At the Pacific Dermatologic Association meeting Alastair Carruthers, M.D. of Vancouver, Canada, pointed out the growing market for fillers in the past year.
"Inamed is still selling collagen, but the manufacturers of Restylane (Q-Med Laboratories) have sold more this year than Inamed, so clearly the expansion in the marketplace has been dramatic."I think we had pushed collagen as far as it would go and Restylane is very different. It offers increased duration, a different feel in the tissue, and the fact that it is of non-animal origin. These are all positive factors that will increase the number of people desiring fillers.
"About half of all fillers are injected into the lips in many practices, and Restylane is fabulous in the lips because of the natural appearance and feel. It passes the kiss test."
Dr. Carruthers doesn't think collagen will be completely replaced by the new fillers.
"There is certainly going to be a place for collagen for quite a while. It has a different feel as it sets in the tissues and it resists wrinkling better than some of these new era filler agents — but it will probably be mainly the human bio-engineered forms that are used."
Dr. Carruthers also talked about the benefits of permanent fillers. He knows some people debate the use of the permanent fillers because of the problems seen in people injected with silicone over the years, but he contends there is definitely a place for the permanent fillers. He says in the faces of those with HIV-therapy-related lipoatrophy, permanent fillers can change lives.
"The results are dramatic and the quality of life survey shows that these people get a huge improvement in the way they live.
"I've had patients put on permanent disability because their looks made it impossible for them to work with the public. Now, they are employable, they are in society and they are out there enjoying themselves. They hadn't realized how much they had retreated from society.
"A patient the other day told me I had given him his life back. How often does a dermatologist have someone say that to them?" he says.
Because of the nature of permanent fillers, Dr. Carruthers says it is important that physicians, rather than nurses or other medical assistants — inject the fillers. He says the doctors are the ones with the aesthetic judgment and understanding of all the medical issues involved.
Dr. Carruthers also talked about results from recent studies on the safety of Botox (Allergan) that show higher doses of Botox injections in men are longer lasting and safer than previously thought.
The average dose used in men is 30 to 40 units, though Dr. Carruthers says he and his colleagues sought to increase that practice.
"We did a study in males, injecting what we thought was a super-high dose because no one had ever explored the upper regions of what is safe in the glabella area. We used doses of up to 80 units. We wanted an amount that we thought we could, in all good conscience, inject into any man who walked in. That was because the study was double-blind and while 80 units might be a large dose for a small man, it wouldn't do him any significant harm.