The ongoing evolution of neuromodulators and fillers

Today’s informative session “Comprehensive Approach to Neuromodulators and Fillers in 2018” (C001) features 10 experts who will address the various aspects that make up this complex therapy. Dermatology World Meeting News spoke with session director Neil S. Sadick, MD, in advance to get a sneak peek. The course will take place today in Columbus KL from 1 to 4 p.m.

Dr. Sadick: “It’s not about changing your face and looking like a celebrity; it’s about bringing out the most natural ‘you’.”

What is the comprehensive approach to neuromodulators and fillers?
Dr. Sadick: Treating patients with fillers and neurotoxins has two goals: to slow down the aging process and reverse signs of aging, and to improve whole body aesthetics in a personalized, customizable manner. It is a 360-degree approach, which takes into account a patient’s specific desires and their individual anatomy in order to volumetrically and structurally rejuvenate the face.

What are the different types of toxins and fillers?
Dr. Sadick: Commonly used neurotoxins and fillers are: Botox®, Dysport®, hyaluronic acid (HA), such as Juvéderm Voluma®, Restylane®, and Belotero®, poly-L-lactic acid (PLLA), such as Sculptra®, calcium hydroxylapatite (CaHa), such as Radiesse®, and polymethylmethacrylate (PMMA), such as Bellafill®. Neuromodulators are usually injected prior to fillers to reduce muscle movement and increase the filler longevity. Viscous fillers like Voluma, Radiesse, and Sculptra are used to replete fat pads that have undergone age-related atrophy. Thin fillers like Restylane Silk are used in the lips or tear troughs, or to provide customized contouring according to the patient’s goals.

Why is this approach important to the field of dermatology and does it change regularly?
Dr. Sadick: There recently has been a paradigm shift to this approach, which is now adopted and integrated in clinician practices at a global level, leaving behind a deprecated methodology that involved just “filling” wrinkles rather than rebuilding the facial structural foundation. We anticipate small improvements in the technicalities of this approach as more anatomical studies become available and the tissue/filler interaction is further elucidated, but overall the overarching philosophy is here to stay.

What are some of the new features of the approach in 2018?
Dr. Sadick: In 2018, we are seeing an increasing trend in treating the male face with fillers, as well as using new-generation volumetric fillers in off-face applications. There is an increase in clinical studies regarding both of these areas that entails carefully assessing the anatomical, physiological, and psychoemotional differences between the genders to adapt the approach to their specific needs.

What is the overall purpose or objective of treatment using neuromodulators and fillers?
Dr. Sadick: Injectables such as fillers and neuromodulators are powerful tools to prevent and correct aging signs. It’s not about changing your face and looking like a celebrity; it’s about bringing out the most natural “you,” and that is what we need to communicate with our patients. Each year, the amount and severity of aging signs tends to increase, which leads to more complexity in treatment planning and more expenses. By starting early and controlling the worsening signs of aging — which means avoiding problems that go from mild, to moderate, to severe — there will be a reduction in the speed of aging, as well as exponential aging, which occurs around menopause for women.


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