Reference

AMET works diligently to keep the following information updated with the most current medical aesthetic news.  This information has been supplied by numerous sources. AMET is not affiliated with any such sources, and the information provided does not reflect the views of AMET.  The function of this page is to simply provide information, and AMET does not accept responsibility or liability for any views/claims/rumors/errors that appears herein.  

6/30/2010
Variety of dermal filler options helps meet specific skincare needs
With a variety of dermal fillers now available to dermatologists, it may be difficult to choose the right one. When a patient comes in, it is best to discuss what changes he or she is trying to achieve, says Ruth Tedaldi, M.D., who practices in Wellesley, Mass.
Variety of dermal filler options helps meet specific skincare needs

Assess scope of treatment before selecting specific product
Explain to patients that process of injectable fillers is a marathon to full correction, not a sprint
Wellesley, Mass. With a variety of dermal fillers now available to dermatologists, it may be difficult to choose the right one. When a patient comes in, it is best to discuss what changes he or she is trying to achieve, says Ruth Tedaldi, M.D., who practices in Wellesley, Mass.

Patients' concerns vary. For example, some patients don't mind fine lines, while others are bothered by areas of depression, concavities and convexities that cause a more undulated appearance. Some patients are simply concerned about superficial sun damage.

"It is helpful to look with the patient in the mirror and ask, 'What is it that bothers you?'" Dr. Tedaldi says. "It is important to make sure your aesthetic sense is synergistic and compatible with the patient's."


State of the skin

Next, Dr. Tedaldi says she takes a close look at the patient's overall skincare. "Regardless of how much volume replacement I am going to do whether it is fine lines, course lines, or actual true volume replacement if they are not really great at taking care of their skin, they are not going to be happy," she says.


A female patient is shown before (top) and three weeks after treatment of oral commissures and mental crease with one syringe of Juvderm Ultra XC. (Photos: Ruth Tedaldi, M.D.)

Dr. Tedaldi addresses skincare issues, such as pigmentation, telangiectasia and exfoliation issues, with all of her patients. "I discuss sun protection, and the use of antioxidants as well as retinols as a way of really trying to rejuvenate the skin," Dr. Tedaldi says.

Filler options

With clear goals in mind, it is time to determine the scope of the treatment necessary before selecting a specific product. Is there an issue of global volume replacement or a more site-specific treatment, such as creases around the mouth? For example, if a patient feels that his or her jowls have fallen around the neck, global volume replacement might be in order.

"Often in a much younger patient, we are just trying to address a few fine lines, perhaps around the mouth or wherever that may be. Often the choice of which filler to use depends on your aesthetic goals," Dr. Tedaldi says.

For a global approach, fat and poly-L-lactic acid can be used to restore the dimensions that were present in a more youthful time.





"Because this does not happen with a vial or two of hyaluronic acid, the biostimulatory fillers like Sculptra (injectable poly-L-lactic acid, Sanofi-Aventis) are very helpful in restoring the more youthful dimension ratios of the face," Dr. Tedaldi says. "Because I don't do fat transfers, I would use poly-L-lactic acid," she says.

Dr. Tedaldi notes that Sculptra is a mainstay in her practice. It had some associated unfortunate events, she says, that were due to its early off-label use, as well as some recent issues with holds on shipping and delivery because some physicians experienced clogging of their needles.

"Now that there are new dilutions and new intervals of treatment and a new technique with guidelines on where to place it, there are far fewer episodes of any untoward events," she says. "The common side effect of subcutaneous papules and nodules (most of them nonvisible but palpable) is pretty much history, in good hands."

Many dermatologists use a variety of dermal fillers. "In my office, we use a lot of hyaluronic acid (Juvderm cross-linked hyaluronic acid, Allergan) and Restylane (hyaluronic acid, Medicis). I especially like Juvderm Ultra, because of the way it feels and because of the control I have during injection," Dr. Tedaldi says, adding that Juvderm XC, which includes the local anesthetic lidocaine, has simplified the treatments.

"With a little bit of ice, a lot of talking and touching and the Juvderm XC, my patients are very happy without any anesthesia," she says.

Radiesse (calcium hydroxylapatite, BioForm Medical) is also available.


"For me, the choice of fillers boils down to how easily I feel I can reconstruct the face and achieve the result both the patient and I desire with the least amount of distortion, the fewest side effects, and the safest outcome," Dr. Tedaldi says. "I prefer using a product where I feel in total control, and for me that product for immediate results is Juvderm Ultra XC, and for a more long-term effect, combining Sculptra with Juvderm Ultra is my mainstay."

Some dermatologists prefer the more heavily cross-linked products, such as Perlane (cross-linked hyaluronic acid, Medicis) and Juvderm Ultra Plus.

"They are thought to have a slightly greater longevity in the face (12 to 15 months), but the Ultra remains my preferred product," Dr. Tedaldi says. "I still use the others, but with Juvderm Ultra, I may not get quite the 15 months, but I am definitely getting 9 to 12 months, and I feel very comfortable with it," she says.

Reversible option

For many patients, the fact that there is a readily available antidote to hyaluronic acid filler makes it favorable.

"If the patient comes back and there is a problem, you can treat the problem with a small injection of hyaluronidase, and this is not true for the other fillers," Dr. Tedaldi says. "This makes injection of hyaluronic acid a very low-risk procedure."

Finally, Dr. Tedaldi explains to her patients that this process of injectable fillers is a marathon to full correction, not a sprint.

"I let them know it is very common for the patient to return every couple of months as I layer product until I achieve the desired result. I don't like abrupt change, and I like to keep an eye on the process and make sure every step is flattering until the result has evolved," Dr. Tedaldi says.

Disclosures: Dr. Tedaldi is faculty injector trainer for Allergan, Sanofi-Aventis and Medicis, and is on the editorial board of Shape Magazine.

http://www.modernmedicine.com/modernmedicine/artic...

back to reference main