New fillers offer targeted approach

Elizabeth K. Hale, MD: ‘You have to find the option that best suits your patient's needs and recognize that not all fillers are the same.'

Elizabeth K. Hale, MD: ‘You have to find the option that best suits your patient’s needs and recognize that not all fillers are the same.’

Dermatologists have an arsenal of fillers at their disposal. With more products coming on the market, dermatologists have been left trying to stay up to date. Annual Meeting attendees gained a better understanding of the individual characteristics and ideal uses for several fillers during the Friday afternoon Hot Topics presentation, “Aesthetics: Fillers and Toxins,” directed by Elizabeth K. Hale, MD.

“There continue to be many different injectable options for our patients, and each filler has specific strengths and indications. Clinicians need to familiarize themselves with all of the therapeutic options because some have benefits over others,” said Dr. Hale, clinical associate professor of dermatology at New York University Langone Medical Center and co-director of CompleteSkinMD, New York.

She pointed to fillers intended for the deep dermis and subcutaneous tissue. If injected superficially, they can cause problems. Likewise, some fillers for more superficial lines have little efficacy if they are placed too deeply.

Physicians also must consider the patient perspective.

“Some fillers have immediate onset. Some work on the principle of new collagen formation, so they bring delayed gratification,” Dr. Hale said. “You have to find the option that best suits your patient’s needs and recognize that not all fillers are the same.”

An overwhelming majority of regularly used fillers are hyaluronic acid fillers. Generally speaking, hyaluronic acid fillers work to fill in hollows, wrinkles, or folds, whereby other products, like poly-L-lactic acid and calcium hydroxylapatite, work to promote new collagen formation.

She described how dermatologists used to see patients who would point to their nasolabial folds and marionette lines and say, “I just want this filled.”

“We’ve realized that the reason people get those lines is because as we age, we lose volume in our faces,” Dr. Hale said. “The face sort of deflates. Combined with gravity, that leads to accentuated wrinkles and folds.

“We’ve moved away from just filling wrinkles and lines. We actually optimize results for patients by choosing products that add volume. That’s a more aesthetically pleasing way to rejuvenate the face and to address biologically what’s happening as we age.”

Dr. Hale also noted that dermatologists are going beyond the front view of a person’s face to take in the side view, which will often reveal unevenness in facial contours.

“As we age and lose volume, everything gets a little more concave in certain areas. That leads to a less smooth appearance from the side. Placing fillers along the mandible can dramatically rejuvenate the area. It’s not just plumping up one wrinkle or line, but re-creating a smoother contour from a side view and along the jaw line,” she said.

With regard to toxins, Dr. Hale noted that a new topical botulinum toxin that has yet to receive FDA approval may offer an option for patients who are apprehensive of injections to soften their wrinkles or who want a more diffuse effect for the treatment of hyperhidrosis.

For Dr. Hale, some patients will benefit from combination treatment.

“I might use a collagen stimulator to replace lost volume either along the mandible or in the cheek, but those same products would not be indicated in the lips or under the eyes. Those are thin-skinned areas where you wouldn’t want to use a bulky filler,” she said. “Dermatologists should be familiar with all of our treatment options to know which you’re going to reach for when you’re treating an individual problem or when you’re doing more global facial rejuvenation.”

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