Consider proper criteria in assessing new injectables

Orlando - Assessing newer injectable fillers is easier if certain criteria are used to evaluate and compare them. According to Murad Alam, M.D., these criteria can be either objective, based on research and anecdotal evidence, or can be patient-directed and somewhat subjective.

"Given the new products and their appropriateness for the new age of minimally invasive cosmetic procedures, dermatologists need to know how and when to use them," says Dr. Alam, chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University, Chicago.

Even for someone experienced with fillers, he says, the consultation is a good idea.

"Try to learn at least two new materials with different properties and usage so that you are able to offer patients what they need, and not be restricted by what you know," he says.

Objective criteria Understanding how a filler measures up to the following criteria can provide direction in selecting the appropriate one:

Implantation technique - The implantation of most fillers is by needle injection of a fluid or gel to the site of correction. Primary differences are the thickness of the filler and the depth of the injection site.

"Thicker fillers tend to be injected deeper and last longer," Dr. Alam notes.

Safety - Short-term fillers are theoretically safer than medium-term or permanent fillers because they do not persist long enough to create any immune effects. Dr. Alam says all currently approved fillers are minimally immunogenic and extremely safe. What is unclear is the safety of off-label use of long-lasting or permanent fillers, he says.

Persistence - While few in vivo animal or human studies demonstrate how fillers interact with skin or show how much is metabolized, Dr. Alam has found that medium-term fillers "offer the best combination of persistence and safety."

Maximal natural correction - He prefers this phrase to the term "efficacy" and finds that filler benefits can be either long-lasting or precise, but not both. For instance, medium-term or permanent fillers have the benefit of lasting effects but cannot be fine-tuned as easily as short-term fillers. And short-term fillers last only three to six months but can be precisely injected to correct and fill the most superficial of all facial lines.

"More research needs to be done to show which of the current (fillers) provide the best cosmetic effect at specific anatomic locations," he says.

Cost per complete correction per year - "Slightly more expensive fillers that last longer may be more cost-effective since they need to be injected less often," Dr. Alam says.

Although permanent fillers can be five to 10 times as expensive as short-term ones, total placement costs are lower, given the fewer number of injections and follow-up visits needed.

He says a two- or three-fold increase in cost between a short-term and long-term filler may be inconsequential for some patients.

Patient preference Consider the patient's outlook on the following three criteria when selecting a soft tissue augmentation material: discomfort during delivery, inconvenience during treatment and overall satisfaction.

"Different patients may weigh different factors more heavily in deciding which technique they like best," Dr. Alam says.

For cosmetic procedures, he says, "Patient satisfaction is senior to physician judgment and objective evaluation."