DESTIN, FLA. Rosé or cabernet?
Hyaluronic acid cosmetic fillers, it turns out, are a bit like wine: selection depends on whether the occasion calls for something soft and light or something big and bold, Dr. Patricia Farris said at a meeting sponsored by the Alabama Dermatology Society.
"Not all wines are the same, and not all hyaluronic fillers are the same either. … If I'm injecting crow's feet, I'm probably not going to pull for Perlane or Restylane," said Dr. Farris of the department of dermatology at Tulane University, New Orleans.
Those "cabernets" are bolder than necessary for that application. A light "rosé" like Hylaform or a slightly more complex "pinot" like Juvéderm would do the trick, she said.
On the other hand, if a patient comes in asking for a "really, really big Paris lip," her choice is Restylane. If a patient says she wants a fuller lip but doesn't want to look like Angelina Jolie, something like Hylaform or Juvéderm is better, Dr. Farris said.
"These are just softer fillers, and … they are far more forgiving," she said, which is particularly important for novice injectors. Although they can't do what Restylane and Perlane can do, Hylaform and Juvéderm are "easier, smoother, and the flow properties are really good," she noted.
The important thing is to be comfortable with the product. Everyone has their own level of comfort and their own favorites for each application, and it is important to go with what you like and what you know works for that application, and not with what the patient comes in asking for, Dr. Farris stressed.
A patient who wants Restylane for crow's feet doesn't necessarily understand that such a bold filler isn't necessary. The wine analogy is a great way of explaining this to patients.
"I think they get the point," she said.
For deep nasolabial folds, however, go with the cabernetunless the patient would prefer something lighter, she advised, describing one patient who had a prior bad experience with lumpiness following Restylane injection (probably because of bad injection technique), and wanted to steer clear of that.
"So I got my pinot [Juvéderm] out for her," she said.
Because the various hyaluronic acid fillers are so different, it pays to be experienced with a variety of them.
The hyaluronic acids work well for a number of problem areas, including prejowl grooves, tear troughs, lips, and noses.
The "puffing up" of the prejowl groove area following injection with a hyaluronic acid filler improves contour, and patients tend to be very happy with the "lighter, much nicer look they get with this," Dr. Farris said.
For undereye circles, a filler such as Juvéderm can be injected in the tear trough with a great result.
When it comes to lip enhancement, a number of different fillers will work. Be sure to ask patients what they are looking for. If lipstick line bleeding is the concern, then running the vermilion border with a filler will suffice. In addition to the hyaluronic acids, CosmoPlast also works well for this.
If the patient wants a bigger lip, then both the border and the body of the lip should be injected.
As for noses, the hyaluronic acids can be use to "straighten" a crooked nose, Dr. Faris said. Restylane is great for filling in the area around a bump and thereby deaccentuating it, or for filling in narrow areas.
The hyaluronic acids are easy to use and complications are rare, with the exception of some injection phenomena such as bruising and swelling. Lumpiness and bluish nodules may occur, but these are typically a result of poor injection technique. Sterile abscesses are also common, but they can be effectively treated intralesionally, she said.
A caveat with Perlane is the likelihood of injection phenomena such as bruising and a needle-stick line resulting from the need to use a 27-gauge needle.
"I'll spare you the pain. I tried the 30-gauge needle, but it's almost impossible to get [the product] out because of the 100-micron particle size," Dr. Farris said.
Use the 27-gauge needle but warn the patient of the potential effects, she advised, noting that the product is otherwise great.
Dr. Farris' presentation at the meeting was sponsored by Medicis, manufacturer of Perlane and Restylane.