History Of Injectable Collagens

Soft tissue fillers have been used for more than a century to improve contours, soften rhtytides, blunt depressed scars, and enhance lips. The history of soft tissue augmentation dates back to 1893, when Neuber first attempted to use autologous fat transfer for tissue augmentation. He utilized blocks of free fat harvested from the arms to reconstruct depressed facial defects. In 1899 Gersvny injected paraffin into the scrotum as a testicular prosthesis for a patient with advanced tuberculosis.

Lexor, in 1910, used large-block grafts to treat malar depressions associated with chin recession. This was followed by Brunings, who in 1911 first described using the syringe technique to transfer free fat. In 1950, Peer reported 50% survival of transplanted fat using syringe aspiration. Baronders published a review of permanent soft tissue augmentation with liquid silicone in 1953. Although useful when injected by an experienced physician, this product has had a tumultuous history and continues to be controversial. Silicone’s sole approval is for retinal tamponade in patients with retinal detachments. Fortunately, there is an ongoing multi-center study exploring the benefits of injectable microdroplet silicone for patients suffering from facial lipoatrophy due to infection with the human immunodeficiency virus (HIV). Due to the FDA Modernization Act, which allows the use of medical devices off-label, silicone (Silikon 1000, Alcon Inc., Fort Worth, Texas) has been used for off-label indications with increasing frequency for permanent soft tissue augmentation. In fact, when used appropriately by experienced physicians with the microdroplet technique, medical grade silicone has provided good results. However, when administering this product physicians must discuss its use with their medical malpractice carriers because the administration of silicone may not be covered in the event of legal action.

One of the most significant advances in soft tissue augmentation was the introduction of bovine collagen. Initial investigations began in earnest in 1958 and continued through the next 2 decades. In 1981 Zyderm I (McGhan Medical, Santa Barbara, CA) became the first FDA-approved xenogenic agent for soft tissue augmentation. Following this the two additional formulations of bovine collagen, Zyderm II and Zyplast, were granted FDA approval. Until 2003, when the injectable hyaluronic acids became available, bovine collagen remained the most commonly used dermal filler. It is perhaps the success and availability of these products that ushered in a renewed quest for the ideal formulation for soft tissue augmentation. In 2006, following the acquisition of Inamed Corporation (Santa Barbara, CA), all of the commercially available collagen products became available from the sole distributor, Allergan (Irvine, CA).

No two wrinkles are created equal as each has a different derivation, and they vary in shape and size. As such there is no one filler agent that is suitable for all defects.

Therefore treatment should be predicated based on the defect and individualized to each patient’s needs. The selection of the appropriate implant; whether dermal or subcutaneous, temporary or permanent; liquid or solid, requires knowledge of all of the available materials as well as their characteristics. Furthermore filler substances may be used as monotherapy or combined with other dermal implants or other procedures such as resurfacing, botulinum toxin, or surgery.