Fillers: The latest options

Dr. CohenFillers approved in the last two years have done a nice job to round out product portfolios for Allergan and Galderma, arming dermatologists with lots of options for facial rejuvenation, according to Joel Cohen, M.D., director of AboutSkin Dermatology and DermSurgery, in Greenwood Village, Colo.

Dr. Cohen, who spoke on the topic of fillers in March at Maui Derm for Dermatologists 2017 says the focus with studies and marketing for the newest Galderma fillers, Refyne and Defyne, has been “naturalness” of post injection appearance, including with expression.

Restylane

Galderma announced both fillers in the Restylane portfolio had been FDA-approved in December 2016 for treatment of moderate-to-severe facial wrinkles and folds in patients 21 years and older. And both have been used in other parts of the world for a few years, including Europe and parts of Asia, under the names of Emervel Classic for Restylane Refyne and Emervel Deep for Defyne. Galderma claims the newer fillers feature XpresHAn Technology, which gives the products flexibility and support.

“The marketing campaign by Galderma has really focused on expressions-showing people in animation before and after filler,” Dr. Cohen says. “…as people move facial muscles, their expressions can look very natural (and sometimes enhanced) after filler placement around the mouth.

Some of the histologic studies looking at Refyne and Defyne show these products really enmesh themselves with the surrounding dermis. So, similar to some of the histology cases with Belotero, [this suggests] that Refyne and Defyne, like Belotero, don’t tend to cause a Tyndall effect optical chamber discoloration, perhaps even after a bit more superficial of an injection,” Dr. Cohen says.

In addition to using the new Restylane Refyne and Defyne fillers to address the nasolabial folds and marionette areas, Dr. Cohen says he has used them off label to inject and rejuvenate the infra-orbital, temple, forehead and brow areas.

“I think many physicians are enjoying using Refyne off label under the eye. The product, with its 30g needle, tends to inject very slowly. I like it along the periosteum,” he says.

Defyne

Defyne works well in the secondary smile accordion lines, and can also be a nice product at the lateral supra-brow, according to Dr. Cohen.

Restylane’s full portfolio includes Restylane Lyft, formerly Perlane-L, which Dr. Cohen says he uses very effectively for cheek augmentation, to lift the area and provide definition to the cheekbones.

“Traditional Restylane continues to be popular, and I use it in many areas including the nasolabial fold and oral commissure, but I really like Restylane Silk for fine lines around the mouth and some of the etched-in secondary smile lines layered on top,” he says.

When providers first started using Restylane Silk years ago, the tendency was to inject it too quickly, resulting in swelling, according to Dr. Cohen.

“One of the keys is to inject Restylane Silk very slowly. As a result, you’ll see less swelling,” Dr. Cohen says. “Some people, regardless of what filler you use, seem to get more swelling than others. Sometimes, taking a nonsedating antihistamine can be helpful, like Claritin, or Allegra or Zyrtec, the day of the procedure plus for a few days after…. And I do this especially for folks who indicate that they had a fair amount of swelling on their last filler visit.”

Juvéderm

Allergan has also been significantly expanding its Juvéderm filler portfolio, with the addition of two fillers in the past 10 months. Volbella, first approved in Europe in 2011, was approved in the U.S. in May 2016 for lip augmentation and perioral rhytid correction. It has really rounded out Allergan’s portfolio with a product that nicely addresses fine lines around the mouth, he says.

Vollure XC, known as Volift in Europe and other countries where it has been used since 2013, was approved in the United States in March 2017 for correction of moderate-to-severe facial wrinkles and folds, such as nasolabial folds.

These two Juvéderm fillers use Vycross technology, as is the case with Voluma, in which low and high molecular weight hyaluronic acid are blended. The feature is thought to increase longevity, according to Dr. Cohen. In fact, the FDA study for Vollure indicated durability up to 18 months in the nasolabial fold in nearly 60% of study participants, the longest duration seen with an HA product in the nasolabial folds, he says. 1

Radiesse and Belotero

Dr. Cohen says he also likes to use other filler products on the market, such as the Merz portfolio of products, including Belotero, which he often uses for fines lines and, sometimes, for infra-orbital hollows.

Still another filler, Radiesse (Merz Aesthetics), is good for definition of the jaw line and cheek contouring. Radiesse is the only FDA-approved filler for augmentation of the dorsal hands, and it does a nice job of restoring some of the volume loss on the backs of the hands, as well as camouflaging some of the bluish veins with its opaque nature, according to Dr. Cohen.

“Overall, I think we have strong filler portfolios and a lot of products that offer optimal results in certain areas, and it’s up to the physician to decide what products we like to use in which locations and for what purpose,” he says. “We all have our favorites in specific regions.” ƒ

Disclosure: Dr. Cohen has served as a consultant and clinical trial participant for Merz, Galderma and Allergan.

References:

1. First and Only Hyaluronic Acid (HA) Dermal Filler FDA Approved for the Correction of Moderate to Severe Wrinkles and Folds, such as Nasolabial Folds, That Lasts up to 18 Months(1,2*).; March 20, 2017. Available at: https://www.allergan.com/news/news/thomson-reuters/juv-derm-vollure-xc-approved-by-u-s-fda-for-correc.