Collagen Injections

Reviewed by Michael Olding, MD, FACS; and Scott R. Miller, MD, FACS

Those laugh lines that you had so much fun earning may not be as funny as they used to be. Through the process of aging, our skin loses its youthful appearance. As our facial muscles get a daily workout, the not-so-popular results culminate in many types of lines, wrinkles, and sagging or lax skin. If the face that looks back at you in the mirror is not pleasing to you anymore, collagen fillers may an option.

Collagen injections may improve deep and fine wrinkles on the forehead, crow's feet, laugh lines, frown lines, scars, thin lips, naso-labial folds (deep folds produced by sagging skin that hangs from the nose to the mouth), vermilion border wrinkles (wrinkles that accumulate around the mouth), or depressed scars.

Collagen Basics

Collagen is an essential protein complex found in the human body. Collagen molecules form fibrils that produce necessary fibers for our bodies. The configuration of fibers is the foundation for tissue formation. Collagen supports the skin, bone, cartilage, and blood vessels in our bodies.

Collagen fillers are classified as two types:

• Collagen fillers containing human collagen much like that found in skin. Manufacturers of this type of collagen filler include CosmoDerm and Cosmoplast.
• Collagen fillers that are bovine-based or mammal-based. Manufacturers of this type of collagen filler are Zyderm and Zyplast.

Ideal Candidates for Collagen

Candidates for this type of treatment are typically between 35 and 60. People who should not receive collagen injections include those who are pregnant or nursing, people with allergies to bovine products or lidocaine, or those with certain medical conditions such as autoimmune diseases.

Consult a Qualified Doctor

Dermatologists and plastic surgeons may have extensive knowledge and experience with this type of procedure. However, some may not have expertise with selecting accurate injection points and proper dosage; or have familiarity with both human-based and bovine-based collagen fillers. Finding a doctor with specific experience in these areas is important for achieving optimal results. Consulting a qualified doctor will help ensure that you receive the most appropriate treatment for your condition.

Here are some tips to consider when consulting a doctor:

• Review the doctor's credentials, education, training, type of certification held, and number of times that the treatment has been performed by the doctor.
• Request information about the type of filler recommended, bovine-based or human-based collagen. If the doctor is using a bovine-based collagen filler, the doctor will perform an allergy test that requires four weeks of review in order to ensure that the patient will not have an allergic reaction. If the test rules out allergies, the bovine-based collagen filler can be used. Human-based collagen filler does not require an allergy test.
• View before-and-after photos of patients with similar conditions who received collagen fillers and alternative procedures such as Restylane.
• Inquire about complication risks and possible side effects.
• Ask the doctor to estimate the number of treatments required to achieve and maintain the results you are looking for.
• Request a list of pre-op and post-op instructions. Following these instructions can reduce the risk of complications.
• Inquire about how long the procedure will last. Results vary among patients and doctors, lasting two to three months on average.

The Collagen Injection Procedure

Collagen injections are typically performed in the doctor's office. They are most often performed without anesthesia, although the collagen filler itself contains lidocaine, which is a local anesthetic.

The careful selection of injection points is critical to the success of the treatment. The points of injection are "scored" by the doctor with a marking pencil. Your doctor may select numerous injection points for each location to be treated. Antiseptic is also applied. Your doctor will then decide on the correct amount of collagen to be used. The collagen filler is injected into the marked points beneath the skin.

You may experience some minimal discomfort from the needle injection. Depending upon the extent of treatment, the procedure can take 15 to 30 minutes. You can go home shortly after the procedure.

Wrinkles or depress scars are significantly improved immediately following the procedure. In some cases, the treated area may initially appear to be overfilled. However, this will dissipate soon after to produce a more natural-looking appearance. Results are fully evident within one week. Collagen fillers do not necessarily result in 100 percent improvements, nor are the results permanent. Results may be unpredictable, lasting from two to three months.

Recovery after Collagen Injections

After the procedure, you may experience some swelling and bruising, which typically subsides within 48 hours. The treated area may appear red for the first 24 hours and may last up to a week.

Normal activities can be resumed immediately; however, you are advised to stay out of the sun. Unmanageable pain or any symptoms that are progressive or abnormal should be reported to the doctor immediately.

Complications and Risks of Collagen Injections

Complications are possible with any medical procedure — complications from collagen fillers are typically minimal. Some possible complications include uneven texture of the skin, an allergic reaction, infection, abscess, and scarring. Your doctor can answer questions about complications and their proper treatment during your initial consultation.

Alternative and Additional Treatments

While collagen remains a viable option, its popularity has recently waned with the introduction of fillers such as Restylane, which can last longer. Regardless of the treatment you are considering, it is always a good idea to investigate alternative treatment options. Other minimally invasive procedures include Botox, which may be complementary to collagen, or Restylane, which may be a better substitute for collagen. For more severe conditions, surgical procedures may be more appropriate, such as a facelift, forehead lift (brow lift), and blepharoplasty (eyelid surgery).

Your doctor may recommend additional treatments for you to consider in conjunction with collagen, such as a chemical peel, laser skin resurfacing, or microdermabrasion.

The Cost of Collagen Injections

The cost for collagen fillers can range from $300 to $400 per syringe. Patients may require more than one syringe to achieve a benefit. The total procedure costs may be up to $700.

Purely cosmetic procedures are not covered by insurance. If the cost is too much to pay at once, ask your surgeon about monthly payments. For financing options and tips, continue reading about Patient Financing.

[page updated May 2008]