.--Collagen Replacement

Consultation  Pre-Treatment Visit  Day Of Therapy  Follow-Up Visit  Risks


Background On Collagen Replacement Therapy
Collagen is the most common substance now in use for soft tissue augmentation. It was approved for this purpose in 1981 by the FDA and since then nearly 2 million patients have received collagen treatments. Collagen is actually part of the natural support structure of your skin. Wrinkles form when this natural collagen thins. This thinning is mostly a process of aging, however, other important factors include the amount of sun exposure received over a lifetime, smoking history, pollution, health and lifestyle. With decreased collagen support, wrinkles and lines start to form wherever the skin moves.

The most commonly injected collagen in the United States is provided under the brand names Zyderm I, Zyderm II and Zyplast. Each of these variations of injectable collagen is a sterile, purified, suspension of collagen derived from cowhide. The manufacturing of the product is carefully regulated to maintain the highest degree of safety.

The collagen is received in refrigerated, prefilled syringes mixed with lidocaine, a local anesthetic. The material is injected with a very fine needle into the skin of the wrinkles to be treated. The lines or wrinkles that can be effectively treated include the worry lines (forehead lines), frown lines (glabellar folds), crow's feet (periorbital lines), lip border (vermillion border), smile lines (nasolabial folds), vertical lip lines (perioral lines), and marionette lines (oral commissures).

Collagen injections have an immediate effect on lines and wrinkles. Like your own collagen, however, your body eventually absorbs collagen, so ongoing treatments are necessary. If you discontinue treatments, the new collagen is reabsorbed and your face gradually returns to its natural contour. Collagen treatments last from 3 to 6 months depending on the individual and area treated.

Since a small percentage of patients develop an allergic reaction to injectable collagen (approximately 3%), sensitivity testing is required prior to initiating collagen replacement therapy. Most patients are very pleased with the results of collagen and experience no side effects.

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Collagen Replacement Therapy Consultation
At your initial visit with Dr. Capella, he will perform a directed physical examination and take a medical history with attention to current medications, allergies, previous plastic surgery and skin care regimen. An inquiry will be made into past sensitivity to collagen injections or a history of multiple severe allergies or anaphylactic reactions. He will examine you in front of the mirror and discuss your skin concerns. If Dr. Capella feels that other modalities such as laser resurfacing, Botox, microdermabrasion, glycolic acid peels or surgery may be more beneficial to you, he may make these suggestions. Dr. Capella will describe the technique of collagen replacement therapy along with its risks, benefits and hopeful outcomes. Photographs will be taken of the areas to be treated so that the lines or wrinkles of concern can be compared with their appearance following treatment.

If you are interested in proceeding with collagen replacement therapy and Dr. Capella feels you are a good candidate, the appropriate consents will be reviewed and signed. Because approximately 3% of patients develop a sensitivity reaction to either collagen or lidocaine, every candidate for collagen replacement therapy must be carefully screened. Potential hypersensitivity to injectable collagen therapy is reliably determined by intradermal skin testing. Skin test syringes with .3ml of Zyderm I are used to screen for hypersensitivity to all three forms of injectable collagen. A tuberculin-like test is performed on your left forearm on the day of your initial visit. You will be contacted by a physician’s assistant within 48-72 hours after the injection regarding the outcome of that test. A positive skin test is defined as swelling, firmness, tenderness, or redness that lasts or occurs more than 6 hours after the test is performed. A positive result would prohibit collagen replacement therapy.

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Collagen Replacement Therapy Pre-Treatment Visit
Identifying patients sensitive to collagen is very important. Two weeks following your first test, Dr. Capella will evaluate the site on your left arm. If it appears that you had no reaction to the first test, Dr. Capella will inject another test dose in your right forearm. Two weeks from this second test, if no unfavorable reaction is elicited, collagen replacement therapy can be safely performed.

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Day Of Collagen Replacement Therapy
Dr. Capella will first verify that your second sensitivity test was negative. You will be asked to remove any make-up from your face with mild soap and water. Dr. Capella will then swab the areas to be treated with alcohol. Collagen replacement therapy is essentially painless. Similar to the test doses, Dr. Capella will use a very fine needle to inject the collagen into the skin at a very specific depth. Depending on the number of areas to be treated, the procedure may take from 10 to 30 minutes. You may notice that the areas treated are slightly overcorrected immediately following the procedure. This overcorrection is done on purpose because some of the fluid injected with the collagen will be quickly reabsorbed, leaving you with a desirable facial contour. Dr. Capella's staff will apply a cold compress to the areas treated. This helps soothe the skin and constrict blood vessels so you can apply make-up afterwards. You may resume your normal daily responsibilities immediately after the procedure but are advised to avoid strenuous exercise, extensive sun and/or heat exposure, and alcoholic beverages for 24 hours following the injection. This type of exposure can cause temporary redness, swelling, and/or itching at or near the injection site.

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Collagen Replacement Therapy Follow-Up Visit
As previously mentioned, implanted collagen will gradually get reabsorbed by the body. The effects of the therapy can last from 3 to 6 months. The collagen tends to get reabsorbed more quickly in areas of greater muscle activity such as the laugh lines. You should contact the office if you have any questions or concerns.

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Risks Associated With Collagen Replacement Therapy
Replacement collagen therapy is very safe when proper screening is performed on prospective patients. Applying two skin tests prior to commencing therapy effectively selects out those patients likely to have a significant reaction to the injectable collagen, although it does not eliminate the risk completely.

The risk of infection is always present with any injection and it is possible to experience a reaction to the process itself, such as mild bruising at the injection site. This is more likely if you are using drugs to reduce coagulation such as aspirin or non-steroidal anti-inflammatory drugs. Occasionally, injected collagen has been reported to be visible in the skin in the form of a small raised or white area at the treatment site, which may persist for weeks or months. Flu-like symptoms have been reported in a small number of patients. A rare patient who had a negative skin test may develop prolonged redness, swelling, itching and/or firmness. Some of these patients may develop a cyst-like reaction that can drain and form a scar. For additional information about the risks of collagen injections, click here.

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