Fillers find success in correcting volume depletion in various body areas

September 1, 2011

Though the most common indications for fillers include the treatment of wrinkles, acne scars and lip augmentation, these devices also can prove extremely useful for more esoteric cosmetic and medical issues.

Key Points

Chicago - Though the most common indications for fillers include the treatment of wrinkles, acne scars and lip augmentation, these devices also can prove extremely useful for more esoteric cosmetic and medical issues.

"For years, aesthetic physicians have concentrated on using fillers for facial rejuvenation, but now, it is becoming more in vogue to think about other indications where fillers can be useful," says Kevin Pinski, M.D., Pinski Dermatology & Cosmetic Surgery, S.C., Chicago. "Most of the commonly used fillers today can be very effective in volumizing tissues, even for not-so-typical aesthetic indications."

The most common fillers used today include the numerous hyaluronic acid-based fillers, as well as poly-L-lactic acid (Sculptra, Sanofi-Aventis), calcium hydroxylapatite (Radiesse, Merz) and fat transplants. These devices' primary aesthetic goal is to volumize tissues that have been depleted because of aging or due to a disease that causes local volume depletion.

According to Dr. Pinski, the hands are a quick giveaway of one's age. As one matures, the hands will age and undergo volume loss, which leads to skin laxity and the obvious appearance of the tendons and veins. Fillers can be very useful in rejuvenating the hands, Dr. Pinski says, returning them to a more youthful appearance.

When injecting synthetically manufactured fillers for this indication, Dr. Pinski suggests placing the filler in between the tendon sheaths in multiple small bolus injections and then vigorously massaging the material in the target area.

When using fat transplants, Dr. Pinski says he will typically make one injection site under local anesthesia. Following a stab incision using an 18 gauge needle at the dorsal wrist crease, a small 18 gauge cannula is threaded along each tendon sheath toward the knuckles and fat is deposited where cosmetically needed.

According to Dr. Pinski, the technique is relatively atraumatic, and patients may have some transient swelling or bruising post-procedure.

"All of these procedures and techniques tend to work really well. However, my favorite among the filler products for this indication is probably Radiesse, as one can achieve results that can last for approximately one year," Dr. Pinski says.

"Sculptra can also work well here. However, one may require multiple injections to achieve a more sustained effect," he says.