Collagen vs. hylauronic acid - which is better for wrinkles?

Evolence is the latest Dermal Filler to be FDA approved. Of all the fillers, it is the most natural, and causes the least swelling and bruising. It is a collagen based filler but overcomes the hurdles that prior collagen fillers had. There is no need for pretesting to see if you have an allergy to it. Also, while prior collagen fillers had a very short duration of about 2-3 months, Evolence is approved as a 6 month duration filler, but in studies it has been shown to have up to a 12 month duration.

The longevity of Evolence is based on it's glycomatrix technology. After the collagen is purified, a process is used that is similar to what occurs in the human body. The collagen strands are linked with ribose, a naturally occurring sugar.
The collagen is Porcine based. Similar to what is used in heart valves, lenses, and surgical meshes. The collagen is cleaved in a process using natural enzymes (pepsin) resulting in a collagen that is so natural it is actually integrated into the bodies own collagen matrix. Blood vessels and cells grow into the Evolence after it is placed!

Hyaluronic Acid fillers (Juvederm, Restylane, Perlane) cause some minor swelling based on the fact that water is absorbed by these fillers. Water absorption adds to the fillers longevity. There is no water absorption with Evolence, therefore the swelling is minimal or none after injection. In addition, collagen is a natural hemostatic agent, meaning it will minimize any bleeding that occurs after injection. This means there is less bruising with Evolence as well. 

Unfortunately, Evolence is not indicated for lip enhancement. However, within the next 6 - 12 months, another filler called Evolence Breeze should be FDA approved, and that will be a great filler for the lips - long duration, minimal bruising and swelling.

For the time being, only company trained physicians will have access to Evolence.  (I am a Physician Trainer of Evolence for the Panhandle of Florida, Alabama, Parts of Mississippi and Louisiana.)

First you should know a brief history of dermal fillers.

Zyderm and Zyplast were some of the first collagen fillers introduced into the market. At that time, that was all we had and they did a pretty good job achieving nice corrections. However, the use of these products is complicated by allergic reactions and the need for skin testing. Studies have proven that Zyderm and Zyplast do not last as long as the newer hyaluronic acid fillers such as Perlane and Restylane and Juvederm. So, in short there are very few people left using Zyderm and Zyplast and almost no reason to choose these products.

As for hyaluronic acids, their major advantage is a longer duration of improvement as well as the fact that they are reversible. (Though rarely needed, there is an enzyme you can inject called hyaluronidase which will reverse any unwanted cosmetic results within 24 hours.)

Lastly, because the newer hyaluronic acids are obtained from non-animal sources, they are very safe to use. By contrast, the newest collagen filler that is about to hit the market is obtained from porcine (pigs).

Again, I will reiterate that the most important selection that you make in choosing your filler is not what's in the syringe but who is on the other end of it!

Collagen and hyaluronic acid filler work differently. The older forms of collagen generally lasted a shorter amount of time than the new formulations of hyaluronic acid. As noted by other physicians, collagen works by plumping in the skin while the hyaluronic acid fillers work by not only plumping the skin but also trapping water in the large molecules.

Johnson and Johnson at the end of June 2008 received FDA approval to market a new collagen in the United States. It has been used overseas and it is a special formulation which promises to last longer than previous collagen products. In addition, no skin testing is needed. Physicians will be required to attend training before they can administer the product but it should be available by the last quarter of 2008 according to J&J.

The advantage to the hyaluronic acid fillers over the collagen fillers is that the hyaluronic acid fillers can be removed with an enzyme called hyaluronidase even before they natrually dissolve. 

Universally, most doctors have switched to the hyaluronic acid fillers for most of their work, as they last longer than the collagen fillers and there is no skin test needed prior to the first treatment. There can be between a 1 and 3 percent allergic reaction with collagen skin treatments but it is extremely rare with hyaluronic acid fillers.

There is, however, more bruising, although subtle, with hyaluronic acids than with collagen injections, not as a result of the technique but as a direct effect of the chemical nature of the Juvederm and Restylane hyaluronic acids. These acid fillers can plump up the lip with water binding more unnaturally, especially in the lip line, so that human collagen, Cosmoderm and Cosmoplast (which does not need a skin test) is still used by many of us physicians to give better definition and can be applied at the same time as hyaluronic acid fillers, either in different areas, or layered in the same location.

There are over 300 different dermal fillers available world wide. If one filler or type of filler was really better, then most of the other fillers would have disappeared long ago. Every filler available has pros and cons. The ideal filler has yet to be produced. Nevertheless, you can a great result from many fillers. You can also get a terrible result from the same filler. The most important factor is the doctor on the other side of that syringe!! Technique in filling is most likely going to be much more important than which filler is used.

Having said that, most docs I know, including myself, use Hyaluronic Acid Fillers (Restylane, Juvederm, Perlane) more than collagen fillers. The Hyaluronic Acid Fillers are easy to work with, almost painless to inject with good technique, last long enough but not too long, and they can be dissolved with Hyaluronidase.

Michael Sinclair, MD

www.epilution.com

Generally, patients prefer the results from Hyaluronic Acid-based fillers such as Restylane, Perlane, and Juvederm as they tend to provide more natural looking results and tend to last longer.

In either event, the key is to find an experienced injector to optimize the look that is created from the product.