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Fillers on the horizon abound


The disadvantages (of using long-acting fillers) are that any mistakes made by the physician are cosmetically punishable because of the permanent defect caused to the patient.

Palm Springs, Calif. - The soft tissue filler market is booming, and pharmaceutical companies have a host of new products waiting in the wings pending Food and Drug Administration (FDA) approval to fill the rising demand of these rejuvenating techniques.

These new fillers give the physician and patient the availability of more choices to tailor to the specific needs of each patient. Here, one expert gives a brief review of the newest fillers and what physicians and patients can expect from them.

"Aside from the positive characteristics that the existing fillers on the market impart concerning safety, biocompatibility and adverse effects, to name a few, new and improved fillers should provide more versatility, have a more natural look and feel, should be inert so that no skin test is required, achieve a longer lasting correction, have a better adverse event profile, be easier to store and they should be cheaper," says Frederic S. Brandt M.D., P.A., who practices cosmetic dermatology in Manhattan, N.Y., and Coral Gables, Fla., and is the principal investigator of his Dermatology Research Institute in Coral Gables, Fla.

Short-acting fillers

Dr. Brandt explains that collagens have been the gold standard for tissue augmentation for more than 20 years.

He says the short-acting collagens are made up of either:

1. Bovine collagen (e.g. Zyderm I, II, or Zyplast, Allergan Medical)

2. Human-based collagen (e.g. Cosmoderm I, II, or Cosmoplast, Allergan Medical)

3. Other collagen preparations (e.g. Evolence - made of cross-linking porcine collagen, and currently under U.S. clinical trials, ColBar LifeScience).

"In one clinical trial, results demonstrated that Evolence produced immediate effects on nasolabial folds equivalent to those produced by Zyplast. However, Evolence showed extended contour correction compared to Zyplast over an average period of 15 months," Dr. Brandt tells Dermatology Times.

The hyaluronic acid (HA) fillers include Perlane (still awaiting FDA approval at press time) and Restylane (both by Medicis Aesthetics), Captique, Juvederm Ultra and Ultra Plus (all three Allergan Medical and FDA approved). According to Dr. Brandt, these fillers possess very versatile materials and, when used correctly, are very safe and demonstrate results that are predictable and durable.

"NASHA gels are isometrically degraded. The gel can hold more water the less concentrated it becomes. As the gels degrade, each molecule progressively binds more water. The effective stabilization method makes it possible to maintain more volume with less material over a longer period of time," Dr. Brandt says.

He adds that the hyaluronic acid gels are excellent for the correction of glabellar lines, nasolabial folds, lips and perioral lines, as well as periorbital lines.

Advantages, disadvantages

According to Dr. Brandt, the advantages of short-acting fillers are that mistakes made by the physician are short-lived and the adverse events are not very problematic.

Because the fillers are short-acting, the patient has the opportunity to get a preview of results. Also, the current products available offer more longevity. The disadvantages are the frequency of patient visits, the usage of more needles, more downtime and bruising.

Long-Acting Fillers

Dr. Brandt says that Silikon 1000 (polydimethysiloxane, Alcon) is a sterile, non-pyrogenic, clear and colorless material and has been used in the correction of fine lines, acne scars, age-related depressions, facial atrophy and asymmetry, as well as lip augmentation.

Here, the best results can be achieved via the micro-droplet technique.

He says that Sculptra (injectable poly-L-lactic acid, Sanofi Aventis) is a biodegradable and biocompatible, crystalline, amorphous mixture and is reserved for the restoration and/or correction of the signs of lipoatrophy in patients with HIV. He says this filler has an immediate mechanical action and it induces collagenesis over time and restores dermal volume.

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