The use of collagen-based dermal fillers has noticeably dropped off in recent years—and it shows in the announcements by two leading makers, Allergan and Johnson & Johnson, that they will stop producing their respective collagen products (the human-derived CosmoDerm and CosmoPlast, the bovine Zyderm and Zyplast for Allergan; the porcine Evolence for Johnson & Johnson).

For a long time, collagen was the dermal filler of choice for plastic surgeons and dermatologists. Considering donor tissue origins, however, it is understandable that questions might arise with the use of collagen. Plus, collagen-based fillers require skin allergy testing and are relatively short-lived compared to the newer generation of fillers.

As in many markets, demand and money drive the evolution of new products, and dermal fillers are no exception. The popularity of non-animal hyaluronic acid (HA) fillers (known as replacement fillers because they replace lost volume) and PLLA and PMMA fillers (known as stimulatory fillers because they stimulate collagen and fibroblast production) has been strong in the recent past. Restylane, Radiesse, Perlane, Juvéderm, and Sculptra currently dominate the US market. Dermatologists report these hypoallergenic HA, PMMA, and PLLA fillers as being more versatile, longer-lasting, bulkier, and better for deep-volume filling than collagen.

But what about fine and thin line use, such as for foreheads or smokers lines around the mouth? Collagen was usually considered better for those applications. But Restylane Fine Lines is one HA product that makers hope to take over what used to be collagen territory.

What will the world of dermal fillers look like in the future? It’s difficult to say but change is definitely underway. Although fillers that indirectly stimulate fibroblast production are holding sway, direct injection of fibroblasts with Human Dermal Fibroblasts (HDFs) may be a trend. UK dermatologists are currently testing Valveta, a filler derived from the foreskins of male babies that is reputed to repopulate skin with healthy young cells and be long-lasting, if not permanent.