The key components that will determine a physician's success with injectables are education about what is out there, choosing the right product line and then perfecting the injection techniques.
The injectable filler market is bursting with new products that have either just been approved by the Food and Drug Administration (FDA), or are about to be.
Dermatology Times spoke with Jean Carruthers, M.D., an ophthalmologist at the University of British Columbia, Vancouver, about the impact of the growing market of injectables and what they mean to dermatologists' practices.
"A physician who is thinking about adding a new filler to his or her practice must get really educated about it and then perfect the technique," she says. "With fillers, success is 99.9 percent technique."
Adding injectables - where to begin?
There is no doubt that adding injectables can expand the bottom line, according to Dr. Carruthers.
"A good starting point is to add a biodegradable filler such as Restylane (Q-Med) or Juvederm (Allergan)," she says. "Then get one collagen product such as Cosmoderm or Cosmoplast (both by Inamed), and finally a longer-lasting product like Sculptra (Dermik), Radiesse (BioForm) or Artefill (Artes)."
When physicians start adding cosmetic services to their practice, they usually start it as 10 percent of their practice.
"Then you need to decide if you will keep it at 10 percent, and whether or not you will perform these treatments yourself or delegate some to someone else," Dr. Carruthers says.
The caveat with delegating is that there is a direct correlation between the experience of the injector and the end result.
"Unless the patient gets what they want, they aren't going to come back to your office," she says.
The latest injectables
When it comes to a longer-lasting filler, several new injectables fit the bill nicely, according to Dr. Carruthers.
"Radiesse is one product with the 'wow' factor," she says. "It gives a soft facial fullness with one treatment."
Consisting of tiny beads of calcium hydroxylapatite, the filler is injected beneath the skin where it plumps the tissues. The product is ideal in combination with a vitamin A product to stimulate new collagen formation in the skin.
Another volumizing product is Sculptra, a poly-L-lactic acid that creates new collagen under the skin. It plumps up the tissues for a refreshed, younger look. Although the product created some initial problems for European physicians, the issues have been worked out by switching from sterile water to sterile saline when diluting, and changing the saline dilution from 3 cc to 5 cc to 6 cc.
Not yet approved by the FDA, but nonetheless causing some excitement is Perlane, a more viscous form of Restylane that can be used for deep dermal filling or subcutaneous filling. The product is well accepted by patients, it creates volume and lasts six to nine months.
In addition, Juvederm is a hyaluronic acid that appears to be well tolerated and long lasting.
Dr. Carruthers suggests getting to know each of these fillers by reading about them in the literature and at their manufacturers' Web sites; finding a mentor or two to observe; and then getting mentored through the first injections.