Filler choices, creativity expanding

Las Vegas

- The availability of a broad range of hyaluronic acid (HA) fillers has allowed dermatologists to employ greater creativity in correcting not only facial lines and wrinkles, but also age-related volume loss, an expert says.

Manifestations of facial aging include increasing prominence of nasolabial folds, deepening of the nasolabial groove, thinning of the lips, ptosis of the oral commissure, flattening and lengthening of the upper lip, atrophy of the Cupid’s bow and depression of the prejowl region, Dr. Nestor tells Dermatology Times.

Such changes involve both soft tissues - including loss of fat and muscle mass - and loss of bone mass, he says.

Accordingly, Dr. Nestor says filler goals in the mid- and lower face include not only filling lines and wrinkles, but also replacing lost volume (cheeks, mesolabial fold, chin, lips) and contouring structures (prejowl sulcus, tear troughs, mesolabial fold).

For volumization, he recommends treating areas including the tear trough, nasojugal groove and nasolabial folds as zones rather than individual wrinkles.

"You don’t necessarily inject lines," he says. "It’s really a complex relationship between lines, muscles and underlying tissues" that one must address.

In pretreatment evaluations, Dr. Nestor says, dermatologists must sit patients up at a 90-degree angle, look into a mirror with them and listen to their concerns.

"What I see and what they see could be very different," he says.

"The wrinkle that troubles a patient most might not be her largest one, he explains, but one that she believes makes her look like her mother."

As for HA complications, Dr. Nestor divides them into true complications (such as allergic reactions) and perceived complications (such as needle marks and bruises). Keys to avoiding complications include injecting the right product at the appropriate layer of the dermis and massaging the treated area to smooth out lumps.

Perhaps more importantly, he says, "The more slowly you inject, in most cases, the fewer complications you’ll have." DT

Disclosure: Dr. Nestor is a speaker and advisory board member for Medicis, Allergan and other filler manufacturers. He also receives research grants from Medicis.