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Plump, Plumper, Plumpest
The best advice for anyone considering filling a line or a feature in their face is; KNOW YOUR FILLERS.
Today I want to talk to you about fillers and what is new and innovative in the U.S injectable market. Non-surgical non-invasive facial rejuvenation procedures commonly rely on “injectables” or “dermal fillers. The products are popular, safe and effective and give patients fantastic results without surgery. These fillers act by plumping wrinkles or depressed areas on the face or lips with different biological materials. Hyluronic acid based dermal fillers such as Juvederm, Restylane and Perlane, as well as calcium hydroxylapatite based Radiesse have been around for some time now and account for the majority of fillers used in aesthetic procedures.
More than ever patients are having fillers because they work, they are affordable and they allow the patient to buy time before the need for the unavoidable, immanent, invasive facelift. As the use of fillers has grown, manufacturers have taken note for the need of increasing the patient comfort during the treatment. By adding lidocaine containing versions of the product, Juvederm XC, Restylane-L and Perlane-L won FDA approval in February of 2010. Radiesse FDA clearance came in July 0f 2009 when they provided physicians with their method of mixing lidocaine with the product. Randomized studies were conducted on blindfolded patients treated for different areas of fillers such as the nasolabial folds, cheecks and lips. Altogether, patients reported less pain during, immediately after and 24 hours post treatment with the lidocaine version of the product over the original one. This has made fillers with lidocaine among the latest advancements in injectable options in the U.S. Delivering fillers to the patient with less pain not only makes the experience more pleasant to the patient but it allows the surgeon to have better control of his technique.
Other Innovations in the world of fillers include new injection technology using an automated injection system such as an injection pen. The system, Anteis Injection System is currently awaiting FDA approval. It delivers the filler in a more precise fashion, fewer side effects and more importantly what seems to be less pain to the patient.
Although there are over 100 fillers available on the market , in mentioning the choice of different filler substances, most manufacturers have been claiming that their products last longer than older fillers or that their effects can be permanent. Liquid injectable silicone stands apart from other fillers. Medical grade liquid injectable silicone is FDA approved only for intraocular use, yet it has been used for facial correction -off label- for years. The product is permanent, which is both an advantage and a disadvantage. Its permanency can be a big drawback in inexperienced hands. But in the trained hands of a cosmetic surgeon, liquid injectable silicone can be safe and versatile. The product is technique dependent and requires a micro droplet serial puncture technique in very small volume over two to five sessions around one month apart. Since the effects are permanent, extreme caution is indicated especially when augmenting lips and cheeks. Again the permanency of the product must be respected for safe results and patients have to be informed of the off-label use of the product.
One cannot review injectables without mentioning fat transfer. The technique, which relies on transferring fat from one body area to “plump” another, such as the face, breast or buttocks, offers all the above benefits with fewer drawbacks. It also is technique dependent where in some hands there is no permanency while in others the results are long lasting.
In conclusion, who is performing the “plumping” may be as important if not more important than what plumping material is being used. All board certified plastic surgeons have an intimate knowledge of anatomy while possessing in addition an innate gift for artistry.
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