context: Collagen and other injectable wrinkle fillers give skin a plumper, smoother appearance. Although collagen is the best known wrinkle filler, there are many other substances doctors can use to plump up your skin, including fat from your own body and synthetic materials. Take a look at how collagen and other injectable wrinkle fillers your doctor may recommend work. Collagen is a key part of your skin's structure. It forms a network of fibers within your skin that acts like a framework. In young skin, the collagen framework is intact and the skin remains moisturized and elastic. Over time, the support structure weakens and the skin loses its elasticity. The skin begins to lose its tone as the collagen support wears down. Using your facial muscles -- smiling, frowning, or squinting, for instance -- is part of expressing yourself. That's normal, but it does stress the collagen in your skin. Over time, that stress adds up and contributes to facial lines and wrinkles. Collagen creams work only on the skin surface and, like other moisturizers, mainly slow the rate of water loss from the skin and help keep the skin supple. A moisturizer with or without collagen cannot penetrate the skin and is not designed to be absorbed. No moisturizer can undo the effect of collagen loss and make wrinkles disappear. Collagen injections replenish the skin's natural collagen. By supplementing your skin's own collagen, injections help smooth facial lines and some types of scars. The natural beauty of your skin is enhanced as the contour of the support structure is restored. These products can come from cows (bovine) or human cells. Collagen injections include the following brands: Bellafill, Cosmo Derm, Cosmo Plast, Zyderm and Zyplast, as well as the implant Fibrel. Yes. They include: Botulinum toxin ( Botox Cosmetic, Dysport, Jeuveau, Xeomin) is not an actual wrinkle filler. Rather, botulinum toxin is injected into facial muscles to immobilize the underlying cause of lines and wrinkles. Botulinum toxin may improve eyebrow furrows, crow's feet, and forehead creases. Calcium hydroxylapatite ( Radiesse) is a semi-permanent wrinkle filler that's suspended in an aqueous gel and used to increase soft tissue. This is a collagen stimulator to improve the surface texture of your skin as well as stimulate your own collagen to enable the product to last longer. Fat from your own thighs or abdomen can be also be injected. There's no risk of allergic reaction, and most people achieve semi-permanent results. Several injections may be required to get the most benefit. Hyaluronic acid ( Belotero, Elevess, Juvederm, Prevelle Silk, Restylane, Restylane Lyft) is a substance normally made by the body that gives your skin its volume and fullness. Hyaluronic acid injections fill the space between collagen and elastin fibers within the skin, which replenishes the natural volume lost with aging. There is always a risk for skin infection with injections, and you will need repeated treatments to maintain the result. Hyaluronic acid also attracts and binds water, which helps maintain fullness where it's injected. Some hyaluronic acid materials are thicker and can add significant volume and structure. Others are smoother and thinner and have the ability to flow more consistently. Poly- L-lactic acid ( Sculptra) is an injectable filler used to replace lost facial fat. This synthetic polymer has been used for many years in dissolvable stitches and bone screws. This product stimulates the body's own collagen for better skin texture and a more long lasting result. Polymethylmethacrylate beads ( PMMA microspheres - Bellafill) are tiny round, smooth plastic particles. Thousands of synthetic PMMA microspheres are embedded in cow collagen, which is gradually absorbed by your body and replaced by your own collagen. Since the beads are not readily reabsorbed, and your own collagen is stimulated to form around them, this filler can last for years. Injections are placed under skin folds and in hollows to re-volumize and improve skin tone and texture. Before you get a wrinkle filler, you and your doctor will discuss your goals. You'll also discuss your medical history, the areas you want treated, and what results you can expect. Injections are not appropriate for certain lines and scars. Certain medical conditions also make them inappropriate. It is very important to have realistic expectations about what the results may be. For instance, one treatment may not remove every line on your face. With your doctor, you can decide which facial areas are most important to you and discuss how many treatments you may need. You should also discuss cost. Keep in mind health insurance doesn't pay for cosmetic procedures. So be sure you're clear on what you'll need to pay for and what your payment options are. If you and your doctor decide injections are right for you, your doctor may start by giving you a skin test on your forearm to make sure you aren't sensitive to the substance being used. You'll need to watch the area carefully for four weeks. Most men and women tested show no reaction to the skin test and can proceed with the injections. Depending on the substance injected, you will likely need more treatments to maintain the effect. That depends on which wrinkle filler you use. Just like natural collagen, collagen replacements begin to lose form. That means they will eventually wear down. Treatment may require collagen injections two to four times a year to maintain the smoothing effects. The âsofterâ hyaluronic acid fillers like Restylane and Juvederm last three to nine months or longer depending on the product and where it is placed. Other fillers last longer: Juvederm Voluma, Restylane Lyft, and Sculptra last up to one year or longer. Radiesse and Juvederm Vollure last up to one and a half years. Bellafill is a semi-permanent filler that can last years.