The Newest In Dermal Fillers

Dermal fillers remain one of the most known methods of non-surgical rejuvenation, due to its popularity and effects, many patients have preferred dermal fillers. However, not everything ends well because of the possible adverse effects of dermal fillers. Thus there have been studies to ensure the safety of administering inejctables.

A couple of studies.

Double Injection Technique

Novel techniques are developed and presented to ensure the delivery and safety of the filler. Injecting requires skill and precision, thus it is crucial to learn safer techniques in injecting dermal fillers especially in the danger zones. One dermatologist mentioned that during a demo, the subject had become blind also.

Intravascular injection is something that all providers avoid due to disastrous side effects it causes on patients, and due to this delivery of injection, there have been cases of blindness and providers must always practice care and precision in administering the injection. 

The technique was double injection, as presented by the researchers, Huang and Lin, which could help prevent intravascular injection. Their method aims to thwart the possibility of intravascular injection, basically there would be an inner and outer needle in performing the procedure. In the event of drawn blood, the inner needle would move the blood out.

The researchers do admit limitations to their method and there could be more research that may be done in order to use this method.

Regeneration is the new Rejuvenation?

Dermal fillers could also demonstrate its efficacy in regeneration. Only two studies have examined dermal filler use for regeneration, it seems likely that in the near future, physicians could use dermal fillers for soft tissue regeneration. There are two studies regarding tissue regeneration and filler or fat injection, which have regenerative properties.

Fallacara et al. (2017) suggest that Urea could be cross-linked with HA considering its properties. According to the researchers, this could be the future of dermal fillers, and that could treat cosmetic issues other than its usual common dermatological concerns (e.g. psoriasis, calluses)

Additionally, there is another alternative to filler for tissue regeneration, which was discussed in detail by Dr. Cohen through Medscape that fat was also helpful in rejuvenating and regenerating  the reason he used fat was it made for a more natural look and that it lasted longer as compared to using fillers. Additionally, it adds more volume.

CaHA with Ascorbic Acid?

The study examined the efficacy of CaHA with Ascorbic acid to treat stretch marks. The researchers tested it on 35 patients, and on areas where stretch marks commonly appear such as: thighs, knees, buttocks, abdomen, and breasts. 

Findings:

• 63% of patients in the study were satisfied with the treatment; while only 1 was unsatisfied.
• Most patients were more satisfied in areas like abdomen, buttocks, and breasts.

Dermal fillers would have more potential uses in the future, and that it could have other uses in the future. For now, dermal fillers remain as one of the most popular treatment for cosmetic concerns, leaning towards rejuvenation.

A list of cosmetic dermal fillers here.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426873/
https://www.researchgate.net/publication/315818101_Hyaluronic_Acid_Fillers_in_Soft_Tissue_Regeneration
https://journals.lww.com/prsgo/Fulltext/2017/09000/Calcium_Hydroxylapatite_Combined_with.17.aspx

Juvederm Ultra XC: Year-Long Lip Fillers

The US FDA has approved Allergan's JUVEDERM® ULTRA XC for the injection into the lips and perioral area for lip augmentation in adults over the age of 21.

Allergan's trials show that results last up to a year in the lips, but as always, there are two sides to the coin.

Since 2006, Juvederm formulations were already FDA approved for correction of moderation to severe facial wrinkles and folds such as parentheses lines around the nose and mouth. Then in 2013, the Juvederm XC for age-related mid-face volume loss was introduced.

Clinical trials for Juvederm revealed that 79% of subjects showed an improvement in lip fullness three months following the treatment. More than 78% of the subjects reported an improvement in their overall satisfaction with the smooth and natural look and feel of their lips at one year after treatment.

Executive Vice President & President, Allergan Medical Philippe Schaison said that:

As the leader in medical aesthetics, Allergan is committed to continued research and development in this area. Providing physicians and patients with premium products that allow them to achieve the aesthetic results they want is always our goal. Understanding that the desire with lip augmentation is to achieve a natural-looking and lasting result, we continued our research of JUVEDERM® ULTRA XC for the lips. With this approval, JUVEDERM®ULTRA XC is now the only filler that is approved to last up to one year in the lips while providing natural-looking results.

Juvederm Ultra XC contains a smooth gel formulation of modified form of hyaluronic acid (HA) and a small amount of lidocaine. The hyaluronic acid helps the skin to maintain its moisture and softness and the lidocaine acts as a local anesthetic to improve the comfort of the injection.

While the increase in the time between injections is going to be welcomed by patients, there are some physicians and clinics that might lose income since patients are not coming in as frequently. Additionally, these longer fillers might not be appropriate as a "first-time" filler for patients who are unsure if thy're going to love the effect. There's a big psychological difference between living with a change for a few months and an entire year. Still, the general increase in lenght is a good thing for clincs and patients who are familiar with the effects.

Painless Neurotoxin Injection Method? Join the Discussion!

What injection methods are most useful and reliable for neurotoxin injections: Botox & Dysport.

I have been in clinical private practice going on 14 years now and enjoy a busy and healthy cosmetic surgery practice.  Injectables, both fillers and neurotoxins, remain an integral part of my practice and I suppose that the loyalty my patients show by continuing to return to me as their injection provider is testament that my skills must be competitive with the many other local physicians who offer the same procedures.  I definitely do not price cut to keep the volume or attract new patients, and I believe I price fairly taking into consideration both my training and experience with typical pricing in my area by "mainstream" cosmetic providers.

I continue to strive to offer the least painful experience for my patients and have tried multiple different methods to decrease the degree of injection discomfort for my patients.  From topical anesthetics, icing, slow injection delivery, and currently vibration-distraction techniques, I have yet to find the WOW approach. I do use lidocaine-treated fillers and believe that these have advanced our patients' injection experience to an appreciable degree.

My intent for this entry is to stimulate a healthy community discussion on what methods the readers have found useful and reliable for neurotoxin injections (to keep this discussion focused I am not encouraging discourse on filler injections but perhaps this can be a future topic of discussion), in addition to disregarding any approach that they have found particularly not beneficial.  We all want to make our injections as easy as possible for our patients, so I am hopeful that this topic can generate healthy dialogue!