Restylane – The answer to long-lasting wrinkle correction
By: Dr. Charles A. Wallace, M.D., F.A.C.S.
NewTech Magazine, April 2004
One of the most exciting and challenging aspects in the practice of medicine is the continual development of new products and biotechnologies to enhance outcomes of all sorts, irrespective to the specialty.
Speaking as a plastic surgeon, this has been particularly gratifying, as the last 15 years have produced a veritable pipeline of new treatments for all manner of conditions. The challenge arises in sorting out which of these treatments and products represent legitimate advances and which are passing fads. When liposuction was first introduced in the 1980’s, many people thought it would be a passing fad, which proved to be as far from the truth as possible. Popularized in the 1980’s, injectable fillers, such as Collagen changed little until the middle 1990’s when human sourced Collagen was developed by a variety of companies. Unfortunately, none of these held up to their promises of lasting longer with fewer problems.
In 1996, Europeans were the first to have the benefit of hyaluronic acid fillers, now marketed in the United States as Restylane. Probably because of past disappointments our FDA was slow to approve Restylane for distribution in the U.S., but that all changed in January of this year. All indications are that Restylane will follow Botox as being one of the most popular plastic surgery options to come along in many years. Restylane is a non-animal source hyaluronic acid product that comes as a clear gel already packaged in syringes that can be injected through ultra fine needles for the correction of moderate wrinkles, depressed areas of the skin, and it has become quite popular for plumping the lips and depressed nasolabial folds.
We have the benefit of over seven years of clinical studies in Europe and Canada with a long record of clinical safety. Because this is a biotech produced material identical to the hyaluronic acid found in skin and cartilage, there is no chance of allergic reactions and equally no chance of transmission of diseases, such as hepatitis, HIV, etc. This also makes skin testing and preliminary testing unnecessary.
One of the lingering concerns about any injectable material or plumping material has been about the duration of benefit. Certainly our experience with bovine and human source Collagen has been disappointing when the duration of benefit comes to be discussed. As this is a non-Collagen product that is bioidentical to the hyaluronic acid found in the body, there is no allergenic response created and consequently experience has shown the duration of benefit to be on the order of six to twelve months.
Equally exciting is that because of the mechanism of reabsorption, most of the benefit of the product is retained until the very end — rather than a gradual diminution with time. Restylane has taken its place along with Botox principally in treatment of the nasolabial folds — lines emanating from the upper lip —and for enhancement of the lips themselves. This can be done both as a bulking procedure to balance and enhance the lips, and also along the periphery of the lip as a lining type procedure. These procedures are done in the office under local anesthesia similar to the blocks a dentist puts in for a dental procedure. Patients are able to drive themselves to and from the visit and extraordinary swelling and pain do not occur. Patients are back at work or school the next day and what little swelling occurs is usually gone within a week or 10 days.
We frequently combine this treatment with Botox treatments on the forehead areas and around the eyes for maximum benefit from a relatively non-invasive procedure. This allows correction of forehead lines and relaxing of muscles (correcting an upset, angry or tired look) in the u