Waging the War on Wrinkles

In America, women and men eager to fight the signs of aging are spending more than $250 million a year on injectable wrinkle fillers.

"It's an ugly little trick our body plays on us as we age," a Manhattan cosmetic dermatologist, Dr. Melanie Grossman, said. "[The body] takes away fat from where we want it — the face — and puts it places we don't."

The most popular among the fillers, Restylane, is a hyaluronic acid used to plump facial wrinkles and naso-labial folds, or laugh lines. It is getting competition from several new products that are vying for its spot in an extremely aggressive and lucrative market.

One of the most intriguing new options is Artefill, a cow collagen suspended in permanent Plexiglas balls, which creates a new category of non-resorbable, long-lasting filler. The balls are made up of a microscopic material that has been used for decades to make dental and bone implants.

A San Diego-based company, Artes Medical Group, would like for its product to appeal to consumers who are tiring of the cost and physical toll of frequent injections. The biocompatible, degradable ingredients in Restylane break down in the body within six months. (The marketing tagline for Artefill is "The First to Last.")

"The industry has been longing for a reliable, Food and Drug Administration-approved, longterm filler," said Dr. Philip Miller, a facial plastic surgeon and one of only a handful of New Yorkarea physicians using Artefill. "It has a huge track record in other countries."

Artefill has been widely used in Europe under the name Artecoll for more than 10 years. Artes Medical recently submitted data to the FDA seeking approval to market its product with a five-year efficacy rate (it's currently approved for one year).

With a more durable product, the importance of finding a clinician skilled at placing wrinkle and facial-fold fillers increases, since any unpleasant results will linger.

"The key to any [dermal filler] procedure is finding someone who does them well, in a way that is aesthetically pleasing to the patient," Dr. Grossman, who hasn't tried Artefill in her Madison Avenue practice, said. "Each physician has a different aesthetic eye. It's part art, part technique, and part science."

Artefill will generally cost two times as much as shortterm fillers. At Dr. Miller's practice, depending on how many areas are treated, Restylane injections can cost between $750 and $1,500, while Artefill will cost between $1,800 and $2,400.

But don't count out the short-term fillers entirely. Any hint of permanence can scare away some potential consumers. "I don't think the longerlasting fillers are going to stop people from using Restylane," Dr. Grossman said. "Many patients like the fact that it's temporary. They want to make sure they like the results."

The manufacturers of Botox are of the same opinion. Allergan has created Juvederm, another hyaluronic acid, to compete with Restylane. To gain attention, Allergan sent free samples to doctors to administer to patients who were already using Restylane. Juvederm is a gel injectable that also lasts six months, and is available in two forms, while Juvederm Ultra is a thicker formula designed for deeper facial folds where more volume is desired.

Seeking to maintain their domination in the dermal filler market, the makers of Restylane, Medicis Aesthetics, have started a sort of frequent-flyer miles reward program as an incentive for first-time patients.

Radiesse, created by BioForm Medical, falls somewhere in between the short- and long-term filler categories: It lasts one year, and is considered an injectable implant like Artefill, but is eventually absorbed by the body as are the hyaluronic acid formulas.

Radiesse is made of calcium hydroxylapatite, a synthetic substance that mimics the minerals in bones and teeth, and is being touted as a "biostimulator," a substance that stimulates the body to produce new collagen. Radiesse is slightly more expensive than Restylane, but the makers say the annual costs are actually less because of the product's durability.

Although some physicians say the advent of dermal fillers gives patients the option of putting off that facelift, others argue that they are a perfect complement to facial plastic surgery. But one thing is certain, if you're intent on waging war against the aging process, you have more weapons available than ever before.