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To no one's surprise, the U.S. fillers market continues to grow rapidly. Growing along with it is an awareness that the burgeoning array of products is having a significant impact on facial Aesthetic procedures.
"In a general sense, recent additions to the fillers market and what's coming down the pipeline are providing greater longevity, different source products and more customization of treatments to different skin types," says Boston dermatologist Ranella Hirsch, M.D. "The fillers market is robust and still growing, and we're trying to best understand the final role of filler in the full context of aesthetic rejuvenation."
Washington-based dermatologist Tina Alster, M.D., agrees.
According to Dr. Hirsch, who is also president-elect of the American Society of Cosmetic Dermatology and Aesthetic Surgery, hyaluronic acid-based fillers are, by far, the category leader among currently available products. These include Juvéderm (Allergan), Restylane and Perlane (both from Medicis), which are commonly used for procedures involving nasolabial and mesolabial folds and for lip-plumping.
Among other popular fillers are human collagen products such as Cosmoplast and Cosmoderm (Inamed Aesthetics, a division of Allergan), used mainly to define the vermilion border of lips, and Radiesse (BioForm Medical), a calcium hydroxylapatite-based filler that Dr. Alster says offers more volume for cheek and mandible procedures and has longer-lasting effects.
"The recent approval of Elevess means we now have an option with topical anesthesia, which is excellent," Dr. Hirsch says.
ArteFill, approved by the FDA in October 2006, is the first injectable aesthetic filler that is nonresorbable, which provides longer-lasting results, according to manufacturer Artes Medical.
As for fillers in the pipeline, Dr. Alster points to Prevelle, another hyaluronic acid filler that is currently being marketed outside the United States. Manufacturer Mentor Corp. has announced that it is seeking FDA approval for Prevelle and its lidocaine-containing sister product, Prevelle Plus. That approval could come by late 2008, according to Mentor.
"Evolence, made by ColBar Life Sciences, and which includes porcine collagen, is another filler in the pipeline that could gain FDA approval in the not-so-distant future," Dr. Alster says. "Evolence is said to last longer than fillers containing human or bovine collagen."
Also awaiting approval for cosmetic indications is Sculptra (Dermik Laboratories), which is already FDA-approved for correction of the signs of facial lipoatrophy in HIV patients.
William Philip Werschler, M.D., assistant clinical professor of medicine and dermatology at the University of Washington School of Medicine, Seattle, says he believes the rapidly evolving fillers market will require a similar evolution on the part of dermatologists and the manner in which current and future products are used.
"We're evolving from filling lines and wrinkles to doing overall facial shaping - what's become known as volumization or volume replacement," he tells Dermatology Times.