The world of fillers is changing rapidly, and although the products in use at the present time are wonderful, there are new ones on the horizon that appear promising.
Evolence: Not Your Mother’s Collagen
In a classic “what is old is new again” theme for cosmetic dermatology, collagen is making a comeback. But, this is not your mother’s collagen. The new collagen, Evolence, is significantly different from the familiar older forms that we know and, in some cases, like. It offers a range of advantages that appear to make it a significant competitor to the hyalurons that presently dominate the filler arena.
What’s New
Differences with Evolence include its source, cross-linkage, persistence, storage and several other critical aspects.
Its source.To begin with, Evolence is derived from porcine-based collagen. The rationale for this is quite simple: Pig skin is very similar to human skin, so the collagen derived from this source should be less antigenic than bovine-based products. This may have nuances for patients who are Jewish or Muslim or others who might be precluded from treatment with porcine-based materials.
Skin testing not required. According to the company (Colbar), skin testing is not required. In this respect, the product is similar to the human-derived Cosmoderm and Cosmoplast.
Cross-linkage. As with other filler molecules, it is imperative that the molecules are cross-linked and stabilized. If not for the cross-linking, they would rapidly be degraded and the correction would disappear. Prior versions of collagen used glutaraldehyde to cross-link the collagen fibrils. Using a “Glymatrix” technology, Evolence incorporates ribose moieties to cross-link the fibers of collagen in a stable matrix that resists degradation by the body’s enzymes.
No refrigeration. Among logistical differences between Evolence and prior collagens is that the product does not have to be refrigerated. This makes it much easier to store.
No anesthetic. Another difference between Evolence and prior collagens is that it contains no anesthetic. Most patients treated for nasolabial crease correction will tolerate pre-treatment with topical anesthetics such as LMX or compounded products. However, for patients who are sensitive to discomfort or are being treated in sensitive areas (such as the lips), injectable anesthetic may be appropriate. Many physicians are now using either 1% lidocaine with epinephrine or Septocaine (a dental product with rapid onset and rapid offset).
Less concentrated.The collagen concentration in this product is 30 mg/ml. This is less than the 35 mg/ml of Cosmoderm, Zyderm I, Cosmoplast and Zyplast. It is also a significantly lower concentration than the 65 mg/ml found in Zyderm II.
Product Applications
There are presently two different versions, Evolence and Evolence Breeze, the latter of which is designed for fine lines such as perioral ones. According to the company, it is intended for injection into the upper to mid dermis and it is approved in the EU and Israel. Different versions will be available for deeper dermal injections in the near future.
Unlike other products, Evolence requires correction to the desired contour or volume. This removes a great deal of guesswork from the injection process. For volume correction or contour sculpting, it is much easier to inject a product where what you see is what you get than it is to estimate whether 150% is good or 200% is better, as was the case with prior collagens.
Injection Methods
Injections with Evolence are similar to those with other fillers, and skilled injectors should not have any difficulty adapting to its use. Many physicians using this product employ a tunneling technique. However, it is likely that as the experience with the product grows, techniques will become as plentiful as the number of people injecting it. Serial puncture and cross-hatching techniques will most likely also become part of the injection techniques.
Duration of Effect
One significant difference between Evolence and prior collagens is the duration of correction. Unlike prior collagens, which were useful for a period measured in weeks or a few months, this recent entry is able to persist for up to 1 year. This duration will most likely increase the demand by patients for the product and result in many physicians returning to collagen for a portion of their soft-tissue augmentation practice.
Using Evolence with HA Fillers
Whether or not collagens in general and Evolence in particular act synergistically with hyaluronic acid fillers remains to be determined. There is some intuitive rationale to assume that the matrix laid down by long-term collagens will enable some of the cross-linked hyaluronic acids to stimulate more collagen formation, but clinical trials will be necessary to determine whether this is the case.
Some dermatologists adhere to a principle of mixing collagens with hyalurons in an attempt to utilize the anesthetic found in the bovine products and on an assumption (never tested) that the bovine collagens when mixed with hyaluronics will have less bruising. It is anticipated that if porcine collagen dominates the collagen market, the former indication (anesthetic) will dissipate while the latter (stability of hyalurons) will either be tested or discarded.
Its Potential
In summary, even as the synthetic molecules for soft-tissue augmentation proliferate, this is a new product that holds the potential for a durable and natural-appearing correction.
As with many fillers that preceded it, Evolence will most likely find a niche for each injector based on his or her experience and patient population. It is unlikely that it will displace any of the popular molecules already in use or those that are close to market. It is instead most likely to grow the market for fillers as more patients learn about this durable and safe soft-tissue augmentation product.
The world of fillers is changing rapidly, and although the products in use at the present time are wonderful, there are new ones on the horizon that appear promising.
Evolence: Not Your Mother’s Collagen
In a classic “what is old is new again” theme for cosmetic dermatology, collagen is making a comeback. But, this is not your mother’s collagen. The new collagen, Evolence, is significantly different from the familiar older forms that we know and, in some cases, like. It offers a range of advantages that appear to make it a significant competitor to the hyalurons that presently dominate the filler arena.
What’s New
Differences with Evolence include its source, cross-linkage, persistence, storage and several other critical aspects.
Its source.To begin with, Evolence is derived from porcine-based collagen. The rationale for this is quite simple: Pig skin is very similar to human skin, so the collagen derived from this source should be less antigenic than bovine-based products. This may have nuances for patients who are Jewish or Muslim or others who might be precluded from treatment with porcine-based materials.
Skin testing not required. According to the company (Colbar), skin testing is not required. In this respect, the product is similar to the human-derived Cosmoderm and Cosmoplast.
Cross-linkage. As with other filler molecules, it is imperative that the molecules are cross-linked and stabilized. If not for the cross-linking, they would rapidly be degraded and the correction would disappear. Prior versions of collagen used glutaraldehyde to cross-link the collagen fibrils. Using a “Glymatrix” technology, Evolence incorporates ribose moieties to cross-link the fibers of collagen in a stable matrix that resists degradation by the body’s enzymes.
No refrigeration. Among logistical differences between Evolence and prior collagens is that the product does not have to be refrigerated. This makes it much easier to store.
No anesthetic. Another difference between Evolence and prior collagens is that it contains no anesthetic. Most patients treated for nasolabial crease correction will tolerate pre-treatment with topical anesthetics such as LMX or compounded products. However, for patients who are sensitive to discomfort or are being treated in sensitive areas (such as the lips), injectable anesthetic may be appropriate. Many physicians are now using either 1% lidocaine with epinephrine or Septocaine (a dental product with rapid onset and rapid offset).
Less concentrated.The collagen concentration in this product is 30 mg/ml. This is less than the 35 mg/ml of Cosmoderm, Zyderm I, Cosmoplast and Zyplast. It is also a significantly lower concentration than the 65 mg/ml found in Zyderm II.
Product Applications
There are presently two different versions, Evolence and Evolence Breeze, the latter of which is designed for fine lines such as perioral ones. According to the company, it is intended for injection into the upper to mid dermis and it is approved in the EU and Israel. Different versions will be available for deeper dermal injections in the near future.
Unlike other products, Evolence requires correction to the desired contour or volume. This removes a great deal of guesswork from the injection process. For volume correction or contour sculpting, it is much easier to inject a product where what you see is what you get than it is to estimate whether 150% is good or 200% is better, as was the case with prior collagens.
Injection Methods
Injections with Evolence are similar to those with other fillers, and skilled injectors should not have any difficulty adapting to its use. Many physicians using this product employ a tunneling technique. However, it is likely that as the experience with the product grows, techniques will become as plentiful as the number of people injecting it. Serial puncture and cross-hatching techniques will most likely also become part of the injection techniques.
Duration of Effect
One significant difference between Evolence and prior collagens is the duration of correction. Unlike prior collagens, which were useful for a period measured in weeks or a few months, this recent entry is able to persist for up to 1 year. This duration will most likely increase the demand by patients for the product and result in many physicians returning to collagen for a portion of their soft-tissue augmentation practice.
Using Evolence with HA Fillers
Whether or not collagens in general and Evolence in particular act synergistically with hyaluronic acid fillers remains to be determined. There is some intuitive rationale to assume that the matrix laid down by long-term collagens will enable some of the cross-linked hyaluronic acids to stimulate more collagen formation, but clinical trials will be necessary to determine whether this is the case.
Some dermatologists adhere to a principle of mixing collagens with hyalurons in an attempt to utilize the anesthetic found in the bovine products and on an assumption (never tested) that the bovine collagens when mixed with hyaluronics will have less bruising. It is anticipated that if porcine collagen dominates the collagen market, the former indication (anesthetic) will dissipate while the latter (stability of hyalurons) will either be tested or discarded.
Its Potential
In summary, even as the synthetic molecules for soft-tissue augmentation proliferate, this is a new product that holds the potential for a durable and natural-appearing correction.
As with many fillers that preceded it, Evolence will most likely find a niche for each injector based on his or her experience and patient population. It is unlikely that it will displace any of the popular molecules already in use or those that are close to market. It is instead most likely to grow the market for fillers as more patients learn about this durable and safe soft-tissue augmentation product.
The world of fillers is changing rapidly, and although the products in use at the present time are wonderful, there are new ones on the horizon that appear promising.
Evolence: Not Your Mother’s Collagen
In a classic “what is old is new again” theme for cosmetic dermatology, collagen is making a comeback. But, this is not your mother’s collagen. The new collagen, Evolence, is significantly different from the familiar older forms that we know and, in some cases, like. It offers a range of advantages that appear to make it a significant competitor to the hyalurons that presently dominate the filler arena.
What’s New
Differences with Evolence include its source, cross-linkage, persistence, storage and several other critical aspects.
Its source.To begin with, Evolence is derived from porcine-based collagen. The rationale for this is quite simple: Pig skin is very similar to human skin, so the collagen derived from this source should be less antigenic than bovine-based products. This may have nuances for patients who are Jewish or Muslim or others who might be precluded from treatment with porcine-based materials.
Skin testing not required. According to the company (Colbar), skin testing is not required. In this respect, the product is similar to the human-derived Cosmoderm and Cosmoplast.
Cross-linkage. As with other filler molecules, it is imperative that the molecules are cross-linked and stabilized. If not for the cross-linking, they would rapidly be degraded and the correction would disappear. Prior versions of collagen used glutaraldehyde to cross-link the collagen fibrils. Using a “Glymatrix” technology, Evolence incorporates ribose moieties to cross-link the fibers of collagen in a stable matrix that resists degradation by the body’s enzymes.
No refrigeration. Among logistical differences between Evolence and prior collagens is that the product does not have to be refrigerated. This makes it much easier to store.
No anesthetic. Another difference between Evolence and prior collagens is that it contains no anesthetic. Most patients treated for nasolabial crease correction will tolerate pre-treatment with topical anesthetics such as LMX or compounded products. However, for patients who are sensitive to discomfort or are being treated in sensitive areas (such as the lips), injectable anesthetic may be appropriate. Many physicians are now using either 1% lidocaine with epinephrine or Septocaine (a dental product with rapid onset and rapid offset).
Less concentrated.The collagen concentration in this product is 30 mg/ml. This is less than the 35 mg/ml of Cosmoderm, Zyderm I, Cosmoplast and Zyplast. It is also a significantly lower concentration than the 65 mg/ml found in Zyderm II.
Product Applications
There are presently two different versions, Evolence and Evolence Breeze, the latter of which is designed for fine lines such as perioral ones. According to the company, it is intended for injection into the upper to mid dermis and it is approved in the EU and Israel. Different versions will be available for deeper dermal injections in the near future.
Unlike other products, Evolence requires correction to the desired contour or volume. This removes a great deal of guesswork from the injection process. For volume correction or contour sculpting, it is much easier to inject a product where what you see is what you get than it is to estimate whether 150% is good or 200% is better, as was the case with prior collagens.
Injection Methods
Injections with Evolence are similar to those with other fillers, and skilled injectors should not have any difficulty adapting to its use. Many physicians using this product employ a tunneling technique. However, it is likely that as the experience with the product grows, techniques will become as plentiful as the number of people injecting it. Serial puncture and cross-hatching techniques will most likely also become part of the injection techniques.
Duration of Effect
One significant difference between Evolence and prior collagens is the duration of correction. Unlike prior collagens, which were useful for a period measured in weeks or a few months, this recent entry is able to persist for up to 1 year. This duration will most likely increase the demand by patients for the product and result in many physicians returning to collagen for a portion of their soft-tissue augmentation practice.
Using Evolence with HA Fillers
Whether or not collagens in general and Evolence in particular act synergistically with hyaluronic acid fillers remains to be determined. There is some intuitive rationale to assume that the matrix laid down by long-term collagens will enable some of the cross-linked hyaluronic acids to stimulate more collagen formation, but clinical trials will be necessary to determine whether this is the case.
Some dermatologists adhere to a principle of mixing collagens with hyalurons in an attempt to utilize the anesthetic found in the bovine products and on an assumption (never tested) that the bovine collagens when mixed with hyaluronics will have less bruising. It is anticipated that if porcine collagen dominates the collagen market, the former indication (anesthetic) will dissipate while the latter (stability of hyalurons) will either be tested or discarded.
Its Potential
In summary, even as the synthetic molecules for soft-tissue augmentation proliferate, this is a new product that holds the potential for a durable and natural-appearing correction.
As with many fillers that preceded it, Evolence will most likely find a niche for each injector based on his or her experience and patient population. It is unlikely that it will displace any of the popular molecules already in use or those that are close to market. It is instead most likely to grow the market for fillers as more patients learn about this durable and safe soft-tissue augmentation product.
