It turns out that fillers are not just for the face. Sabrina G. Fabi, M.D., a volunteer assistant clinical professor at the University of California San Diego, also uses cosmetic fillers off-label to enhance patients' necks, chests, hands, medial arms, abdomens and buttocks.
Dr. Fabi, who presented on the topic of fillers in non-facial areas yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, tells Cosmetic Surgery Times that cosmetic surgeons who use fillers off the face should consider diluting the filler products they use, depending on the areas they're injecting, to avoid lumps and bumps. "Non-facial skin is classically thinner and less forgiving," Dr. Fabi says.
Another tip, according to Dr. Fabi: "Consider using a 25-gauge cannula when injecting the hands and inject very superficially, as Lefebvre-Vilardebo M et al found that we are commonly injecting into tendon, when we think we are injecting subcutaneously.â
Dr. Fabi's preferred injectable is Poly-L-lactic acid (PLLA), at a 16 cc reconstitution, for the chest, and Radiesse (Merz), blended with 0.5cc of lidocaine, for the hands.
"I typically don't inject more than one vial of PLLA in the chest per treatment. And I split one 1.5 cc syringe of Radiesse blended with 0.5 cc of lidocaine to the hands to minimize swelling with treatment, and do a second syringe two weeks later. I prefer Belotero Balance (Merz), blended 1:1 for horizontal necklines and use a 25-guage 1.5 inch cannula," she says.
Non-facial filling is a trend, according to Dr. Fabi, because laser and energy based devices can only do so much.
"There is a component of volume loss that needs to be addressed to achieve optimal results," she says. "In California, it is popular, as people are in tank tops and shorts most of the year and non-facial sites are exposed, making patients more aware of the discrepancy that begins to exist between treated facial skin and nontreated non-facial skin."
Disclosure: Dr. Fabi is an investigator and consultant for Galderma, Merz, and Allergan.