Freiburg, Germany — With more than 70 brands of permanent filler substances available today, the marketing appeal and patient demand to use these products are strong.
But according to Eckart Haneke, M.D., Ph.D., a dermatologist in private practice here, and guest professor of the department of dermatology at St. Radboud University Nijmegen, The Netherlands, physicians should use extreme care when using long-lasting fillers for soft tissue augmentation.
Advantages, disadvantagesDr. Haneke believes that permanent fillers have one advantage, and only one: to save the client a lot of money.
But the disadvantages are many.
"The main problem concerning these permanent fillers is that almost all durable fillers have side effects," he explains to Cosmetic Surgery Times. "What you get is permanent filler and permanent side effects, including hard-to-control granuloma formation, bumps, inflammation and asymmetry. That's the same with all permanent fillers whether it's silicone, Artecoll (Rofil Medical, International) or DermaLive (Q-Med)."
Ideally, permanent fillers should meet many criteria. They should have a wide margin of safety, and be easily fabricated, obtainable and implanted. They should allow systematic injection or implantation techniques. In addition, the procedure should yield a predictable and persistent correction with a natural consistency and resist mechanical strain. It should be biodegradable or retrievable, non-toxic, non-inflammatory and non-carcinogenic, with no migration. Plus, it should be cost effective and multipurpose with a minimal malpractice potential. Unfortunately, each of the permanent fillers in use today has only a few of these properties, Dr. Haneke says.
Instead of using permanent fillers, Dr. Haneke suggests physicians discuss other options with their clients such as lipoinjection, or using the patient's own fat, which is a long-lasting filler substance.
"I personally tell my patients to stay with a temporary product that is biodegradable," Dr. Haneke says. "In rare cases, a patient will get a granuloma and chronic inflammation. This will disappear within two months to two years with short-lived fillers. It will not disappear if you have used permanent filler like DermaLive."
To avoid irreparable disappointment for clients, they should try temporary fillers for their first few treatments, just to make sure it is providing them the results they want.
"If they are satisfied," Dr. Haneke says, "they may want to opt for a permanent filler."
But with so many long-acting filler products to chose from, physicians should "choose wisely and then perfect their technique," he advises.
The attraction to permanent fillers is understandable: patients want a long-lasting, pleasing result that will eliminate the need for touch-ups and save them money.
But the flurry of media surrounding these fillers is causing many clients to become very demanding, according to Dr. Haneke. His advice to physicians is to be very careful with these patients. The likelihood of problems down the road is high with these permanent products, he says, and "a demanding client is more likely to sue you. Even if you win your trial, it will be an unpleasant and inconvenient experience."
While he has never used permanent fillers in his own clients, he has removed granulomas from many patients that were caused by these products. The appearance of these irreversible, permanent side effects "makes these products very tricky," he says. "They are big, and they are sometimes encapsulated. And there is still substance in the skin and under the skin, and the patient will continue to develop more granulomas."
Nonetheless, new developments in research, products and techniques are all helping to make permanent fillers better, according to Dr. Haneke. With the recent Food and Drug Administration approval of permanent fillers in the United States, an informed patient can make a choice that is right for them.
"There is a need for permanent fillers," he adds, "but we still do not have the perfect one. Until we do have it, they should be used with utmost caution."