Banishing Wrinkles With Fillers
As "Soft-Tissue" Fillers Rise in Popularity, Doctors Fine-Tune the Taming of Nose-To-Mouth Lines
By
Kathleen Doheny
WebMD Health News
Reviewed By
Louise Chang, MD
May 9, 2008 (San Diego) — Next to Botox, the most popular nonsurgical way
to freshen up your looks is with a so-called "soft tissue" filler,
often relied on to smooth the nose-to-mouth line called the nasolabial or nasal
labial fold.
As more of these fillers have become available and demand has soared,
physicians who inject them have learned more about how to use them effectively
to wipe away the years, say physicians speaking at the annual meeting of The
American Society for Aesthetic Plastic Surgery in San Diego.
Among the popular fillers are those with hyaluronic acid, such as Restylane,
Juvederm, Perlane, and Elevess; and those that are synthetic, such as Artefill,
Radiesse, and Sculptra. Typical costs are $500 and above per syringe, with more
definitive folds needing more filler.
The Goal: Don't Obliterate It
The goal of using the fillers should be not to "obliterate" the line
but to restore it to how it used to look, says H. Steve Byrd, MD, a Dallas
plastic surgeon and clinical professor of plastic surgery at the University of
Texas Southwestern Medical Center at Dallas. Byrd spoke on a panel about
effective management of the nasolabial fold.
"I like patients to bring in photos of themselves 10 or 20 years
ago," he says, and he uses the photographs as a guide.
Nasal Labial Crease vs. Nasolabial Fold
It's important to distinguish between a nasolabial crease versus a fold,
says Miles H. Graivier, MD, an Atlanta plastic surgeon who also spoke on the
topic.
When gravity sets in further, the crease can develop into a fold, where the
skin droops down over the crease, he says.
For moderate to less severe folds, one of the dermal fillers may be enough,
he says. But for deep folds, just injecting filler may not solve the problem,
he says.
For these, he uses an incision-less dissection device that includes a needle
and wire; when inserted, it releases the deep lines by separating them from the
underlying tissues. Then a filler can be injected more easily, if it's still
needed, says Graivier, who serves on the medical advisory panel for the
device's manufacturer.
Long-Term Filler Results
The filler calcium hydroxylapatite (Radiesse), already on the market,
performed well in a postmarketing study that included an average of 30 months
of follow up, according to Lawrence Bass, MD, a New York plastic surgeon
and clinical assistant professor of plastic surgery at NYU School of
Medicine.
Radiesse, approved in December 2006 by the Food and Drug Association, is one
of the synthetic dermal fillers. Bass oversaw the long-term follow-up study. He
has worked as a consultant for filler companies, including the maker of
Radiesse.
In the follow-up study, an independent panel of doctors evaluated how the
nasolabial folds treated with Radiesse looked long-term compared to a picture
taken before the injections. All participants got at least two injections, one
at the study start and one six months later. Some also had a touch-up injection
two weeks after the first one. At the three-year follow-up, one one-third of
the 89 women still enrolled at this point had improvement, Bass says.
The FDA originally approved labeling that Radiesse would typically last six
months, Bass says. "It's very clear it's longer than that."
During the longer-term study, Bass tells WebMD, no adverse events such as
infection or nodules forming were reported.
On the Horizon?
Yet another dermal filler, Glymatrix collagen, is under study. It's derived
from pig collagen, says Z. Paul Lorenc, MD, an aesthetic plastic surgeon in
Manhattan and assistant professor of surgery at the New York University School
of Medicine.
He was the principal investigator for a study comparing the new filler with
a hyaluronic acid filler. Participants got one side injected with the new
filler and the other with the hyaluronic acid filler.
Of the 145 participants evaluated 12 months after injections, 76% still had
improvement in the side injected with the Glymatrix collagen, Lorenc reported
at the meeting. They had less bleeding, bruising, and swelling on the Glymatrix
side than the other side. The participants said they could feel the Glymatrix
more than the other filler.
The brand name of the new filler, not yet FDA approved, is expected to be
Evolence, says Lorenc, who has worked as a consultant for the manufacturer of
the new filler and for other filler companies.
Although fillers can improve appearance, Bass says they're not effective
forever.
SOURCES: American Society for Aesthetic Plastic Surgery Annual Meeting, San Diego,
May 2-6, 2008. Lawrence Bass, MD, New York plastic surgeon and clinical assistant professor
of plastic surgery, NYU School of Medicine. H. Steve Byrd, MD, Dallas plastic surgeon and clinical professor of
plastic surgery, University of Texas Southwestern Medical Center, Dallas. Paul Lorenc, MD, aesthetic plastic surgeon, Manhattan; assistant professor
of surgery, New York University School of Medicine. Miles H. Graivier, MD, Atlanta plastic surgeon.
© 2008 WebMD Inc. All rights reserved.
Skin RSS