New Orleans — The array of available absorbable and semi-permanent fillers today allow cosmetic surgeons to skillfully treat and meet the needs of a wide variety of patients.
"It is not an absolute 'yes' or 'no' answer as to which filler — absorbable or semi-permanent — is better," says Mary H. McGrath, M.D., M.P.H., division of plastic surgery, University of California, San Francisco, and moderator of the panel discussion on the topic of absorbable and semi-permanent fillers here at the American Society for Aesthetic Plastic Surgery's (ASAPS) Aesthetic Meeting 2005.
The panel, which also included Trevor Born, M.D., in practice in Toronto; Steven Cohen, M.D., in practice in San Diego; and Miles Graivier, M.D., in practice in Cummings, Ga., discussed fillers such as Restylane (purified hyaluronic acid filler, (Q-Med), Radiesse (formerly Radiance, soft tissue filler, calcium hydroxylapatite, BioForm Medical), Artecoll (homogeneous polymethylmethacrylate microspheres, Artes Medical) Sculptra (poly-L-lactic acid, Dermik Laboratories) and autologous fat.Depending on the case, surgeons may decide to select one filler over another, or they may choose to use more than one in the same patient for different applications, she says.
Options with absorbables Dr. McGrath points out that from an esthetic standpoint, there are times when using an absorbable, which is not permanent, is a better choice.
"Patients may not want to have as much fullness in a particular area as they age," she says. "For example, in facial aging if a surgeon creates a permanent bulk, the patient may age around it in a way that several years later may not look natural anymore."
For some applications, such as an acne scar, a semi-permanent filler can be used effectively lessening the chance of the acne scar softening or reappearing.
"However in other cases, such as facial aging, it is not a bad idea for a filler to have longevity, but not permanence, because it could then soften over time and permit the aging face to change and contour as it is going to do anyway," Dr. McGrath explains.
Ability to reverse When considering cosmetic surgery, patients often think in terms of permanent changes, but occasionally they will want the ability to reverse the change.
"The option of reversibility is very desirable, especially if after a person has something done and it wasn't quite what they expected," Dr. McGrath tells Cosmetic Surgery Times.
In addition, more fillers and new applications will be developed for different indications and made available. The use of absorbable fillers, therefore, allows for the use of other newly developed fillers at a later date.
Learning curves Not all cosmetic surgeons have used all the available types of fillers.
"Many people are confused because there are so many options and they do not know if they are interchangeable, and many of them are not," she says, adding, that each product looks like it is going to have a separate use.
Combination treatments are also going to be popular. "Using more than one filler in combination allows a surgeon to treat patients in a more skillful way. The combined treatments will provide better contours and give a more natural appearance," she says.
She notes that because many of these products are injected into different depths of the dermis and subcutaneous tissue, surgeons will have more choices and will not be forced to put the filler into a certain plane because that is the indication for a particular filler.
"The combination of these fillers is going to be fascinating. For example, the combined use of collagen and Restylane already has been popular. Other products are going to be used together more and more," Dr. McGrath adds.