Straight talk about pros, cons of newest injectable fillers

September 1, 2006

An explosion of new, longer-lasting injectable fillers will offer dermatologists more choices for ?sthetic treatments.

An explosion of new, longer-lasting injectable fillers will offer dermatologists more choices for aesthetic treatments.

But the big question is how to decide which filler to select.

"We'll all be hearing more and more about these products, so we need to get familiar with them," she says. "The FDA has recently determined that they are safe and effective, but it's up to us to learn about them, get skilled in injection techniques, compare them to prior injectables, decide in whom and in what locations to use them, and take note of side effect rates."

ArteFill

The unique aspect of ArteFill is that the product stimulates the body to create its own collagen, thus filling in wrinkles.

ArteFill is made of microscopic spheres of polymethylmethacrylate (PMMA) mixed with purified bovine collagen. It is injected under the skin, where it remains permanently and encourages new collagen formation. As with other collagen products, over time, the collagen portion of the filler is absorbed, while the PMMA microspheres remain. The ArteFill product actually accounts for 20 percent of the end result - the way the body's own tissues react to the filler creates the other 80 percent. The nasolabial folds are particularly good locations for this product.

There are some downsides, however, according to Dr. Alster.

"There's a chance that the PMMA microspheres could become encapsulated, with an inflammatory response," she says. "The patient can develop granulomas or nodules around the permanent implants, which can be particularly obvious in thin-skinned areas."

Still, the chance of developing problems is minimal.

Radiesse

Radiesse is an injectable compound that contains calcium hydroxylapatite, which is suspended in a clear, aqueous gel.

This filler tends to require a bit deeper and more exacting application into the skin than regular collagen or hyaluronic acid.

"I particularly like to use this product in the nasolabial and mesolabial folds as well as the mouth corners. When injected into the cheek hollows, a lifting effect appears to take place," Dr. Alster says. "I tend to use Radiesse for people who require two or more syringes of the shorter-acting fillers (e.g., hyaluronic acid) for correction. It may be a bit more costly, but it lasts longer."

Like ArteFill, this filler has the potential for granuloma formation if not correctly placed. Also, the injections are a bit uncomfortable for the patient during the actual injection, with a little more bruising. Nonetheless, Dr. Alster says she prefers this product over ArteFill because "You only have to worry about one thing, and that's calcium hydroxylapatite."

Juvederm

Juvederm is likely to be a big hit, according to Dr. Alster.

Introduced by Allergan, it will probably be priced very well, have a lower potential for allergies due to removal of bacterial proteins from the final product, and prove to be longer- lasting than other hyaluronic acid products because of its high density. In addition, it may be easier for some physicians to make the jump from other hyaluronic acid-containing products that they are currently using to Juvederm, compared to ArteFill or Radiesse. Physicians will see a smooth substance - like gelatin - when injecting, and the results can last up to a year.