Storage of excess Restylane use debated

Las Vegas - You've injected a patient with what appears to be just the perfect amount of Restylane (Q-Med), but there's just one problem - there's still some left over, and, with a hefty price tag, the last thing you want to do is simply discard it.

Sparking the debate was the question to a panel of filler experts from an audience member about whether and how to store unused Restylane for later use. The questioner noted a recent study that looked at the issue and suggested that, despite manufacturer warnings, reuse of remaining material in a syringe could be safe and economical (J Am Acad Dermatol. 2005 Jun;52(6):988-990).

Fellow panel member David Duffy, M.D., offers a counterpoint, however, saying that while he doesn't necessarily prefer to store product, he finds that patients appreciate the effort.

"I don't like storing because it's a nuisance, but the good news is that when they come back, they get that extra amount, so it can make it cost-effective," says Dr. Duffy, a clinical professor of medicine (dermatology), University of Southern California, and a private practitioner in Torrance, Calif.

Dr. Duffy adds that he withdraws the plunger before taking the needle off of the syringe in order to prevent squirting out too much of the filler.

Marta Rendon, M.D., president of the American Society for Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), notes that the debate gives rise to the issue of how much product manufacturers provide.

Dr. Carruthers counters, however, that that situation is rarely the case for him.

"I have yet to see a face that couldn't use a little more volume somewhere," he says. "So I always use the entire syringe, and my patients understand that there are not partial syringes," Dr. Carruthers says. "I won't reuse it on them or anyone else."

In a phone interview with Dermatology Times, Ranella Hirsch, M.D., who is also on the ASCDAS panel and is vice-president of the society, says she is on the side opposed to the storage of filler due to potential risks.

"I'm vehemently against it," she says.

In reference to the study on filler reuse, Dr. Hirsch emphasizes that there are big differences between a study setting and a clinical practice.

"There's such a huge difference between a research study, where you take 10 vials and put them in the fridge and watch them to see if there is bacterial contamination, compared to a day-to-day practice.