Zyderm and Zyplast are made by the
Allergan Corporation and are composed of highly purified bovine dermal collagen
that has been used to correct facial imperfections since the 1980’s. The bovine
collagen is processed to create a product that is similar to human collagen.
Bovine collagen was the first legally approved product for soft tissue
augmentation in the United States, and it remains the criterion standard against
which all other dermal implants are measured. Bovine collagen is still the least
expensive treatment option available. Zyderm and Zyplast are available in 0.5-
to 2-mL syringes, and all three types of bovine collagen dermal fillers
available contain 95% type I bovine collagen and 5% type III bovine collagen.
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There are three forms of Bovine Collagen
An allergy test is needed for this
product because it is made from cows. As many as 5% of all patients tested for
bovine collagen can experience some sort of hypersensitivity to this injectable.
For this reason, skin testing is required before treatment. Two skin tests
performed 2 weeks apart, with the last test at least 4 weeks before treatment,
is now standard. The skin test is administered in the forearm to determine if
there is any reaction to the implant material. Positive test result is defined
with redness, swelling, hardness, or tenderness that persists for more than 6
hours after implantation. Three percent of people tested may have sensitivities.
Collagen is most commonly used to fill
out superficial wrinkles, skin depressions and some scars. It has been largely
replaced by newer substances including
human collagen and
hyaluronic acid gel.
Bovine collagen has fallen out of favor because of the short term effects with
this. The longevity can last from just a couple of weeks to possibly 3 months.
Zyderm I was approved for treatment by
the FDA in 1981. Zyderm I contains 95-98% type I collagen, and the remainder is
type III collagen. It also contains 0.3% lidocaine, so it make the injections
less painful. Zyderm is 3.5% bovine dermal collagen by weight suspended in
physiologic phosphate-buffered sodium chloride solution. It comes packaged as a
single-use syringe with 30-gauge needle.
Zyderm II was FDA approved in 1983.
Zyderm II is identical to the chemical makeup to Zyderm I. The only exception is
that Zyderm II has 6.5% bovine dermal collagen by weight compared to Zyderm I -
3.5 % bovine collagen. It comes packaged as a single-use syringe with 30-gauge
Zyderm II is for injection into the
shallow reticular layer of the dermis - which consists of dense irregular
connective tissue. Reticular dermis differs from the papillary layer which is
made up of mainly loose connective tissue. The reticular layer of the dermis is
important in giving the skin it overall strength and elasticity, as well as
housing other important epithelial derived structures such as glands and hair
Zyderm II indications are for course
wrinkles as well as acne scars and lip augmentation. Less overcorrection
(approximately 50%) is required than Zyderm I because of a higher concentration
of collagen and slower re-absorption. Zyderm lasts longer than Zyderm I because
of the larger collagen weight.
Zyplast was FDA approved in 1983, at the
same time as Zyderm II. Zyplast is 3.5% bovine dermal collagen cross-linked to
form a latticework and a more viscous compound. Zyplast is less immunogenic than
Zyderm I or Zyderm II, and it is more resistant to degradation. It comes
packaged as a single-use syringe with 30-gauge needle.
Zyplast is injected into the mid to deep
reticular dermis for treatment of deeper wrinkles or rhytides and contour
marionette linesand significant
augmentation. No overcorrection required. Zyplast should not be used in the
glabellar region because of possible local tissue necrosis. It is often layered
with Zyderm I or Zyderm II for more dramatic, longer-lasting results.
ADVANTAGES AND DISADVANTAGES OF BOVINE
Bovine collagen is still the least
expensive treatment option available, cheaper than any other filler that is
One of the biggest disadvantages of
bovine collagen is that it is very short lived, lasting a few short weeks or
months. The other inconvenient factor of bovine collagen is that because it is
different from human collagen – allergy is possible, two separate sensitivity
tests must be performed weeks ahead of the first treatment.
Injection of Zyplast into the
region is not recommended because of the risk of skin necrosis.
Although collagen fillers changed the
face of beauty when they entered the marketplace in the 1980’s, they quickly
fell out of favor when longer lasting
hyaluronic acid was introduced. However,
many doctors still use collagen for plumping the lips and filling in “smoker’s
lines” around the mouth. Collagen type products are still being used by many
doctors for particular facial lines. Collagen is a softer fill and avoids the
bumps or lumps seen with hyaluronic acid and also avoids the “drop in the
eyebrow” seen with BOTOX sometimes. Another advantage of collagen is that it is
great for recreating “structure”. Collagen’s biggest strength is its structural
effect. It can be used along the side of a drooping or disappearing lip line to
help hold the entire lip up. It’s downside however, is that most Collagen
products are very short lived, and will last a couple of weeks to maybe 3 months
CosmoDerm I, CosmoDerm II and CosmoPlast
are FDA-approved fillers consisting of natural human collagen grown under
controlled laboratory conditions. CosmoDerm and CosmoPlast are made by Allergan
Corporation. Pre-treatment skin tests are not necessary so you are able to get
the filler the day of your first appointment. These materials that go into CosmoDerm and CosmoPlast are screened extensively for purity from a single
fibroblast cell culture. Human-Based Collagen is manufactured from human tissue
which has been grown in a controlled laboratory environment.
Images courtesy of CosmoDerm and CosmoPlast
Both CosmoDerm I and CosmoPlast products
contain 35 mg/ml of human-derived collagen in phosphate-buffered physiological
saline containing 0.3% lidocaine. CosmoDerm II is identical to CosmoDerm I
except that it contains twice as much human-bioengineered collagen per
This dermal filler has characteristics similar to those of Zyderm
II, and the indications are identical. CosmoPlast contains the same ingredients
as CosmoDerm I, but the collagen proteins are cross-linked by glutaraldehyde in
the same manner as Zyplast.
This dermal filler has characteristics similar to
those of Zyplast, and the indications are identical.
and Cosmoplast products do contain 0.3% lidocaine, no additional local anesthesia is required.
No skin test is required
because this is made from human tissues rather than an animal source. Because of
it being made from human tissues there is no risk of causing a hypersensitivity
CosmoDerm and CosmoPlast
are injected just below the surface of the skin to fill in superficial lines and
wrinkles and to
define the border of the lips.
Cost of Procedure: The cost for a Cosmoderm
ranges from $400 - $700 per cc– depending on your geographical
DISADVANTAGES OF COSMODERM AND COSMOPLAST
A couple of the
advantages of both CosmoDerm and CosmoPlast are that they both have the least
potential for post injection swelling – and no allergy or skin testing needed
like Zyplast or Zyderm. Has a longer longevity rate than bovine collagen.
The disadvantages of
CosmoDerm and CosmoPlast are that they do not last as long as some of the other
hyaluronic acid fillers.
Collagen makes up to 70%
to 80% of the skin’s dermis – and is known for being an abundant building block
that provides structure, strength, and support. As we age, our natural occurring
collagen starts depleting; leaving the aftermath of new wrinkles and folds. Also
factors such as sun exposure, genetics, hormonal changes and smoking all
contribute to collagen diminishing.
With the FDA approval of Evolence,
collagen is getting attention again. Evolence is a new dermal filler that
replaces lost collagen with a new collagen that will last several months.
Doctors who have used the porcine (pig-derived) collagen are optimistic about Evolence, saying that it’s easy to inject and it causes less bruising and
swelling than the
hyaluronic acids. Some studies are showing that Evolence can
last up to nine months, which is a significant improvement from the other
collagen products available. Evolence is approved for the
however Evolence can be used “off label” for other wrinkles and facial folds.
Evolence will also have a higher formulation that is suitable for fine lines and
lip augmentation – called Evolence Breeze available soon.
Because Evolence is porcine and not
bovine (cow) collagen, there is no need for an allergy test. Evolence has a
unique technology called glycomatrix. It is this technology that adds to the
longevity of Evolence. This process purifies the collagen somewhat like what
occurs in the human body. The collagen strands are linked with ribose, which is
a naturally occurring sugar. Evolence is made in a process using natural enzymes
(pepsin) – which will result in a collagen that is so natural which will then
actually integrate itself into the bodies own collagen matrix. Blood vessels and
cells grow into the Evolence after it is injected.
Evolence is marketed in the United
States by the Aesthetics Group of OrthoNeutrogena, a division of
Ortho-McNeil-Janssen Pharmaceuticals, Inc., and part of the Johnson & Johnson
family of companies. This innovative collagen structural dermal filler was
developed by ColBar Life Science, Ltd., a biotechnology company specializing in
reconstructive medicine and tissue engineering.
This comes packaged as a sterile non-pyrogenic gel in a 1.0 ml syringe with a 27
can cause some
minor swelling based on the fact that water is absorbed by these fillers. Water
absorption adds to the fillers longevity. There is no water absorption with Evolence; therefore the swelling is minimal after injection. In addition,
collagen is a natural hemostatic agent, meaning it will minimize any bleeding
that occurs after injection. This means there is less bruising with Evolence as
well.A lot of physicians refer to Evolence as the “event filler”,
because of this fact you can have this treatment done with minimal bruising,
redness or swelling. However, if this product is not injected properly it can
cause lumps or areas of hardness.
You might see the tiny injection holes
from the needle after the treatment of Evolence, but that is about it. Makeup
can be used fairly quickly after injection if necessary. Evolence tends to be a
firmer and stiffer compound than some of the other soft tissue fillers, such as
Evolence is not indicated for lip
enhancement; however the new formulation Evolence Breeze will be and should be
approved within the next 3 to 6 months. Evolence Breeze is also great in fine
lines and wrinkles.