News about cosmetic fillers and potential complications gets plastic surgeons’ attention. After all, fillers are the second most common procedure (following neuromodulator injections) that plastic surgeons perform, according to Jamil Ahmad, M.D., director of research and education, The Plastic Surgery Clinic, Ontario, Canada, and assistant professor of surgery at University of Toronto.
Fillers that are approved for use around the world but not yet in the U.S. were among the hot topics when Dr. Ahmad presented “What’s happening in fillers and neuromodulators?” yesterday at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Las Vegas.
Specifically, he spoke about Allergan’s hyaluronic acid fillers Volift and Vobella, which Dr. Ahmad says Allergan hopes will be FDA approved this year.
“Volift and Vobella are formulated with a different type of cross-linking, which slows the breakdown, or degradation, process. For instance, Juvéderm Ultra or Ultra Plus [Allergan] used to last seven to nine months in a patient. On average, these new fillers by Allergan last beyond a year,” Dr. Ahmad says.
Volift and Vobella have different consistencies. Vobella, the thinner of the two, can be injected intradermally, into fine lines and to hydrate (not volumize) areas. It’s ideal, according to Dr. Ahmad, for smoothing out lipstick lines.
“Volift has a medium consistency, whereas, Voluma [which is approved in the U.S.] is very thick and Vobella is very thin. Volift can be used more superficially than Voluma, in corners of the mouth, cheeks, nasolabial fold. It’s a good multipurpose filler,” Dr. Ahmad says.
Although rare, complications from fillers occur, and it’s important that injectors recognize them early — at the time of treatment or in the hours following treatment — in order to avoid long-term consequences, according to Dr. Ahmad.
One of the problems is that “everybody” is injecting fillers, including plastic surgeons, facial plastic surgeons and dermatologists who are knowledgeable in facial anatomy, as well as injectors who are nonphysicians (nor are under the direction of a physician), who might not know what to look for in complications and don’t understand facial anatomy, according to Dr. Ahmad.
“An injectable filler can block a blood vessel and block the blood flow to the skin in an area. You can recognize that right away because you see changes in the skin,” Dr. Ahmad says.
Injectors using hyaluronic acid fillers, he says, can inject hyaluronidase, massage the area and potentially break up the product, so that there’s really no long-term problem. But if the injector does not recognize the complication and there’s a delay in treatment, usually by the time it’s clear to the patient, the patient is outside the window where it’s possible to use any type of treatment, he says.
Disclosure: Dr. Ahmad reports no relevant disclosures.