Collagen still seen as 'gold standard'

Stanford, Calif. - Presenting his method for injecting the popular collagen-based fillers at the One Step Symposium at Stanford, Miami dermatologist Stephen Mandy, M.D., says collagen continues to be the "gold standard" because of virtues related to its flow, injectability, plasticity and tactility.

"Collagen, which has been around since the early '80s, is very well understood. Whether the collagen is bovine-derived (Zyplast/Zyderm) or from human sources (CosmoDerm, CosmoPlast), the nature of the material itself is soft and pliable, which is especially important for lips, and its flow is very smooth and even. This makes placement easy and predictable and enables us to give the patient who wants a quick fix a very immediate correction since there is little post-treatment inflammation with collagen," he says.

"My basic premise is that if you are using large volumes of material, you're probably not injecting correctly," he adds.

Zyplast/Cosmoplast For Zyplast and CosmoPlast, which are inserted deeply into the dermis, he generally uses the threading withdrawal technique. "I first insert the syringe needle deep into the skin, and inject the material upon withdrawal."

Using this method for nasolabial folds and marionette lines, he injects medial to the fold and sculpts afterwards. Lips are injected at the submucosal level between the actual mucosa of the lip and the muscle.

An exception to this injecting-upon-withdrawal rule is the approach taken to the vermilion border of the lip. "Here I actually do inject in advance of my needle because I want the collagen to track along the vermilion border." In this procedure, he first stretches the vermilion and injects into the white pearly line.

In the Paris lip technique, the substance is injected into the filtrum.

Zyderm/CosmoDerm Dr. Mandy says "superficial is the operative word" in implanting Zyderm/CosmoDerm into rhytides. Small deposits of the substance are injected using multiple serial punctures at a 90-degree angle to the wrinkle.

He explains, "I generally overlay the CosmoDerm/ Zyderm over CosmoPlast/Zyplast, so I inject at two different levels. For example, for marionette lines and nasolabial folds, I first inject the Zyplast or CosmoPlast, then overlay that with a superficial layer of Zyderm/CosmoDerm."

Dermatologist Stephen Mandy, M.D., maintains private practices in both Miami and Aspen, Colorado.