While the nation’s economy has deflated over the past few years and continues to stagger without any obvious improvement, certain types of cosmetic treatments has not. To no surprise, cosmetic surgery may be down but less costly in-office procedures have increased as a result. (or maybe as a substitute for some) The array of injectable fillers has changed since the first introduction of the new hyaluronic-acid based filler in 2002. (Restylane) The following is some of the highlights and trends of the past few years in this area.
The number of commercially-available injectable fillers remains in a near constant state of flux. Evolence, a pig-derived collagen based filler, was unexpectedly and without explanation withdrawn from the market in late 2009. At the end of this year some old familiar fillers will be retired. This include the bovine and human-derived fillers of Zyderm, Zyplast, CosmoDerm and Cosmoplast. Zyderm and Zyplast were the original injectable fillers introduced way back in 1981 and shouldered the market alone until 2002. Their animal derivation, short duration of persistence by today’s standards, and a higher incidence of allergic reaction will relegate them shortly to of historical significance only.
One of the more recent innovations to injectable fillers has been improvements in pain management. There is no way around the fact that sticking a needle into someone’s face is not the same as a spa experience. To make injectable treatments more tolerable, the use of nerve blocks was often necessary. The fear of pain keeps some patients from coming back for more treatments or even touchups. The addition of the local anesthetic, lidocaine, into injectable fillers helps make for greater comfort during treatment. Increasing number of fillers now contain them including Juvederm XC, Restylane-L, Perlane-L and Radiesse. These products differ from their predecessors only in the addition of lidocaine as part of their formulations. While very helpful, it is still necessary to get the needle past the skin first to get the lidocaine under the skin. So to call them completely pain-free is not completely accurate.
In conjunction with these new filler combinations, new innovations in needle designs and injection techniques are being introduced. Changing from the sharp bevel of a fine needle to that ofa micro-cannula (blunt-tipped), less pain , bruising and tissue injury can occur from an injectable treatment. Products such as DermaSculpt and Pix’Lpromise to make filler procedures easier and more precise. These injection tips with lidocaine-containing fillers will revolutionize the whole concept of facial fillers.
While some injectable fillers have been subtracted from the market, new ones are lining up to take their place. They usual course is that they have been in Europe first and then make their way to the U.S. The concept is to expand an existing product line to fill specific needs for areas in which one type of formulation is not ideal. For example, what one would use to add volume to the back of the hands should not be exactly the same as filling fine line and wrinkles on the face. Juvederm Hydrate, Juvederm Voluma, Restylane Vital and Restylane SubQ are examples are what will be coming in the near future.
The missing piece in injectable fillers is one that can consistently last a much longer time than any of the existing hyaluronic-acid based fillers. One such potential filler is Aquamid which is currently under FDA evaluation. Composed of hydrogel particles which integrates into the skin and does not dissolve over time, its potential for longer lasting effects is promising. Whether such prolongation of volume persistence is associated with any increased tissue reactions remains to be seen.
More advancements and innovations have taken place in injectable fillers in the past five years than in the twenty years preceding it. Plastic surgeons and patients alike anxiously await what the next five years will bring as injectable fillers become more reliable and easier for patients to receive their cosmetic benefits.
Dr. Barry Eppley
Indianapolis, Indiana