Collagen Replacement

What and Why

To understand collagen depletion, first consider the basics of skin architecture.  The two outer layers of the skin are the epidermis, what you see, and the dermis, just below the visible surface.  The dermis consists mostly of a protein called collagen, a network of elastic-like fibers that forms the support structure of the skin.  

Even if we didn’t know the science behind it, we know just by looking at the epidermis that with aging, the support structure underneath the skin has weathered or weakened.  Where the collagen has broken down below the skin’s surface, the visible result up top is sagging, wrinkling, and loss of elasticity and tone.  The natural expressions of smiling and frowning stress the skin’s collagen and in time stretch it out (think of a rubber band that has lost its bounce).  Environmental factors like negative lifestyle—drinking, smoking, excessive sun, inadequate nutrition—also work to break down collagen.  Without intervention, the collagen structure will continue to wear, and the skin we see will look ever less like it used to.  The good news: now medical science can intercept or even reverse this process and its unwanted visible effects. 

‘Collagen Replacement’ is a bit of a misnomer.  In fact the term generally refers to the two ways to restore facial fullness, not collagen per se.  The methods are:

1) Adding a volumizing substance (formerly often collagen from animals; now more often a biocompatible substance like hyaluronic acid, such as Restylane) to parts of the face where it is depleted.

2) Stimulating the growth of new, natural collagen to take the place of the lost collagen 
The first method is far faster.  ‘Collagen Replacement’ is more accurately called “Facial Filling.” 

Initially, animal collagen injected just under the skin was the most effective advance toward replacing natural fat loss.  (These injections, usually derived from bovine collagen, are still available and in use, although less so in recent years as better alternatives have been developed.) The collagen in ‘Collagen Replacement’ now refers not only to the original animal collagens, but also to the new facial fillers derived from hyaluronic acid, or poly-L-lactic acid, or calcium—natural substances found in the human body.    (See Restylane, Juvederm, Sculptra and Radiesse.)  Most dermatologists and plastic surgeons consider these recent products superior because, for one, they last longer.  Animal collagen is too quickly adapted to and absorbed, and thus its visual corrective effects on the face are too fleeting.  Also, patients must be tested for allergic reaction to animal collagen.  These tests are administered two or three times prior to treatment, adding to cost and subtracting from ease and efficiency.

You will hear terms other than Collagen Replacement to describe what is essentially the same thing: replacing lost facial volume with an injectable ‘filler.’  Known variably as ‘Soft Tissue Enhancement,’ or ‘Facial Fillers’, or ‘Restylane,’ (a brand name), the objective is to fill folds and sags, smooth facial lines, replenish thinning lips, restore original structure and add youthful volume.

The new crop of fillers is biocompatible and biodegradable, and they last from about six months to over two years.  Since the effects are not permanent, touch ups will eventually be required to maintain the effect.

Note on ‘Collagen’-containing cosmeceuticals: Although the cosmetics market has been flooded with creams and topical solutions that claim to correct collagen loss, these products have precious little penetration value and probably can do no more than retard the rate of moisture loss from the skin.  In fact, they cannot address collagen replacement/renewal at all.  Certain light-based therapies, like Laser Toning and GentleWaves, can stimulate new collagen growth, as can regular Chemical Peeling and even Acupuncture.  These procedures have less of an instant gratification quotient than injecting fillers, but have a long-term collagen-stimulating effect. At NYDG, we often recommend more than one collagen boosting therapy for aging or environmentally challenged facial skin.

Who and When

Depending on your age and the condition of your skin, as affected by sun exposure, lifestyle and genetics, collagen replacement may be an excellent anti-aging choice, far less drastic and more natural looking than surgery.  Keep in mind that although surgery lifts the muscles, it tightens the skin by pulling, not plumping, often with a debatably attractive, stretched result.  After surgery, the skin itself will continue to show signs of aging, whereas the new options in cosmetic dermatology deliver a much more pleasing and natural effect both structurally and on the surface skin. 

Collagen replacement therapy and its namesakes are used principally to:
-  Minimize nasolabial folds
-  Fill marionette lines
-  Correct deeper wrinkles and scars
- Plump thinning lips
- Restore structure to cheekbones and jaw line

A consultation with the doctor will determine if and where collagen replacement is a good option for you.  Results are immediate—you can literally watch your face grow younger in the hand mirror as the dermatologist works—and patients who receive collagen replacement are typically delighted with the results.  Please see Facial Fillers;

Restylane, Juvederm Sculptra and Radiesse; The Fifteen Minute Facelift® result

Collagen replacement, or facial filling, has the great advantage of showing immediate results.  For example, if your objective is to diminish the sagging area between the side of your nose and your cheek, that result will be evident by the time the dermatologist has finished injecting the filler, i.e., in a New York minute.  Though there may be some swelling at the injection site, what you see is pretty much what you get, and patients are usually thrilled that their cosmetic issue can be attended to so easily, quickly and effectively.  Patients can also participate in the process, determining with the doctor how much is enough.

Q: Does collagen replacement hurt?

A:  Used with a mild numbing agent or a nerve blocker, the procedure is painless. Depending on the patient’s tolerance of needles, sometimes icing is all that’s required.  There is often some bruising at the injection site(s).  This minor side effect can be minimized by avoiding aspirin and ibuprofens for a week prior to treatment, by icing, and by using Arnica Montana (available at drug and vitamin stores) pre and post procedure.