Know techniques, combinations when using fillers

Dermatologists, for the most part, relied on bovine collagen facial fillers Zyderm and Zyplast (Inamed), fat injections and silicone until about two years ago, when several fillers burst onto the U.S. cosmetic scene, including human fibroblast collagen fillers CosmoDerm and CosmoPlast (Inamed), as well as hyaluronic acids Restylane (Medicis), Hylaform (Inamed) and Captique (Inamed).

Today, dermatologists might also resort to off-label uses of fillers approved by the FDA for other conditions, such as Sculptra (Dermik) and Radiesse (BioForm Medical).

Customized care

Today's dermatologists have specific fillers, as well as combinations of fillers and other procedures, to address specific areas of concern. There are fillers that are used for superficial lines, medium lines and wrinkles, as well as deep folds and volume replacement.

"As we get older, we lose volume in our faces and that includes collagen, fat, hyaluronic acid, muscle, bone - everything. So, when you replace the volume you plump up the skin and can get a virtual facelift," Dr. Narins tells Dermatology Times.

Dermatologists experienced in using the filler substances often mix and match them to achieve more dramatic results, according to Dr. Narins.

"You might want to use a superficial filler over a medium-depth filler. For instance, you might want to layer CosmoDerm over CosmoPlast, or layer CosmoDerm over Restylane. So, there's a combination of fillers that are used by layering, and then there is a combination of fillers where you might want to use, depending on the areas being addressed - such as deeper volume, maybe Sculptra or Restylane, or silicone for the deeper areas combined with Restylane for the lips."

Sculptra and Radiesse are contraindicated for the lips because they can lead to bumps due to the powerful muscles of the lips. Zyplast, CosmoPlast, silicone and the hyaluronic acids, such as Restylane, on the other hand, are great filler options for the lips, according to Dr. Narins.

Go slowly

"With these fillers you want to go slowly. It is good to replace the volume over two to three visits, so that you can actually sculpt the face," she says. "Especially with permanent fillers, you always want to go slowly and never want to overcorrect with a permanent filler.

As a matter of fact, you probably do not want to overcorrect with any long-lasting filler, such as Sculptra, Radiesse and sometimes Restylane (which can last up to a year)."

Dr. Narins dispels the old wives' tale that permanent fillers look peculiar in the face as women age.

"We have used silicone for 20 to 30 years and what happens is quite the opposite. Fillers can actually slow the progress of many of the deeper lines. So, rather than looking peculiar it actually looks wonderful with time," she says.

Optimum results

In order to get optimal results with silicone, dermatologists must use the microdroplet injection technique, according to Dr. Narins.

She uses the technique every four to six weeks until the results are where she and the patient want it to be; then, she does not have to adjust it for years.