The recent commercial introduction of the injectable hyaluronic acid (HA) filler, Prevelle Silk, is the first one to have the numbing medication lidocaine in it. While some fillers in Europe already have it in their preparations, this is the first such filler here in the U.S. There will undoubtably be others in the near future given its potential patient appeal. Pre-approval clinical studies have shown that patients had less pain with injections using this product compared to HA injections without lidocaine.

The question is….what is the value of pain reliever that does not take effect until after it is injected? In my practice, I make a big point of making any injection procedure as painless as possible. When it comes to fillers, which are most commonly done in the lips and nasolabial folds, I usually perform an intraoral nerve block which takes away most of the injection pain and is well tolerated by all patients when skillfully done. A filler with a numbing agent would have great value if it prevented the pain of injection. However, this product concept doesn’t start working until after you have injected, a little late from the patient’s standpoint. I think it does have some utility if you inject an area very slowly, taking a break between the injection sites. This gives the local anesthetic time to take effect. I have tried this product a few times in lips which I have not previously numbed up. I must admit it was more tolerable with this ’slow’ technique than any other lip filler that I have used.

I like the concept of a numbing injectable filler but I still will not rely on its anesthetic effect exclusively. It is the needle stick that makes up at least half of the pain of injection and this still requires an external anesthetic method to have the most pain-free experience.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologymd.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Injectable fillers provide a simple and immediate cosmetic treatment that is particularly good for the areas of the nasolabial folds (cheek-lip grooves) and for lip enhancement. While there are many different name brands of injectable fillers, they basically do the same thing (plump up the skin) even though there are some differences in what they are made of. These basic differences in makeup (collagen vs. hyaluronic acid vs particulated), while not conferring any different filling properties, are different in more than just the name also.

 
In theory, what you are primarily paying for with an injectable filler treatment is for how long it lasts. The least expensive injectable fillers, such as old-style Zyderm and Zyplast (pig collagen) or more modern Prevelle (hyaluronic acid), last about 6 to 12 weeks or less than three months. The longer-lasting fillers, such as Radiesse (dissolvable ceramic beads) and ArteFill (non-dissolving plastic beads), are by far the most expensive but they do last anywhere from 12 to 18 months after a single injection session. The real question is then…..how much are you paying for what length of time. (no true permanent injectable fillers exist at this time) You want to be sure that the price somehow correlates to how persistent the result is.

 
That can be a difficult task for any patient to decipher. Many times what a practitioner may charge may not necessarily correlate with the product’s behavior. But the purchase price to the injector (which does differ for all injectable fillers) is the same throughout the country for all syringes sold. Therefore, you can ask to see a price list or ask the price (per syringe) for the types of injectable fillers that they offer. This makes it easy to do comparison shopping…although beware that price may not be indicative of the injector’s experience or expertise.

Here in the midwest, very short-term (3 - 4 months) injectable filler treatments (one cc or a full syringe) will cost around $300 - $400,  medium-lasting (6 to 8 months)injectable fillers around $550 - $650, and long-lasting (9 to 18 months) injectable fillers around $850 - $1250. While these are price estimates for just one geographic area in the country, they do reflect the relative relationship between injectable filler cost and duration of action.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana’
Clarian West Medical Center, Avon, Indiana’
Indianapolis

The number of commercially-available injectable fillers continues to expand. Most injectable fillers that are available today, and into the near future, are hyaluron or hyaluronic acid-based (HA) due to its human compatability and lack of any significant complications. HA is a sugar molecule well known to the human body being present in much of the body as an intercellular matrix material and in such as areas as the fluid in the eyeball. As a result, no skin test is needed prior to its injection and it goes away much slower than traditional collagen.

 
The Mentor Corporation has just released PREVELLE SILK for commerical use. This is a new line of hyaluronic acid dermal fillers and it contains 0.3% Lidocaine. It is very soft gel that flows in easily and is more comfortable due to its addition of the local anesthetic lidocaine. Due to its soft gel density, there is less likelihood that there will be ridging or lumping. Between its easy flow into the skin and the comfort factor of the lidocaine, there should be less of a chance of any bruising or swelling. Hence the marketing slogan….Today For Tonight….get injected in the afternoon and look completely normal for that evening.

 
When there are so many injectable fillers now available, the bottom line question for patients is……how long does it last and at what cost? There is where Prevelle Silk has a patient niche in my opinion. Based on the clinical studies and FDA submission data, Prevelle Silk will last about 3 to 4 months, probably comparable to Restylane but certainly less than JuvaDerm, Perlane, Radiesse or ArteFill. But the cost to the patient (in my practice) for a .75ml syringe is also less than all other injectable fillers at $425. (Juvaderm $550, Radiesse $850, ArteFill $1,250) This creates an injectable filler option at a very affordable price. So a woman can have her lips done with a smooth, minimally uncomfortable injectable filler at a very reasonable price. Like coffee, you can have Starbucks or Dunkin Donuts….or…..you get (in terms of longevity) what you pay for.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis