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With a variety of dermal fillers now available to dermatologists, it may be difficult to choose the right one. When a patient comes it, it is best to discuss what changes he or she is trying to achieve, says Ruth Tedaldi, M.D., who practices in Wellesley, Mass.
Wellesley, Mass. - With a variety of dermal fillers now available to dermatologists, it may be difficult to choose the right one. When a patient comes in, it is best to discuss what changes he or she is trying to achieve, says Ruth Tedaldi, M.D., who practices in Wellesley, Mass.
Patients' concerns vary. For example, some patients don't mind fine lines, while others are bothered by areas of depression, concavities and convexities that cause a more undulated appearance. Some patients are simply concerned about superficial sun damage.
"It is helpful to look with the patient in the mirror and ask, 'What is it that bothers you?'" Dr. Tedaldi says. "It is important to make sure your aesthetic sense is synergistic and compatible with the patient's."
Next, Dr. Tedaldi says she takes a close look at the patient's overall skincare. "Regardless of how much volume replacement I am going to do - whether it is fine lines, course lines, or actual true volume replacement - if they are not really great at taking care of their skin, they are not going to be happy," she says.
With clear goals in mind, it is time to determine the scope of the treatment necessary before selecting a specific product. Is there an issue of global volume replacement or a more site-specific treatment, such as creases around the mouth? For example, if a patient feels that his or her jowls have fallen around the neck, global volume replacement might be in order.
"Often in a much younger patient, we are just trying to address a few fine lines, perhaps around the mouth or wherever that may be. Often the choice of which filler to use depends on your aesthetic goals," Dr. Tedaldi says.
For a global approach, fat and poly-L-lactic acid can be used to restore the dimensions that were present in a more youthful time.
Dr. Tedaldi notes that Sculptra is a mainstay in her practice. It had some associated unfortunate events, she says, that were due to its early off-label use, as well as some recent issues with holds on shipping and delivery because some physicians experienced clogging of their needles.
"Now that there are new dilutions and new intervals of treatment and a new technique with guidelines on where to place it, there are far fewer episodes of any untoward events," she says. "The common side effect of subcutaneous papules and nodules (most of them nonvisible but palpable) is pretty much history, in good hands."