Fillers: Getting closer to the ideal

Miami - Filler options are getting closer to what David J. Goldberg, M.D., considers ideal.

Finally, for the physician's convenience, it would have no special shipping or storage requirements and would be ready to use with no need for mixing or preparation; it could be readily injected with minimal extravasation; and it would be totally nonallergenic so that sensitization testing would not be required.

Among those attributes, Dr. Goldberg says, both Radiesse and Sculptra have the ideal characteristics of not requiring any allergy testing because they are not animal products, and both are fairly easily injected into the skin via 26-27 gauge needles. Additionally, with a lifespan of about 24 months, both last longer than hyaluronic acid and collagen. While both have been approved by the U.S. Food and Drug Administration (FDA), cosmetic purposes are an off-label use for both.

Their differences, however, are marked.

"With Radiesse, you see results immediately, and because there's one-to-one correction, there's no need to overfill when injecting into areas such as nasolabial folds and lips," he explains.

In contrast, he says, Sculptra, which is FDA-approved for HIV lipoatrophy, is not a site-specific wrinkle filler, and it does not offer immediate results.

"Sculptra is more of a volume enhancer than a filler. It must be injected over time, in a series of three or four injections about a month apart, and requires undercorrection of the injected area. Its effect is gradual and progressive over time," Dr. Goldberg says.

He did point out one application advantage of Sculptra: "Because this material is injected over time, it allows one to titrate the number of treatments with desired clinical results."

But Radiesse - which also has a two-year shelf life and offers "ideal characteristics" such as not requiring refrigeration, reconstitution or special storage, he says - is generally more convenient than Sculptra, which must be reconstituted with sterile water and used within 72 hours of reconstituting.

Other fillers Dr. Goldberg considers silicone, which is a permanent filler, "terrific in the skin when used correctly," but he notes that it is best for saucerized acne scars and facial wasting. The silicone product Silikon 1000 (Alcon) is FDA-cleared for retinal tamponade and generally requires at least three to five monthly skin treatments.