Expert's Opinion

Filling You In

By Edward P. Miranda, Pacific Plastic Surgery Group | December 24, 2012

Dr. Edward Miranda provides details on cosmetic injectable fillers.

Cosmetic injectable fillers first hit the market in 1981, when the FDA approved Zyderm (an animal-based collagen). Over the next 22 years, injectable fillers were only available in either animal-based or human-based collagen, posing difficulties for some patients who had adverse allergic reactions to these substances. Hyaluronic acid changed the face of the U.S. injectable scene in 2003 when Restylane first received approval from the FDA. Hyaluronic acid (HA) is a naturally occurring sugar within the body that was first discovered in the 1930s; since the body naturally produces HA there were far fewer allergic reactions and complications. There are now several injectable filler substances on the market, but they all aim to correct the same thing: add volume to facial tissue where moderate to severe wrinkles and folds occur.
Some fillers yield instantly visible results (Juvederm, Restylane, Radiesse) while other fillers work with your body to stimulate collagen production in the affected area (such as Sculptra Aesthetic). Sculptra Aesthetic is composed of poly-L-lactic acid (PLLA) microparticles and works by initially filling a wrinkle with small PLLA beads. As the beads break down, the body may produce collagen where the Sculptra Aesthetic has been injected.
Dr. Miranda is proud to offer the latest and state-of-the-art injectable treatment in wrinkle-fighting technology, LAVIV (azficel-T). LAVIV (azficel-T) is the first and only FDA-approved therapy that uses your own collagen-producing cells (fibroblasts) to improve the look of your smile lines—for results that are totally unique to you.
Fibroblasts are skin cells that produce collagen and play a key role in the continued health of your skin. Collagen provides firmness and structure to the skin and is essential in supporting the dermis (or middle layer) of the skin. The dermis is a supportive and elastic connective tissue. It is here where fibroblasts are found. As we age, our fibroblasts reduce in number and the collagen matrix that makes up most of the dermis breaks down. This creates an imbalance that causes the dermis to become less stretchable, less resilient, more lax, and prone to wrinkling.
How LaViv Works:
1. Skin Sample Taken: A small skin sample is taken from behind the patient's ear with the use of a local anesthetic.
2. Creating Your LAVIV: Skin samples are sent to the FDA-inspected Fibrocell Science manufacturing facility, where they are expanded into millions of new fibroblast cells to make LAVIV. All of cells are cryopreserved (frozen) and those that are not immediately used are stored at Fibrocell Science’s FDA-inspected manufacturing facility for future use. Your LAVIV fibroblast cell therapy is ready in about 3 months. It will be shipped directly to Dr. Miranda's office and will arrive on the same day as your first LAVIV treatment session.
3. LAVIV Personalized Treatment Sessions: Using a small needle, LAVIV is injected directly into your smile lines. You will receive 3 injections of LAVIV, spaced at intervals of 3 to 6 weeks. When patients were assessed 6 months after the third and final treatment, LAVIV had effectively improved the appearance of smile line wrinkles.

About the Author
Dr. Edward P. Mirandais a board certified plastic surgeon specializing in high risk surgeries and offers the full range of modern cosmetic and reconstructive procedures. Dr. Miranda’s philosophy on aesthetic surgery is that natural, subtle changes reveal true beauty. He believes that natural-appearing changes are often far more powerful in improving appearance and maintaining beauty than dramatic changes. After graduating from medical school at Cornell, Dr. Miranda did residency training in general surgery at the University Of California San Franciscoand became board certified by the American Board of Plastic Surgery.
Dr. Miranda is a native of New York City and now practices in San Francisco, California and serves clients from Northern California and beyond. He is also affiliated withCalifornia Pacific Medical CenterandSt. Mary's Medical Centerin San Francisco, California.

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