The fillers are coming … The fillers are coming. This was the main takeaway message from a recent presentation at the American Academy of Dermatology’s annual summer meeting in Chicago.
Due to a number of high-profile corporate acquisitions, a slew of new fillers might be more likely to make their way to the US.
For example, while one form of the [Hyaluronic acid (HA)-based filler] Belotero is available in the US, two others are available in other countries, and because of a recent deal with Merz Aesthetics, there might be a push for approval here, said Hassan Galadari, MD, assistant professor of medicine at United Arab Emirates University in Dubai.
“The form of Belotero in the US is very soft, and is used mainly for superficial lines, but is also used very safely for injection near the tear troughs without risk of a Tyndall effect. The two forms used outside the US are thicker; one is for volumization, and the other for moderate to severe folds,” Galadari said.
In addition, Ellanse Composition is available in 75 countries, but not the US. The filler is made up of 30% polycaprolactone particles, which are microspheres that act as a scaffold. “The product is purely synthetic, and the body just starts laying down collagen,” Galadari said. AQTIS Medical™ recently acquired Ellanse parent company Sinclair IS Pharma Plc.
Then there is the Teosyal line of fillers, which have been available, overseas for 10 years. Lifestyle healthcare company ALPHAEON acquired the exclusive US license to market the Swiss Teoxane Laboratories’ portfolio of dermal fillers, including the TEOSYAL line. “They make eight different types of fillers which you can inject in different parts of the face, such as the tear troughs, and one called Kiss for the lips. But if you inject them somewhere else, they might be too lumpy or too thick,” he said.
There are also a host of new fillers that have been approved by the US Food and Drug Administration of late.
“I think the most ground-breaking change was the approval of Juvéderm Voluma, which came out last year. You also had Belotero in 2011, and Restylane Silk was approved just a few months ago, which is the only first-generation particulate filler available.” —Hassan Galadari, MD
“I think the most ground-breaking change was the approval of Juvéderm Voluma, which came out last year. You also had Belotero in 2011, and Restylane Silk was approved just a few months ago, which is the only first-generation particulate filler available,” Galadari said. “In the past, you needed either Sculptra or Radiesse to get big volume in the cheeks, but some doctors were averse to using them, because we don’t have an eraser, so you’re stuck for a year-and-a-half to two years, whereas all the new HA fillers dissolve just by injecting a special kind of enzyme,” Galadari added.
The nonpermanence of HA fillers also offers a great advantage, Galadari said. “Because it only lasts for up to 2 years, it’s great for those patients who want implants but don’t want to have the procedure performed [without seeing] how it looks first.”
Physicians who are getting acquainted with the new products need to make sure they are using the correct level, he added. “If the material you’re injecting has a very low G prime or lifting capability, and you inject it very deeply, you’re not going to get the result you want, so soft products should be injected superficially, and the reverse is also true,” Galadari explained.
“Particulate fillers, like Restylane Silk, are firmer and are good for the nasolabial folds. The vermillion border of the lips is a also a good injection site for particulate filler, because it provides the lip with a very nice shape, but not so good for use inside the lip, where it feels and looks unnatural,” he added.
John Otrompke is a contributing writer for Plastic Surgery Practice. He is based in Chicago.