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.