A wrinkle in time: Growing list of filler options allows flexibility


As applications for botulinum toxin treatments, fillers, lasers and light sources expand, an expert cautions against overly aggressive treatment.

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Philadelphia - The newest wrinkles in dermasurgery include expanded uses for fillers, lasers and light sources, while a plethora of botulinum toxin options waits in the wings of the U.S. marketplace, an expert says.

"What's really new is our name," says Anthony V. Benedetto, D.O., F.A.C.P., clinical associate professor of dermatology at the University of Pennsylvania. In the United States, he says, the terms "dermasurgeon" and "dermasurgery" appear to have taken hold.

Meanwhile, the list of fillers approved by the Food and Drug Administration (FDA) has grown to include collagen, Radiesse (calcium hydroxylapatite, BioForm Medical), Sculptra (poly-L-lactic acid, Sanofi-Aventis), various hyaluronic acid (HA) formulations and more. Filler indications and uses likewise have evolved, Dr. Benedetto says.

The burgeoning list of filler options allows dermasurgeons flexibility in establishing their favorites for a given area or application.

For example, Dr. Benedetto says that in the glabellar area, "My order of choice is collagen, HA and then Radiesse.

"But in the periocular area - the malar, brow and temporal areas - I pick up Radiesse first, then HA and poly-L-lactic acid."

Factors that make Radiesse his first choice for the periocular area include the product's texture, durability, ease of use - which allows placement in many different facial areas - and inability to react with surrounding tissues or migrate to undesired areas, he says.

"And yet, it lasts up to a year or year and a half, then it slowly disappears," Dr. Benedetto tells Dermatology Times.

Its duration strikes a "happy medium. It doesn't disappear right away, so patients aren't disappointed, as they might be if they spend $600 to $1,200 on a product that disappears in four to six months," he says.

As for lasers and light sources, Dr. Benedetto says treatment goals include correcting textural irregularities, improving dyspigmentation, tightening skin laxity and reducing the risk of skin cancer.

Laser and light sources

"The newest and hottest topics here include the fractionated CO2 laser and intense pulsed light (IPL) treatments," he says.

ActiveFX (fractional CO2 laser resurfacing, Lumenis) has reintroduced a very effective resurfacing procedure, without the prolonged postoperative morbidity of previous laser resurfacing, he says.

IPL is well-suited for eliminating unwanted pigmentation and blood vessels, Dr. Benedetto says.

Additionally, because it can be used in conjunction with aminolevulinic acid (ALA) for photodynamic therapy (PDT), he says, "Not only can you rejuvenate patients by eliminating sun-induced pigmentation and vascularity of the skin and tightening the skin a bit, but if patients have intense sun damage - with solar elastoses, actinic keratoses and early dysplasia of skin cancers - you can also treat them a little more deeply and effectively."

PDT is also very effective in treating acne, he says.

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