October 29th, 2009
Facial Fillers New York City
New York City, NY – This is a filler update from the Fall AAFPRS meeting, where there was a big push from the new fillers on the block. Though Sculptra has been around for years to treat facial wasting, it was recently FDA-approved for cosmetic use to treat “shallow to deep smile lines (nasolabial fold), contour deficiencies and other facial wrinkles.” However, many of us facial plastic surgeons have already been using it for years as “off label” for cosmetic treatment of the face.
Over the past decade, we have taken a new look at facial aging. Faces don’t just droop and get wrinkles, often they lose volume. Dr. Sydney Coleman was one of the first doctors to disseminate that concept, and treated facial volume loss with fat liposculpture, which was a powerful adjunct to treating facial aging. Some patients really don’t need facelifts, and others need both volume replacement and lifting. Until Sculptra – as well as some of the other longer lasting fillers such as Radiesse, Perlane and Juvederm Ultra Plus – fat was the best option. However, fat rejuvenation is a surgical procedure that comes with prolonged healing and downtime, and some patients only retain 60 to 80% of the injected fat on average, so results are often unpredictable. And to inject more fat requires another semi-major procedure. You might also be one of the rare patients in whom 100% of the fat lasts, resulting in an over-filled face.
Alternatively, Sculptra, a non-invasive injectable, can treat volume loss precisely and effectively in just two to three treatments… no operating room, sedation or significant recovery required.
Results typically last two or more years.
Why Sculptra instead of other fillers? This is really a choice to be decided upon between physician and patient. As I mentioned above, Sculptra may require two to three treatments a month apart, lasting an average of two years before it starts to slowly go away. No other fillers last as long. So, do you want to have this “in and out” treatment with little to no down time and maybe a tweak in one and two months, or get treatments every 6 to 9 months with other fillers, which can be costly over time. Though Sculptra is more expensive, it really doesn’t cost more than shorter-lasting fillers when amortized over two years.
Before Sculptra
After Sculptra
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October 20th, 2009
To continue my summary of new innovations presented at the fall meeting of the AAFPRS in San Diego, I am going to review the latest Hyaluronic Acid (HA) facial fillers. New fillers are continually being developed and released on the market. Which are good, which are not so good and which are going to fade away – that is fade from use not just fade from your face.
The fastest growing selection of facial fillers is the HA fillers. One of the first to be FDA approved and widely used was Restylane followed by Juvederm. Along with Restylane there is Perlane, a thicker version and Juvederm Ultra Plus; a thicker version of Juvederm. Historically, Captique and Hylaform were early contenders but these fell by the wayside as not measuring up to Restylane and Juvederm. New to the market is Hydrelle; the first HA to have local anesthetic right in the syringe. Many of us now combine HA with local anesthetic to reduce the discomfort on injection. This saves a step. However, will Hydrelle stand up as a filler? The presentation on new fillers compared Hydrelle to Captique, which really couldn’t hold a candle to Restylane or Juvederm.
An exciting new pair of HA fillers are Prevelle Silk and Prevelle Shape. These also have local anesthetic. According to the new technologies seminar, Prevelle Silk has the smallest HA particle size. This may work well for treating very fine lines in the skin, especially around the mouth. Right now, the HA options of Restylane and Juvederm can be used, but when injected too superficially, the clear gel may be visible as a bluish bump within the skin called the Tindal effect. A smaller particle should reduce this potential side effect. For really small, superficial lines, the best stuff out there right now is Cosmoderm, but there is a rumor going around that Cosmoderm and Cosmoplast might be dropped from production due to low sales from HA competition and high production costs. I will definitely try Prevelle Silk since it will fill a needed niche in facial fillers.
Next week I will expand on fillers (no pun intended) to discuss Evolence, Radiesse and Sculptra.
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October 16th, 2009
Dysport has been around in Europe almost as long as Botox. Recently it was FDA approved for cosmetic use in the U.S. for glabellar lines. These are the “angry 11’s” or frown lines between the eyebrows. Intentionally, this is the same area that Botox Cosmetic is approved for. Any other cosmetic uses, such as horizontal brow lines, crows’ feet, eyebrow lifts, raise down-turned corners of the mouth, plus loads of other uses, are called “off label.” What this means is that treatments for anything other than frown lines, is up to the doctor to explain to patients that the use is off label, but given the doctor’s professional experience and knowledge they are using the drug in a non-approved yet acceptable way. Off label issues was recently addressed in the NY Times by Natasha Singer.
So, what are the differences? Botox is now formally called anabotulinum toxinA and Dysport is abobotulinum toxinA. I won’t bore you with the technical stuff; these are very similar molecules and most importantly both are Botulinum Toxin Type A. Other Botulinum toxins are currently being investigated, but none have been found to be as effective and have as low a side effect rate as Botulinum Toxin Type A. Clinically, the new kid on the block is always touted as being better. Every new filler company says their filler lasts longer and in the long run, most didn’t. I polled my neurotoxin “guru” at the recent AAFPRS meeting, plus attended the new technology session. Their take is that the effects of Dysport may come on earlier and may last longer than Botox. However, Dysport may also have more diffusion. What that means is that there is slightly more spread from the point of injection. This occurs with Botox as well, but for both I use a very low dilution so spread with either should be minimal.
Will I switch? I had my official training from the Medicis Company for Dysport yesterday. I treated four loyal, astute patients. I will follow them and see for myself how fast it worked and how long it lasts on them, also if they note any differences. What my guru said was that it’s like Restylane and Juvederm, we first had only Restylane and once Juvederm came on the market I found that each has specific advantages and learned which one to use for each individual patient and area of the face to get the best results. I will keep you posted.
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October 12th, 2009
I recently returned from the annual Fall meeting of the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) in San Diego, California. I look forward to that meeting every year as the Academy’s premiere meeting. It is a forum for experts to discuss procedures on panels, new innovations being presented by researchers, new products from medical vendors, and last but not least – the chance to catch up with good friends from all around the country. I missed only one of these fall meetings since my fellowship (1988), and that was two years ago when my twins were due. My next few blogs will be devoted to advances in plastic surgery that premiered at the meeting.
The meeting started off with a superb panel on facelifts. Panelists were chosen to discuss the various popular techniques practiced around the country. These ranged from mini-facelifts to (open) suture suspension lifts, MACS lifts, deep-plane facelifts, bi-planer extended SMAS lifts and the latest: laser lifts featuring the new laser SmartLiftTM.
The goal of facelifts are to re-suspend drooping facial tissues by tightening the underlying muscle layer called the SMAS, then gently laying down the skin, without tension, to obtain natural long lasting results. Each of the above techniques has advantages and disadvantages. My main take home lesson was that there is no one facelift for every patient. Mini-lifts have a place for patients who need minor improvement of the jowls, jawline and mild skin excess under their chin. For patients with heavy faces, the deep-plane facelift is still king.
I was enthralled by the laser lift. I recently purchased the SmartLipo Laser to use for neck contouring and to enhance liposuction results. I have been using it since August for neck liposuction, skin and jowl tightening and getting fabulous results. This laser can also be used to raise the skin for a facelift. By using the laser there is less bleeding and the skin flat is elevated more smoothly and rapidly… which all leads to less downtime and recovery, which gets the patient back to work quicker.
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