lasting Zyplast may produce sloughing of the skin with resultant scarring.

Recently, new filler substances have been introduced in Europe and in Canada, such as hyaluronic acid. Hyaluronic acid appears to offer a good deal of therapeutic promise, but there have been a number of reports of inflammatory reaction to hyaluronic acid with leakage of hyaluronic acid through the skin, resulting in scar formation. Other recently introduced alternatives to collagen have included the use of Alloderm, which is taken from the patient's own skin following surgery elsewhere on the body, or Dermologen, which is produced from cadaver tissue. The preparation of Dermologen is governed by a very stringent protocol, under which every known virus and infectious agent is tested and subjected to destructive procedures. However, many physicians feel that the issue of safety has not been totally satisfied, since prions, a unique form of infectious agent producing neurological disease, cannot at this time be easily detected in tissue and cannot be destroyed. For this reason, many physicians, including myself, are reluctant to use Dermologen.

Other filler substances, which have produced satisfactory results in many patients, include the use of the patient's own body fat. While very satisfactory for many patients, fat injections can be associated with inflammatory reactions. Again, since each of these alternative therapies offer unique risks and benefits, it is important to discuss these with your physician.