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Surgeon notes importance of treatment plan for fillers


While permanence may have yet come to fruition among plastic surgeons, they are recognizing that fillers and other non-surgical modalities are now an important part of their practices.

Philadelphia - With a large audience looking on, four patients approached a stage set for one purpose - the injection of today's most prominent fillers. The goal of the demonstration was multi-faceted, as plastic surgeons assessed the technology that is dominating their practices now and will certainly dictate dermatology's future.

Speaking here at the American Society of Plastic Surgeons (ASPS) meeting, Jeffrey M. Kenkel, M.D., updated the audience on issues that surround fillers and injectables through a live presentation. While topics ranged from the most recent Food and Drug Administration (FDA) approvals to which fillers actually offer the most longevity, the primary focus remained visual and technique-driven.

Teaching technique

"For example, you can inject Hylaform (Inamed) in the mid-dermis and have a very low complication and reactivity rate," says Dr. Kenkel, director of the Clinical Center for Cosmetic Laser Treatment at University of Texas Southwestern Medical Center, Dallas. "Whereas, Sculptra (Dermik) and Radiance (BioForm) are more deep dermal/subcutaneous fillers - if you start putting these in the dermis than you may see some problems that we've read about, such as granulomas. Each of the fillers is somewhat different, and in terms of ease of injection, I think Hylaform is probably the easiest. But each of them has their merit."

In order to fully understand the value of each injectable and filler, the most important notes a surgeon should take are from a facial analysis, according to Dr. Kenkel. Each patient is unique and different, and the surgeon should try to create a treatment plan that is specific for that patient.

"My approach might be why I've not seen complications (from the use of fillers)," Dr. Kenkel says. "I'm fine seeing patients back in two weeks to reassess their needs. If they need more filler, then I will give it to them then. It also comes down to putting the filler in the right place - avoiding the superficial injection and understanding more about the product-specific injection techniques."

Today's trend

Perhaps the most appreciated filler in today's arsenal is Sculptra, due to the impact it's making for those suffering from HIV lipoatrophy.

Approved by the FDA in August 2004 for the treatment of lipoatrophy, Sculptra is currently a topic of investigation in a clinical trial being completed by Dr. Kenkel.

"We're really excited about what we've seen," Dr. Kenkel says. "While it requires at least two separate injections in the nasolabial fold, about four weeks apart, there is a nice collagen deposition, and we're seeing some improvement with minimal side effects."

Most recently, the FDA approved Hylaform Plus (Hylan-B gel), a large particle-size hyaluronic acid-based dermal filler that is indicated for the correction of moderate-to-severe facial wrinkles and folds. Although the list of fillers and their counterparts may be lengthening, they are temporary in effect - yet permanent fillers are fast approaching.

"There are ongoing studies with Artecoll, but I'm a little more apprehensive about using a permanent filler," Dr. Kenkel says. "I think this is something that we're going to have to gain more experience with before using it on our patients."

While permanence may have yet to come to fruition among plastic surgeons, they are recognizing that fillers and other non-surgical modalities are now an important part of their practices.

"There is a rapidly growing number of patients who are interested in non-surgical approaches, so we have to gain this experience and incorporate these methods in our practices," Dr. Kenkel says.

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