Alternatives to surgery remain popular among patients, experts say

Toronto - Noninvasive procedures - specifically, filling agents - are maintaining their popularity with patients, both as independent cosmetic treatments as well as adjuncts to cosmetic surgery, according to plastic surgeons at the 2010 annual meeting of the American Society of Plastic Surgeons (ASPS).

Clark Schierle, M.D., Ph.D., a plastic surgeon with Northwestern Plastic Surgery Associates, Chicago, said that many new filling agents are on the horizon and will enhance choices for physicians and patients.

"It's an exciting field, and there are a lot of new fillers that are coming to the market," Dr. Schierle says. "It's important for patients to know that they act in different ways."

Some new fillers are designed to stimulate the body to create new collagen deposition.

"In this day and age, patients are all looking for less downtime and not having to undergo surgery," Dr. Schierle says.

According to the ASPS, Botox (onabotulinumtoxinA, Allergan) treatments grew more than 500 percent between 2000 and 2009, and the use of soft-tissue fillers rose 169 percent in the same period. One of the increasingly common uses of fillers is to replace lost volume in the face that occurs as a result of aging.

Still, fillers cannot be a replacement for surgery in some cases, says Robert Singer, M.D., a plastic surgeon in La Jolla, Calif.

"Fillers are not totally a replacement for surgery," Dr. Singer says. "If you have significant laxity of skin tissue, there is no amount of filler that can make it look natural."

Breast implant update
Many breast implant products, such as cohesive gel - or “gummy bear” - breast implants, have yet to come to the U.S. market, and according to some observers, there is not an expectation that these products (which are under review by the Food and Drug Administration), will be approved imminently. This despite observations that gummy bear implants appear to have several advantages, such as an increased shelf life, greater longevity and reduced capsular contracture rates compared to the standard of care, according to William Adams Jr., M.D., a plastic surgeon in private practice in Dallas.

"We really don't know when gummy bear implants or any other implants will be brought to the U.S. market," he says. "The (FDA) approval process for breast implants is so drawn out."

Fat grafting is a well-accepted technique to address contour irregularities of the breast, but there is lack of data on the long-term efficacy and safety in using fat grafting as a means to enlarge breasts, Dr. Adams says.

Cryotherapy efficacy
Companies such as MyoScience, based in Redwood City, Calif., are developing approaches using cryotherapy with a goal to reduce facial wrinkles, according to Barry DiBernardo, M.D., medical director of New Jersey Plastic Surgery, Montclair, N.J., and associate clinical professor, plastic and reconstructive surgery, University of Medicine and Dentistry of New Jersey, Newark, N.J.

"It is not yet available, and it is still under investigation," Dr. DiBernardo says.

Current treatments to rid the body of cellulite are producing short-term benefits, but they are not producing long-lasting effects to date, Dr. Singer says.

"People may see temporary improvement," he says. "If they think it will be long-term, they will be significantly disappointed."

Topical botulinum toxin
Revance Therapeutics of Newark, Calif., is conducting clinical trials of a topical formulation of botulinum toxin type A that comes in the form of a gel called RT001. It is aimed at treating crow’s feet as well as axillary hyperhidrosis.

Data from phase 2b clinical trials aimed at exploring the efficacy of the gel to treat lateral canthal lines were presented at the annual meeting of the American Society of Dermatologic Surgery in Chicago in late October.

Topical application would be favorable to a number of patients, says Michael Kane, M.D., an aesthetic plastic surgeon in New York who was one of the clinical investigators for the phase 2a trial of the use of the gel to treat crow’s feet.

"It would be an alternative to injection," he says. "That would be an advantage, and the other is you (the patient) would not get bruised.”