Fort Worth, Texas — The proliferation of new fillers creates both opportunity and risk for cosmetic dermatologists. Paul M. Friedman, M.D., clinical assistant professor at the University of Texas Medical School, Houston, says knowledge and technical expertise are vital for using the fillers to both the dermatologist's and the patient's benefit.
Speaking at the Texas Dermatological Society's Fall CME Meeting, Dr. Friedman said the key to obtaining good results with dermal fillers lies in choosing safe and appropriate agents and using proper technique.
"There are a lot of agents out there, and the key is probably to pick one or two fillers that you are comfortable with. Rather than trying to become an expert on every substance, focus on a few fillers and master them," he says.
The field of fillers includes bovine and human collagen, synthetic semi-permanent and permanent fillers, fat and cadaver-based products.
Dr. Friedman says the new biologic hyaluronic acids offer some advantages that make them extremely attractive in his view.
"The No. 1 thing I think patients are looking for is not only safety, but longevity," he says. "One of the nice things about some of the new hyaluronic acid fillers is that they have a longer efficacy than collagen."
Their advantage over the permanent fillers is that the face changes over the years and permanent fillers don't change with the patient's appearance. The longer lasting non-permanent fillers can be adjusted to provide the best results as an aging face changes.
Learn techniques In addition to the choice of filler, Dr. Friedman says techniques for injecting fillers are of utmost importance. Those techniques need to be learned, but then also practiced to achieve the best result.
"The American Society for Dermatologic Surgery (ASDS) offers dermal fillers workshops, and I recently had the opportunity to lecture along with several outstanding faculty members. The fillers course we recently conducted here in Houston used live patient demonstrations, and I think a lot of the meetings are moving toward live demonstrations and videos with more of a hands-on teaching," he says.
The changing longevity of the filler products is one reason technique is so important. Dr. Friedman explains that if Restylane is injected too deeply into the wrinkle, the results won't last as long.
Choose proper filler "Hyaluronic acid products are injected differently from collagen," he says. "With less viscous collagen products, it was recommended that physicians over-correct. But with the hyaluronic acid products, the level of placement is critical because if the doctor places the product too deeply, it will be absorbed more quickly, and if the injection is too superficial, the patient can get beading in the skin."
The variety of hyaluronic acids now available makes it easier to customize the treatment of the patient's face, according to Dr. Friedman. Different fillers are definitely better for different tasks, and can be used in combination or layered to yield good results.
"Cosmoderm works very nicely for the vertical lip lines - smoker lines, so to speak.