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Filling a niche


Arnold W. Klein, M.D., did not like the injection technique that Collagen Corporation promoted when bovine collagen was first approved by the Food and Drug Administration (FDA) in 1981. So, rather than injecting collagen in the layers, as recommended, he developed a technique whereby doctors would inject it superficially, by serial puncture, a technique he developed and is now used worldwide.

Industry and fellow physicians, who at first thought Dr. Klein was on the fringe with his teachings about filler injection, today embrace his approaches as the gold standard.

In 1984, he developed lip augmentation. Today, lip augmentation is the single largest application of filler substances in the world.

Dr. Klein continues to be at the forefront of filler progress. As an advisor, consultant and principal investigator to Allergan, Medicis and numerous other corporations, Dr. Klein says he has since developed the injection techniques most often used for Botox (Allergan) and Restylane (Medicis) treatment.

Know when to stop

"The magic is not in knowing when to begin the procedure, but in knowing when to end it. Spend enough time to do it right," he says. "Also, look at the patient before you inject. See what is missing. There is more restoration in lip augmentation than augmentation."

While he still uses collagen, Dr. Klein's favorite filler on the market today is Restylane.

"The hyaluronic acids are very exciting as a whole," he says.

Medicine lacking integrity

In addition to touting what he thinks is good for patients, Dr. Klein is known for speaking out against products that he says are unsafe.

"I think we are in a strange age where integrity is missing in medicine," he says. "It happens when doctors take financial ownership or stock options in companies. Once you do that, you lose your objectivity."

Dr. Klein, who says he does not have financial interests in any of the companies he consults for, says that one of the biggest problems is that doctors are advocating for extra label use of agents that have not been approved for those uses by the FDA.

One example: Sculptra (Dermik), which has only been approved in the United States for use in AIDS-related facial lipoatrophy.

"There are a number of doctors who advocate its use as a filler for the general population, and those doctors are advocates for the company," he says. "The FDA approved Sculptra in its rapid approval process. The filler might behave quite differently in people who are not immunocompromised."

Dr. Klein recommends that dermatologists always question what they read and question the authors. Pick a few sources, he says, that you know have a certain level of integrity and listen to them.

"When all is said and done, all you have left is your name," he says.

To encourage the flow of credible information through the media, Dr. Klein, author of the well-known medical text Tissue Augmentation in Clinical Practice, serves on the editorial boards and as expert reviewer of numerous national and international medical publications.

"I want to make sure that what is in the literature reflects accurate studies. I see things written that are inaccurate and untrue," Dr. Klein says.

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