Soft tissue augmentation

Dr. Miller: The first patient is a 40-year-old woman with pale, translucent skin. She is concerned about vertically oriented wrinkle lines in the glabellar area (Figure 1, A ). Dr. Klein, how would you approach this patient?Dr. Klein: If this patient chooses injectables alone and still wishes to have full functioning of the corrugators, my choice would be Zyderm 1 bovine collagen 35 mg per cc (McGhan Pharmaceuticals, Santa Barbara, CA). There is also Zyderm 2, which is administered at 65 mg per cc. To greatly reduce the chance of an adverse reaction, I would perform a skin test initially and again in a month, and then treat her at 6 weeks. I would begin injecting where the lines intersect with the brows and the upper part of the procerus. I would then flow collagen into these areas in a wide, yellowish mass, avoiding any irregularity. When one becomes adept at injecting it, Zyderm 1 produces the best cosmetic result. I frequently get overcorrection in that area when I use Zyderm 2.Timothy A. Miller, MDVal S. Lambros, MDArnold W. Klein, MDSeth Matarasso, MDDr. Miller: Are there any technical considerations that you advise when injecting the Zyderm?Dr. Klein: It is important to hold the surface that you are injecting taut. For Zyderm 1, I use a 32-gauge metal needle rather than the 30-gauge needle that comes with it.The injection should create a yellowish color that can be seen beneath the skin. One should not see a residual whiteness upon completion. I inject in a continuous stream, keeping the material flowing from the advancing border after each injection.Dr. Miller: Why do you use a 32-gauge rather than a 30-gauge needle?Dr. Klein: The 32-gauge needle produces less trauma. I don't get the bruising …