Injectable collagen products are temporary dermal fillers that are used to improve and reduce cutaneous defects that are the result of soft tissue loss or scarring. They are solely approved by the United States FDA for the glabrous skin of the nasolabial fold (NLF) and vermilion border of the lip.
All other uses, although legal are considered off-label. The primary utility for collagen is augmentation of the central and lower third of the face; the NLF, the peri-oral area: the lips and bolstering the adjacent lateral oral commissures. Other areas that are amenable to soft tissue augmentation with collagen include the marionette lines, soft atrophic scars, and combination therapy: static rhytids that are unresponsive to chemode-nervation with botulinum toxin preparations above the zygomatic arch (the forehead, glabella, peri-ocular regions), and peri-oral area (vertical lipstick lines’, mentalis crease, and the oral commissures).
Fueled by the overwhelming success of botulinum toxin chemodenervation for dynamic rhytides, combined with patients’ demand for ambulatory procedures with little time needed for recuperation, the field of soft tissue augmentation has gained significant momentum and popularity. This has been well chronicled by recent surveys by both the American Society of Dermatologic Surgery, which reported all 2% increase in the use of dermal fillers from 2001-2005, and a second poll by the American Society of Aesthetic Plastic Surgery mirrored this growth and yielded comparable statistics. Despite the development of many newer fillers, in particular the hyaluronans, injectable collagen remains an optimal minimally invasive modality. Their unparalleled historical safety profile, the admixture of anesthesia with diminished injection discomfort, and relatively reduced edema and bruising make them a treatment of choice and the cornerstone treatments for many facial ‘imperfections’.