Biodegradable fillers: New options can avert need for allergy testing in patients

Key Points

Montreal - New options for biodegradable fillers will usher in a post-collagen era that will avert the need for allergy testing in many patients.

"For 20 years, we only had (bovine) collagen, but now we have other products that are nonallergenic for which we don't have to do a test," says Dr. André tells Dermatology Times.

The goal in treating aging skin is not only to improve wrinkles, but to restore volume, according to Dr. André.

"We know that when we age, the volume changes around the eyes, the cheeks and folds of the nose," he says.

Fillers made from hyaluronic acid can fill areas around the eyes that appear hollow, replace lost volume around the cheekbones and add volume to the chin by treating marionette lines and restoring the jaw line, Dr. André says.

Moreover, clinicians should recognize when looking at the face and restoring volume to the face that the tail of the eyebrow can dip in appearance because of a loss of fat.

Biodegradable

Injectable fillers that are biodegradable can be used to replace that fat, or fat can be harvested from other parts of the body to replace lost fat.

One of the reasons that biodegradable fillers are preferred is safety. If complications occur, they will disappear spontaneously.

Secondly, if individuals opt for surgical correction around the nose, for instance, the biodegradable nature of the fillers makes surgery still possible. With fillers that are not biodegradable, surgery may no longer be an option if fibrosis develops. "When correcting small defects of the nose, we need to avoid the development of fibrosis under the skin," Dr. André says.

He notes that Radiesse (BioForm Medical) is a dermal filler made of calcium-based microspheres suspended in a water-based gel. It is injected into the skin through a simple and minimally invasive procedure.

Because it is made from a biocompatible substance identical to what occurs naturally in the body, it poses almost no threat of allergic reaction. Very few adverse events have been reported in clinical trials and actual use.

This product is very useful for treating thick skin and/or restoring volumes, and injections must be done deep into the skin, Dr. André explains.

Restylane (Medicis) is a biodegradable filler that has the largest gel particle size in the range. It is used to replace the loss of fat in the face and create or restore a more defined facial contour, Dr. André notes. The procedure requires a larger needle and deeper injections below the skin layers.

Voluma (Allergan), a temporary filler that can last up to several years, has been available in Europe and is pending approval by the Food and Drug Administration in the United States. It can be injected through a needle or a suitable cannula, Dr. André explains.

The biodegradable filler Evolence (ColBar LifeScience) is injected just below the surface of the skin, where it replenishes lost collagen and creates a layer of support to one's own remaining collagen network in the skin. The filler, which was introduced in Europe in 2004, restores shape and smooths creases and lines, giving skin texture a more even tone, Dr. André says.

Macrolane (Q-Med AB) is biodegradable filler that is purported to reshape body contours and correct small atrophies on the body. Made from hyaluronic acid, the filler has a track record of success with facial aesthetics, is noninvasive and does not necessitate any hospital stay. The filler permits breast and buttock augmentation.

Poly-L-lactic acid (Sculptra, Dermik) has been largely used in Europe for a few years, and many adverse events have been reported when the technique is not perfect. The filler can induce fibrosis and must be injected deep to restore volume, not used to treat fine lines or thin skin.

Dr. André notes that numerous biodegradable fillers are very new to the American market or not yet available in the United States but have had several years of use in Europe.