DERMAL FILLERS in VS .NET

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CHAPTER 23 DERMAL FILLERS
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Fillers on the Horizon
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As noninvasive cosmetic interventions have become more prominent, the manufacturing market has responded by developing newer products In fact, there are so many products to consider, it has become ever more challenging for regulatory organizations, physicians, and patients to discern their differences While some clinicians opt to jump on the bandwagon and use novel filling agents by interpreting newer as better, others await satisfactory clinical evidence before integrating these fillers into their practices It is crucial to appreciate the fact that the products once proclaimed innovative have either stood the test of time, with manufacturers reaping the rewards, or they have been superseded This section provides an overview of the up and coming soft tissue augmentation devices EVOLENCE Overview Evolence (Colbar LifeScience Ltd, Herzliya, Israel) is cross-linked porcine-derived collagen (30 mg/mL concentration) Because of the greater
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cross-linked HA products Since Laresse is not cross-linked, it is smoother to inject than HA fillers and imparts a soft contour to the dermis Benefits Skin testing is not required with this product The components have been used in numerous injectable therapeutics and medical devices and are known to be immunologically inert Laresse is easily injected and is reported to produce less pain on injection than other fillers The product is particularly smooth and natural feeling in the skin and it has been used in nasolabial folds and other superficial wrinkles Because of its ability to stabilize and compact in higher concentrations without a need for cross-linking, it is hypothesized that Laresse will have longer durability than HA fillers69 However, no studies have been published in the US to support these claims Drawbacks Although studies have shown that Laresse lasts 6 months in some patients, limited clinical studies have been performed so its duration will become evident as it becomes available in the marketplace The extent of its potential applications in facial augmentation is unclear as the product has been used clinically only since 2007 and its use in the hands of practitioners is still being evaluated Laresse does not contain lidocaine and, therefore, preprocedure anesthesia is usually topical or a nerve block, similar to HA fillers Side effects are analogous to the HA fillers and consist mainly of transient swelling, bruising, and redness Other adverse events are yet to be revealed as Laresse is being investigated by the FDA AQUAMID Overview A novel permanent filler, Aquamid (Ferrosan A/S-Contura International SA, Cophenhagen, Denmark) has been approved and used in Europe, South America, and the Middle East for the past few years33 Aquamid is composed of 975% pyrogenic water linked to 25% cross-linked polyacrylamide polymer When it is introduced into skin tissue, acrylamide stimulates fibrotic and localized foreign-body reactions The gel is packaged in a 1-mL syringe and stored at room temperature It is injected through a 27-gauge needle using a threading technique without overcorrection Bene ts The material is inert, obviating prior sensitivity testing Aquamid is biocompatible and nonabsorbable, which
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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FIGURE 23-13 Patient with prolonged facial swelling one month after Aquamid injections
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yields an inert and durable device that can last indefinitely Aquamid has shown efficacy in lip augmentation, correction of nasolabial folds, depressed mouth commissures, as well as glabellar and perioral rhytides33 Drawbacks Lacking lidocaine content, Aquamid requires local or regional anesthesia prior to the procedure
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Although postimplantation side effects are similar to those of HA fillers (eg, temporary erythema, edema, redness), rare long-term and more severe adverse effects are more prominent with Aquamid The primary author has seen several patients treated in South America with prolonged swelling and edema (Fig 23-13) The exact duration of Aquamid in the skin is still unclear,
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TABLE 23-6 The A, B, C, D Approach to Choosing the Appropriate Filler A Assess the patient a Which areas show aging or asymmetry b Which areas can be easily corrected c Imagine how the patient will look if various areas are corrected d Determine the best areas of injection and proceed to next step B Budget a Determine the patient s nancial budget b Determine the patient s time budget c Re ne plan in your mind about which areas are most important to treat C Considerations a Learn more about the patient b What bothers the patient most c Ask about prior experience with llers d Are there any religious restrictions e Can the patient return for future treatments f Does the patient have an event coming up g Is the patient on anticoagulants h Are there any concerns about outcome i Are there any product promotions going on D Device a Assess pros and cons of available llers b Match attributes of llers to what was learned in steps A, B, and C c Choose the appropriate device d Discuss the plan with the patient
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with most recent studies demonstrating about 2-year durability70 Rare hematomas, lumps, granulomas, and indurations do occur with the use of Aquamid33 Use of this filler should be discouraged until more safety data are gathered
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