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Rupert

my filler research and conclusions at present

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The following is my findings on possible filler treatment for acne scarring. Just as any information on this forum, it should definitely not substitute your own research. With no disrespect to this board but the nature of the internet is that we tend to believe what we read on boards and I have sometimes found info on this board (as well as others) to be off the mark. So I don’t guarantee the accuracy of my information, its just my understanding/take on things at the moment.

Well I’ve been looking into fillers for my rolling acne scars. With so many out there you would have thought that there is one which fulfils the goal. What is the goal? A filler which is injectable, affordable, long lasting, biocompatible, safe, stable at implantation site, able to maintain volume, induce minimal foreign body reaction and cause no foreign body granulomas.

Even though there are so many to research my conclusion is at the moment

*There does not appear yet to be an ideal filler* but I will review the ones I know about.

Some of my beliefs are similar to Old Guy. If you get good results with a half decent temporary filler like restylane then the ideal scenario is to keep on using that until a very tempting permanent one comes out. Lets not forget though that there may be no long term research into how a new long term filler will pan out. That is why I believe that if getting a long term permanent filler then it is crucial to get one which can easily be removed and many at the moment can’t, but some can.

Its all very well saying we should just repeatedly get temporary fillers but I know why many look into permanent ones. Because temporary fillers are expensive!!! sad.gif Here in the UK its about £250 for say restylane and I believe you’ll want it three times a year. So £750 ($1345) a year. Can you afford it? confused.gif The fact is that each year the plastic surgery industry has a newer, better, soft tissue filler. biggrin.gif A good long term one may just be round the corner. Who knows.

But as for long term filler? If I *had* to have one now I would go for Argiform, the new and better version of Formacryl. It has a lot of pros but a nasty con.

Pros of Argiform

1) Added silver ions to repel bacteria. As all permanent fillers run a risk of becoming infected this is a very nice feature. I’ve read that you can sleep easy in your bed at night not having to worry about whether you may get an infection with Argiform. It is rather unlikely that you will get an infection.

2) It stays soft. Unlike say artecoll where it is well documented that artecoll can go hard and lumpy with time.

3) Totally removable

4) Can be injected in dermis as well as subcutaneous layer, so more control over improving acne scars

Cons

1) I know one person on this forum was warned by her plastic surgeon that it wouldn’t work on her particular scarring and he was right. I think it was very superficial scarring though which would have been better being abraded by some mechanism

2) Here we go. This product has those darn residual acrylamide monomers. And they are nasty. It is clearly of concern to Bioform cos when the replacement to formacryl came along (argiform) they reduced the amount of aforementioned considerably. I have no idea how much of a risk argiform is because of this substance. But let me tell you what it can do if absorbed - It is neurotoxic, impairs reproductive function, carcinigenic, induced gene mutations in cells and chromosomal aberrations.

I do believe these monomers are in aquamid as well no?

Anyway here are my conclusions on some other fillers I’ve been researching. (alphabetically)

Amazingel - its got that acrylamide monomer in it as well.

Aquamid – ditto above. I’ve only heard it being injected into subcutaneous layer so wonder how effective it would be for scars in the dermis.

Artecoll

The filler already is hard and I don’t know if this would be so good for treating scars. The rubbery feel commonly associated with its use comes from excess collagen formulation I’ve heard. I’ve read a lot of commentaries of people reporting lumps. What I read is not impressing me too much!!!

I don’t think you can get rid of it either if you don’t like it.

Bio-Alchemid

At least it doesn’t have those monomers I was mentioning in my argiform post.

Now it says that this can only be injected in subcutaneous layer of skin. You would have thought this would have negligible effects on dermis scars which the majority of us have. However members of this board have had their scars improve a lot. Even lonelyman who has had loads of disappointment is now happy (as I understand) having had this filler injected in dermis instead of subcutaneous layer. I thought you couldn’t do that though? Things sure get confusing!!!!!!!!!!! confused.gif

Bioformacryl

Has since disappeared Was a relabelled version of the formacryl which has made room for algiform now.

Bioplastique

Silicon - my views on any silicon prodcut. Silicon works like most injectables – tissue surrounds and encapsulates the foreign body. Its is therefore a potential site of infection. The reason why silicone is all but illegal is because of the sheer number of late infections, granulomas, palpable masses and scary migration to other organs of the body that have been reported with silicone use. There is a reason y’know!!! cry.gif

And if you do have a problem with silcone then they just have to hack it out and I imagine you’ll look worse

Cosmoderm and cosmoplast – human collagen. I read somewhere from human foreskin!!!!!!!!

Again dissipates like cow collagen. Youch at $300 - £600 per cc that is expensive maintenance.

Cymetra – crystal alloderm

Very expensive

Patients say it gets absorbed very quickly – three months or less and as it is so expensive this one is a no – no for me

Can cause very large amounts of scar tissue and that is part of the augmentation

It can cause bumps too frequently

DermaDeep

Too deep for most scars

Dermagen

Another silicone one

DermaLive

Not good for wrinkles therefore presumably of no use for scars

Evolution

This is an intriguing one. This is positively charged filler which attracts hyalluronic acid and other cells for producing collagen. Significantly helps with the integration of collagen and plumping up the skin. Can be injected into mid-dermis, deep dermis and just below the dermis with no ill effect. Evolution is permanent. Only about $400 dollars. Never heard though whether it is at all useful for scarring.

Formacryl

The old Argiform

Newfill

If anybody can actually tell me how this *exactly* works I’d be grateful. Can supposedly work for acne scars.The idea is that it stimulates the fibroplasts to produce more collagen. As I understand it the success depends on the quality of the underlying tissues However obviously you don’t have too many fibroplasts under the scars. So I’d like to hear of anybody who has had this done before I look at it seriously.

Radiance

Can get very hard but does last a few years – 2 - 5

However it is hard to remove if you don’t like it.

From what I’ve read it doesn’t work at all well for small scars

Rhegecoll

Very similar to artecoll

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Hi, I wanted to add Sculptra to your mix of candidates. It was recently FDA approved here in the states. In europe it's called newfill or new-fill, you mentioned it towards the bottom of your post.

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Hi Pete!!!,

oh darn. Yes I forgot fat, I was meaning to put that in. Thanks for reminding.

There are a few naysayers who always talk about fat reabsorption but as I understand it they are ignoring more recent techniques which have had better results. This new technique I believe is called lipostructure. I also know that is is hard to predict who will unfortunately absorb badly with fat or those who will have longer term results. I know Pete has had success with this in a few scars. Pete - are you thinking about geting more done?

I have read surgeons who report only a maximum of 40-50% ever being absorbed by their patients and adding more and more fat can really start dwindling that remaining 40-50% .

But I think I'd be wanting to get someone really with their finger on the pulse in this field, instead of wasting money on ineffective techniques which some will employ. I seem to remember a few names floating around if you do a search for fat transfer on this board.

I also read somewhere that the technology by which they can make fat implants much more likely to stay is a field in which there is considerable investigation as there could be many uses. I'll try and find a link.

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kooky, emmanuel

thanks for the comments but I am by no means a filler expert. Those who have done a load of fillers are the experts, expecially as they get to speak to the plastic surgeons and therefore gleam a lot of information. I am merely trying to start a discussion here where anyone with a view can chip in as they have been.

Sadly there would appear to me to not be a totally ideal filler at the moment otherwise reearch would be easy.

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Every time I get a temporary filler, it bruises for weeks and it never does what I want it to do. You can't just pop in for a filler and go on your merry way. I have a scar that looks like a verticle dent because of a messed up subcision I had two years ago, and one week ago I got some restylane injected in it for $245. Right now, it's still bruised and it caused a couple pimples on top of the bruise. I think the restylane may have even migrated because the dent is still there. I feel like my head is going to explode from all the frustration I've experienced with this stupid scar. I had the same experience with collagen injections. Once you get a scar, you're dead. It will NEVER go away and any attempt to fix it inevitably ends in frustration. That's what I've experienced.

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I was just thinking that maybe I need another subcision along the vertical dent and then the filler. I don't want to compound my problems with another failed subcision though.

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Hi Cameron,

thats an interesting post. Depressing but interesting. How did your subcision go wrong? How did it dent? Are you saying that went the fibres which were holding the skin down were cut then the result was that the scar sunk down even further?

I'm booked for a subcision in a few months and would like to know.

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Hi all...speaking of fillers...I am having Radiance injections this afternoon at 3pm...to fill some old acne scars and deep dented scars from a botched fat transfer I had last January.

I have been waiting 2 months for this appointment...I am nervous...

I keep asking myself...."what if I look worse.??? Then I come to my senses...because I dont think its possible..!!

It will be nice to finally go out in public again!!! after all these months!!

I will keep the board posted on how this goes...Please say a little prayer for me..

I sure could use it..

Hoping for a Miracle ...Vanessa wink.gif

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Hey Brighteyes !!!

Make sure you do come back to tell us how radiance went, I as well as many others are keen to hear your story.

Certainly radiance was number 2 in my choices of if I had to have a long term filler. It wasn't number one (argiform) because I don't think radiance can be easily removed if you don't like it. But seeing as it will only last for say five years this is not a doomsday scernario.

I wish you all the very best of luck. It should turn out good I would have thought.

Please fill us in!! (I've just realised I've done the worst pun this forum has ever seen, I'm sorry lol)

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Hi Cameron,

thats an interesting post. Depressing but interesting. How did your subcision go wrong? How did it dent? Are you saying that went the fibres which were holding the skin down were cut then the result was that the scar sunk down even further?

I'm booked for a subcision in a few months and would like to know.

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How did you get scars from a botched fat transfer? I had a fat transfer test done a few years ago and it didnt create any new scars.

Perhaps your Doc used too large a gauge needle or canula to insert the fat.

Whats Radiance, is it permanent?

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Wow that is f-ing expensive! Hopefully it does last longer than restylane for that kind of dough. Thanks for the link Vanessa. Do you know if it is injected into the skin like collagen or restylane? Do you know if there is any risk for infections, short-term or long term? I'd bee very interested in hearing your progress with this filler a year from now. BTW, I spent the better part of my childhood in Arlington Heights before I had acne scars...oh fond memories.

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anyone tried DermaLive or DermaDeep filler before?? apparently its so popular and been around in europe for some time. don't know if its available in US though. heres a

link..

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here is another good link which gives at a glance info on a lot of the filleres we discuss here including duration, purpose, side effect, description. Its good stuff. I've posted before about what a good website I think cosmeticsurgery-news.com. if you sign up for the newsletter you get all the useful info landing in your email box about once a fortnight.

http://www.cosmeticsurgery-news.com/injectablesgraph.html

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Hi Pete,

Can you please tell me which Doctor advised you of that adn who you are seeing. To find an expert on fillers in Sydney would be good. I was once advised to get fat transfer but was told that it wouldn't last but now it seems from your experience it does last.

By the way I have had acqumid and I would say it is ok, I agree though in that in my opinion it would work best only for small indents

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