The changing face of fiillers


As fillers evolve to address an ever-expanding array of aging skin issues, the term filler, itself, is almost becoming obsolete as modern-day products do far more than fill wrinkles. Using them to just fill, in fact, is kind of like using a Ferrari for trips to the local convenience store, said Wm. Philip Werschler, M.D., F.A.A.D., F.A.A.C.S.

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National report - As fillers evolve to address an ever-expanding array of aging skin issues, the term "filler," itself, is almost becoming obsolete. Modern-day products do far more than fill wrinkles. Using them just to fill, in fact, is a bit like using a Ferrari for trips to the local convenience store, says William Philip Werschler, M.D., F.A.A.D., F.A.A.C.S.

"You can drive your Ferrari down to the local 7-11, or you can take it to a racetrack, where you're really going to see its best performance - and it's the same with fillers," Dr. Werschler says.

"We're finding that if we take a three-dimensional approach, rather than just filling lines and wrinkles, we get much better use out of these products," he says.

The traditional descriptions of fillers as being either temporary, permanent or semi-permanent are also becoming "old-school," as the products are more appropriately categorized according to their mechanisms of action, either as a collagen stimulator such as Sculptra; a replacement filler, such as collagen or hyaluronic acid (HA); or even both, such as Radiesse (Bioform Medical).

Even the issue of longevity has become murky as doctors see wide discrepancies among patients using the same products.

"The problem with longevity is, it's too uneven. What lasts six months in one patient's lips may last a year in another's, so it's nearly impossible to get anyone to agree on what a product's longevity really is," says Dr. Werschler, assistant clinical professor of medicine and dermatology at the University of Washington School of Medicine, Seattle.

Products that are poised to make an entrance in the filler field in 2008 offer some new twists that should additionally shake things up. Among them is a new generation of products that combine hyaluronic acid with lidocaine in order to improve patient comfort. Products in the pipeline include Elevess (Anika Therapeutics), the first FDA-approved HA filler with lidocaine, and Mentor's Prevelle Plus and Puragen Plus.

Another HA product, Belotero (Merz), has completed phase 3 clinical trials and may be on its way to the United States market soon. Merz describes the product as using a "cohesive polydensified matrix" production technology that fills the intradermal space and offers natural-looking results.

"This is probably more similar to Restylane than any other product," says Denver dermatologist Gary D. Monheit, M.D., F.A.A.D., F.A.A.C.S.

Belotero, like Juvéderm (Allergan), is also a monophasic HA and has a unique cross-linking property that makes it highly stable, Dr. Monheit says.

"There is not much free HA, compared to cross-linked HA, in the product, meaning there isn't that quick drop-off in two weeks, requiring the patient to come in for a touch-up. Instead, there is a slow, gradual decline, like we see with Juvéderm," Dr. Monheit says.

Also on the anticipated fillers list is Evolence (Colbar), a long-awaited porcine-based collagen that should receive FDA approval in 2008. The product holds the promise of offering a more stable and longer-lasting option, compared to other fillers.

Colbar reports that it plans to extend the Evolence product line to four products, offering distinctive benefits for fine lines and wrinkles, shaping facial contours, correcting deep facial folds and adding fullness to lips.

"Some benefits (of Evolence) are that it is supposed to be longer-lasting (up to one year), and it is a collagen, which is a natural part of the dermal matrix," Dr. Werschler says. "People like that because it feels soft, just like their own tissue."

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