Be prepared for more dermal fillers featuring a mix of low- and high-molecular-weight hyaluronic acid, as well as options for customization, said Dr. Nowell Solish.
Such a combination results in a highly crosslinked product that promotes greater duration with less swelling of the product and improved spreadability, he said at the Hawaii Dermatology Seminar sponsored by Global Academy for Medical Education/Skin Disease Education Foundation.
Dr. Nowell Solish
“There is a role for dermal fillers with these characteristics,” said Dr. Solish of the University of Toronto. He compared the uses of several combination products, including Voluma, Volbella, and Volift.
Dr. Solish’s take on Voluma: “Great for volume,” particularly for the chest and midface, with a low and manageable rate of adverse events.
By contrast, Volbella, which is not yet approved for use in the United States, is a fast-flowing filler suited for lip hydration and perioral lines, rather than volume, he said. In a 2012 study, 48% of 58 adult patients showed an improvement of 1 point or higher on the Lip Fullness Scale at 1 year, based on physician assessment, he said (Clin. Cosmet. Investig. Dermatol. 2012;5;167-72).
Volift, another combination high/low-molecular-weight hyaluronic acid product, is “likely last to get approved” in the United States, Dr. Solish said. The product, however, is “great for marionette lines and smile lines,” as well as for improving the appearance of mild to moderate lines around the face.
Emervel is an example of a product in which the varying particle size allows for customization. The hyaluronic acid concentration of Emervel is consistent, but the product is available in three particle sizes for three depths of injection and varying lifting capacity, he explained.
Finally, the use of a filler containing polymethylmethacrylate (PMMA) microspheres was associated with significant improvements in atrophic facial acne scars, Dr. Solish said, citing a recent randomized controlled trial of 147 subjects (J. Am. Acad. Dermatol. 2014;71:77-83). The microspheres are designed to be consistent is size (30-50 mcm). Treatment-related adverse events were generally mild and transient.
The calcium microsphere filler Radiesse with lidocaine was recently approved by the Food and Drug Administration and should be available soon, he added.
Dr. Solish disclosed serving as an investigator and consultant for Allergan, Medicis, Revance Therapeutics, Marz, and Indeed. SDEF and this news organization are owned by the same parent company.