Combining products benefits soft tissue augmentation

This is the treatment approach of Leslie Baumann, M.D., director of the University of Miami Cosmetic Center and associate professor in the department of dermatology and cutaneous surgery. Dr. Baumann's message at Academy '05 here was that clinicians should be leveraging the assets offered by different fillers to address the variety of needs each patient may present.

"If you're a painter, you're not going to just use green paint. You're going to use all the colors of the spectrum," Dr. Baumann tells Dermatology Times. "I feel that it's the same way with soft tissue augmentation products; you should use several of them in combination to get the best results."

According to Dr. Baumann, collagen fillers are structural, and function to hold the skin up, like scaffolding. Collagen fillers, such as Zyplast (Inamed) and CosmoPlast (Inamed), are useful for features that are targeted to stand out.

Hyaluronic acid products, on the other hand, bind with water very well and provide volume to features. This is useful in areas such as the body of the lips, over the cheekbones or along the jawline. However, variation between these fillers can be exploited to the benefit of the patient.

In Dr. Baumann's experience, Hylaform (Inamed) is the softest of the hyaluronic acid fillers, Restylane (Q-Med Laboratories) is the stiffest, and Captique (Genzyme Corp.) is in the middle. So while Restylane may provide the best effect for acne scars or very deep wrinkles, Hylaform would be most suitable for adding volume to the lips.

Using a combination of collagen and hyaluronic acid fillers to treat a single area functions to replace what the patient has lost in both structure and volume. However, the benefits go beyond look and feel - combination treatment can also significantly impact patient comfort during the cosmetic procedure and reduce immediate side effects.

For deep lines, such as the nasolabial folds, Dr. Baumann first injects Cosmoplast, which contains lidocaine. By using the collagen product first, the treatment area is numbed for the remainder of the procedure and swelling is minimized by stabilizing eosinophils. The hyaluronic acid filler of choice can be injected afterward.

Additional products and techniques

Although not approved yet in the United States, another hyaluronic acid product, Juvederm (Inamed), appears to extend treatment effects, which last four to six months using the currently approved products.

"Juvederm is very exciting because, unlike the other hyaluronic acid fillers, which are particle-based, it is a homogenous hyaluronate gel," Dr. Baumann notes. "Enzymes have a tougher time breaking it down, so it may last for 12 to 15 months."

A product that Dr. Baumann currently utilizes heavily in clinical practice is Sculptra (Dermik), which she points out is not a true filler.

"I like to call it a dermal stimulator," she says. "The injection encourages the skin to make its own collagen."