Collagen-based dermal fillers: past, present, future

The demand for dermal fillers and the variety of dermal fillers available have evolved dramatically during the past 2 decades. Collagen was the first material to be approved by the U.S. Food and Drug Administration (FDA) for injection into facial scars, furrows, and lines. Bovine collagen (95% type I and 5% type III collagen) was approved in 1981; buffered collagen Zyderm I and Zyderm II followed by Zyplast were FDA approved and released shortly thereafter. This article will focus on the historical benefits and risks of collagen injections and the typical outcomes. With the advent of hyaluronic acid products and other options, the risks of collagen and limited benefit have caused a marked loss of market share. Specifically, allergy is a major concern. As a result, two rounds of skin testing are required adding inconvenience and delay for both the practitioner and patient. Furthermore, a negative skin test does not guarantee allergic reactions or other more serious side effects will not occur. Finally, the perceived clinical efficacy is often short lived despite histopathologic assessments showing that collagen persists at best 9 months.