Photographic documentation reveals the value of achieving full corrections with a next-generation hyaluronic acid filler, an expert says.
National report - A small photographic study shows the comparative benefits of using one, two and three syringes of Juvéderm (hyaluronic acid/HA, Allergan) to treat deep nasolabial folds, says Steven G. Yoelin, M.D., an ophthalmologist in private practice in Newport Beach, Calif., and assistant clinical professor of ophthalmology at the University of California, Irvine.
"The problem we all face is that achieving complete corrections is extremely important for both patients and clinicians. However, there may be a tendency to use less dermal filler than one could or should," usually due to cost concerns, Dr. Yoelin says.
He explains that, in his area, Juvéderm can cost $500 to $600 per syringe, a figure that is typical throughout the United States.
Dr. Yoelin adds that patients often desire subtle improvements. "Sometimes when they get a subtle improvement," he cautions, "they're not as satisfied as they could be if they were to get complete correction."
Complete correction study
To illustrate the benefits of complete correction, Dr. Yoelin treated 14 of his patients (12 female, two male; mean age, 47 years) who had moderate-to-severe nasolabial folds with a syringe of either Juvéderm Ultra or Ultra Plus at three separate visits. He also photographically recorded patients' baseline appearances and improvements after each treatment.
Subjects he excluded were mainly those who had received nonpermanent filler injections into the nasolabial fold area within six months prior to the study and those with prior cosmetic procedures or visible scars that could have affected evaluation of responses and/or the quality of digital photography.
Dr. Yoelin assigned patients to receive either Juvéderm Ultra or Ultra Plus based on skin thickness and the severity of their nasolabial folds. At each visit, he used either a 30-gauge needle (for Juvéderm Ultra) or a 27-gauge needle (for Ultra Plus) to slowly inject the contents of one syringe into the mid-dermis in the nasolabial fold area. After each treatment, he massaged the injection area to ensure smooth, consistent distribution.
He photographed subjects at rest and smiling during each of three visits, which were spaced 10 to 14 days apart (the first visit incorporating an evaluation and the first injection), then again around two weeks after patients received their final treatments. At each visit, Dr. Yoelin used a validated photographic guide and a five-point Wrinkle Assessment Scale (where 0 = none and 4 = extreme). At the final visit, he also asked subjects, all of whom had Fitzpatrick skin types I through III, to evaluate their satisfaction or dissatisfaction with their treatment.
Results and patient satisfaction
Regarding effectiveness, all nasolabial folds showed at least a 1-point (clinically significant) improvement in severity score from baseline after syringe two, and a 1.5- to 2-point improvement from baseline after syringe three, Dr. Yoelin says. Patients reported no serious or unanticipated adverse effects with either filler, he adds, and of 13 who completed the post-treatment questionnaire, all said they were very satisfied with the results. Specifically, Dr. Yoelin says subject satisfaction scores averaged 9 on an 11-point scale.
With photography, he says, "It's nice to see step-by-step how patients change with each additional syringe of product."
And based on informal evaluations of many study patients who have subsequently returned for other cosmetic treatments, Dr. Yoelin says their nasolabial fold corrections have endured at least three months after treatment, which one would expect.
The study itself was fairly easy to conduct because he scheduled all patients in block fashion on Saturdays, he says.