Add new products that make the job easier and longer-lasting, and more and more surgeons are adding nonsurgical alternatives such as botulinum toxin and fillers to their services. Steven Fagien, M.D., of Boca Raton, Fla., along with Rod Rohrich, M.D., of Dallas, teaches a course on advanced uses of Botox (Allergan) and filling agents for facial aesthetic enhancement for the American Society of Plastic Surgeons (ASPS). Evolution of fillersWith Food and Drug Administration (FDA) approval of Botox for cosmetic use about eight years ago, patients coming in for regular Botox injections would ask, "What's another non-surgical treatment that you can you do for me while I'm here that would make me look better?" Dr. Fagien says. "Initially, collagen was the primary option, but while collagen agents like ZyDerm or CosmoDerm (both by Inamed) are useful for the correction of facial fine lines, their persistence is short-lived and their use is less appropriate for volume augmentation." As patients became increasingly disappointed with these short-comings, the popularity of these products waned. When the hyaluronic acid acids became available, the excitement of having a longer-lasting filling agent caused a shift in popularity to agents such as Restylane (Q-Med). Dr. Fagien says that these agents also have their limitations, and there likely will always be a place for an effective and longer-lasting "collagen" product to correct more superficial defects. He believes that several will probably be commercially available here in the United States in the next year, "but for now, the 'HAs' rule." Treating effects of aging The options for using fillers also grew as doctors better understood the aging process, Dr. Fagien explains. "We've really come a long way in determining what happens with facial aging. As much as everybody used to think of this as caused by gravity, it probably has a lot more to do with animation and volume depletion. "Understanding that — which seems so obvious to us now — was not that obvious 20 years ago when the solution was primarily surgical." Dr. Fagien says the fat volume, for example, decreases in several areas in the lower face — particularly the areas around the chin — as people age. When people lose volume there, he says, it creates the appearance of developing jowls. "Because of the way that looks, the solution seemed to be 'Let's lift it.' "It turns out that the area probably doesn't fall as much as we thought — it just appears to fall, because the depression that occurs in front of it makes it look like it's hanging lower." Dr. Fagien says that as a result of understanding this, more surgeons are turning to fillers for that area rather than just resorting to a surgical lift. Even with facelifting procedures, injectable soft tissue augmentation to this region is also commonly incorporated. Still temporary, but lasting longer Another factor that contributes to the increased popularity of fillers is the ability to increase the length of time fillers last before they need to be reinjected. Botox relaxes muscles in the face to provide a more youthful appearance. Restylane and other new hyaluronic acid fillers are providing doctors with better, longer-lasting methods of reshaping the face to give it a rejuvenated look. |
