Filler success: Technique, consultation trump product choice

July 1, 2008

With the array of filler options now available, successful treatment requires knowing what patients want when determining the most effective product for the job, an expert says.

Key Points

National report - Regardless of one's personal filler preferences, thorough pretreatment consultation and careful injection technique help to ensure successful treatments, an expert says.

In 2006, U.S. patients spent $600 million on dermal fillers, but by 2010, this figure is expected to grow to $1 billion annually, says Dr. Weinkle, a Bradenton, Fla., dermatologist in private practice and assistant clinical professor of dermatology, University of South Florida, Tampa.

Dr. Weinkle prefers fillers that require neither refrigeration nor premixing, "so when the patient is there, I can take it off the shelf and use it," she says.

Additionally, Dr. Weinkle says, "The baby boomers we're treating now don't want to have a skin test, if possible. They'd like to have the treatment the day they come in."

Compatibility with other aesthetic treatments also ranks high on Dr. Weinkle's wish list.

"Nowadays," she says, "people don't want one thing - they want lots of things, so we're in the world of combination therapy."

Along with consistent quality and viscosity, Dr. Weinkle says she's most comfortable with semi-permanent filler duration, because permanent fillers don't go away if patients don't like them.

"Fortunately," she says, "semi-permanent fillers are lasting more than three months, which is why we never saw the collagen products achieve the same usage level that newer products have achieved - collagen didn't last long enough," she says.

In today's litigious society, Dr. Weinkle says, doctors must use caution to use only products approved by the Food and Drug Administration (FDA).

In the lip area, Dr. Weinkle says as people age, "We get an elongation and a flattening - we lose the filtral columns, resulting in an inversion. We really start reabsorbing ourselves," including supporting bone underneath the lips.

Lip corrections

Regarding lip corrections, she notes that upper versus lower lip volume is variable.

As a general guideline, she says the ratio of lower to upper lip volume should be roughly 2 to 1.

For lip augmentation, Dr. Weinkle says some patients still prefer collagen, because they believe it creates the softest, most natural-looking corrections, with no swelling and minimal bruising. A typical patient may require CosmoDerm in the lip body, with a line of CosmoPlast (Both: Human collagen, Allergan), a slightly stiffer product, along the vermilion border, she says.

"Restylane (hyaluronic acid/HA, Medicis) is a somewhat stiffer product to inject, although it too can provide very effective lip enhancement," Dr. Weinkle says. When Juvéderm (HA, Allergan) debuted, she says, "There was a slight learning curve, because the plunger pressure needed to be slightly less. The viscosity of the HA in Juvéderm is different than that of Restylane."

Evolence (porcine collagen, ColBar Life Sciences) also is an effective, natural-feeling product that should earn FDA approval in the coming months, she says.