Dermatologists prepare for departure of collagen from U.S. market

San Francisco - The departure of Allergan’s collagen products from the market at year’s end may create a bit of havoc for some providers and patients, while for others it may simply put a new face on fillers.

But whatever the impact in dermatology offices across the country, eventually, everyone will adjust, according to one expert.

“For my generation of dermatologists, collagen was the gold standard of fillers - this is what we were taught to use,” says Seth L. Matarasso, M.D., clinical professor of dermatology, University of California School of Medicine, San Francisco.

“Most of us learned about bovine collagen, the original filler of choice, then later the human-derived collagens, CosmoDerm and CosmoPlast, and then, finally, Evolence, porcine collagen. But the market is changing,” he says. “Welcome to the brave new world of fillers.”

End of an era
In January 2010, Allergan announced to physicians that it would be discontinuing its collagen line of products - CosmoPlast, CosmoDerm and bovine products Zyderm and Zyplast. The company halted production of the products in 2009, but manufactured sufficient inventory to meet estimated market demand through the end of this year, according to Kelly Lao, manager of corporate communications.

“The discontinuation of the sale of our collagen products … is in response to declined market interest ... since the introduction of hyaluronic acid dermal fillers like Juvéderm have become more popular,” Ms. Lao says. Collagen fillers have become a niche product, she says.

Johnson & Johnson announced in late 2009 that it was discontinuing Evolence.

The reasons for the evolution away from collagen products are many, according to Dr. Matarasso.

“There is an overwhelming popularity of the new kid on the block: the hyaluronic acids. They have been embraced universally, and suddenly collagens aren’t as popular,” he says.

HA products plentiful
The attraction of the hyaluronic acid products such as Restylane, Perlane, Juvéderm, Radiesse and Sculptra is due to many factors including more robust, longer-lasting results with more versatility. Also, the new hyaluronic acid products appear to give a better fill. Some even contain lidocaine for less painful injections, and upcoming improvements will provide more volume and contour-changing ability, and the ability to fill deeper lines.

“I think the bottom line is that the overall interest and sales were declining for collagen products, and there may have been some concern about the derivation of the collagens,” Dr. Matarasso says. “In the long run, it probably wasn’t cost-effective to continue to manufacture them.”

While he considers the phasing out of collagen to be an evolution, he is concerned about one important aspect of collagen products that is lacking in the newer fillers.

“There is nothing out there right now that will take care of the fine, thin lines - those lines that radiate up from the mouth that we call smoker’s lines,” Dr. Matarasso says. “You can’t put a hyaluronic acid in them, and products like Radiesse are just simply too bulky and too space-occupying.

“But,” he adds, “I think that we will adjust our palates and get used to the lack of collagen. We will improvise and I suspect that this will spur us on to new technology. It will be interesting to see if one of the manufacturers steps up to the plate and fills the void.”

Getting comfortable
Dr. Matarasso offers advice for dermatologists as they make the switch from collagens to hyaluronic acids.

“Ultimately, we’re not chasing lines anymore,” he says. “What we’re doing now is treating the face as a whole, so we are, in fact, doing more facial shaping, more re-contouring. So what we do need to focus on is combination therapy. For instance, you’re going to need a toxin near the crow’s feet, and a thicker, more robust filler in the infraocular sulcus. Still, we’re gong to need some thinner fillers for those times we need to do some fine-tuning.

“My advice for dermatologists is to get familiar and find your comfort zone,” he says. “Become proficient with one or two dermal fillers, then slowly add new products and eventually introduce newer indications.”

Dr. Matarasso says he believes physicians are just seeing the tip of the iceberg when it comes to the potential of the new fillers.

“The baby boomers are coming of age and are becoming more proactive about their appearance. Science is finally meeting the patient demand,” he says. “Now, we have two neurotoxins. I suspect that by next year, we’ll have three or four. Additionally, where we had only one filler before, we now have well over a half dozen and probably have twice that many in the pipeline.”

Although he doesn’t see the loss of collagen as an insurmountable obstacle, Dr. Matarasso does see it as a double-edged sword.

“Collagen was a product with wonderful efficacy and a great track record,” he says. “But as I said, we will adjust.

“At the end of the day, we know that we are an adaptable specialty,” Dr. Matarasso says. “We will always continue to do what is in the patient’s best interest, and we will find a way to meet patient demand and concerns - whether it’s with new topicals, new lasers, a new toxin and, yes, a new filler.”