The History of Fillers: By Someone Who Was There
Fillers: Juvederm, Voluma and Restylane have been around forever, right? Obviously, not forever, but certainly for a long time and they revolutionized the cosmetic surgery world, right?
Actually there have been many predecessors to today’s fillers. And I was there from the very beginning so let me walk you through the evolution of modern injectables.
It was 1984 and a revolutionary new product appeared, it was called Zyderm. How amazing! You could actually inject, with a tiny needle, small amounts of collagen just under the skin to lift and fill fine lines (hence the term filler). It was glorious and it lasted as long as 6 weeks! I learned how to inject it in my residency and I very clearly remember my first paying patient when I opened my practice in 1985. It was the first time I injected collagen with out an attending physician I could call on if I had a question. I was sweating, my heart was pounding but the hands were steady and the result was perfect. I was hooked, instant gratification and a very happy patient. 10,000’s of thousands of filler injections later and I still love it.
Zyderm was made of proteins derived from cowhide. Despite its lack of longevity it also had a 3 % risk of allergic reaction. Everyone had to be skin tested (a small amount injected into the forearm like a TB skin test), then wait a month and skin tested again, wait longer. If a red bump did not develop then you could be treated. Just my luck, I was allergic. No way for the physician to heal myself.
Zyderm II came next, then Zyplast. Each thicker and lasting a little bit longer. Then Cosmoderm and Cosmoplast came along, the human-derived protein versions, at least these didn’t cause allergies.
A long line of competitors followed, some with less that wonderful results, some with disasterous results. There was one that was an early version of the vampire lift. We drew blood from the patient, spun out the cells and mixed it with fibrinogen and reinjected it into their faces. The pain was nearly unbearable. It wasn’t popular.
Then there was the version where we took a tiny piece of skin from behind the ear and sent it to a lab where they grew the cells in a petrie dish, harvested the collagen. After many weeks, the material was put into a syringe and shipped, a personal custom made product. It worked but it was a lot of work. And how much skin can you donate?
One memorable product was used only once in my office. It was FDA approved and purchased directly from the manufacturer. How could I know what would happen next. One of my staff volunteered to be the first. It’s my practice to use new products on volunteers until I am comfortable and it usually turns out great. This time the volunteer developed swelling and pain a few weeks after treatment. It was so bad that I had to drain fluid from the swelling multiple times and treat her with various medications. Everything resolved and there were no long-term problems but I through out all of the material. No patient of mine would be put at risk. When I spoke with other doctors at an international dermatology meeting I heard similar stories. I ended up publishing the cases in a medical journal. Shortly after the product was withdrawn from the market.
Crazy sounding stuff (like little plastic beads and the stuff bones are made of) have been approved and used as filler. And strangely enough have good track records and are still used today in the US.
But, my all time favorite, material for filler is called hyaluronic acid (HA). It sounds bad to inject acid but it is just an unfortunate scientific name. HA’s just long chain sugars, and they are found in the skin naturally. The difference between an HA and collagen (which also is natural to skin) is that collagen is a protein and people can be allergic. This is not the case with HA’s, sugars don’t cause allergies.
HA’s (Restylane, Perlane, Voluma, Juvederm, Belotero and others) have evolved into a variety of reliable versatile products. Some thick, some thin, some last up to 2 years (the thicker Voluma) and others up to 6 months (the thinner Belotero). We now have all we need to treat everything for lips to mid facial volume. And as a plus it is completely reversible, in case you don’t like it…..but chances are you will love it! I do.