Choosing the best filler for the job

Today’s abundance of filler choices might seem overwhelming, but Jill L. Hessler, M.D., sees the growing product pallet as a way to refine results.

Dr. Hessler, medical director of Hessler Plastic Surgery and adjunct assistant professor, Stanford University, Palo Alto, Calif., presented on optimal filler use during the 2017 Vegas Cosmetic Surgery and Aesthetic Dermatology meeting, in Las Vegas.

She says new products coming to the U.S. market are filling a need and refining physicians’ abilities to treat facial rejuvenation with a needle.

“Initially there were only fine products and bulky products. Now, we have products that can treat … most any facial concern,” Dr. Hessler says. “Choosing the right product for the right area is what will help to create a natural enhancement, without the look of ever having been injected.”

According to Dr. Hessler, there is no one best filler for all jobs, but there are fillers she considers best for specific jobs.

“Some patients want added fullness to the lips, while others only want to soften the dryness and lines. … you can achieve both of these goals but use different products to achieve them,” she says.

Five highlights from Dr. Hessler’s presentation:

Number 1: The new Restylane Refyne (Galderma) is a new class of hyaluronic acids injectable. Fillers in this new class have a flexible and elastic quality to them that allows the products to move with the patient. As a result, patients and others can’t see the filler with expressions, including smiling, according to Dr. Hessler.

“It is my go-to filler for patients that have fine lines around the mouth and smile lines, but don’t want to add fullness and only want to fill the fine lines naturally,” she says.

Number 2: The new Restylane Defyne (Galderma) also uses the company’s XpresHAn (pronounced ex-ˈspre-shən) technology to create this smooth flexible gel, she says.

“The Defyne product is used when more support is needed, particularly in the cheeks or upper face area,” Dr. Hessler says.

Number 3: “[Juvéderm] Volbella (Allergan) is wonderful, very smooth filler for patients who want to create a smooth enhancement to the lips and soften the lip lines without a lot of fullness,” Dr. Hessler says. “It does not add a lot of volume but just a subtle fullness to the lips.”

Number 4: “We’ve realized volume loss in the face is a main cause of the appearance of facial aging particularly the mid-face fat pocket,” Dr. Hessler says.

Juvéderm Voluma (Allergan) gets high marks from Dr. Hessler when used for patients who need more support.

“Voluma is great to recreate the apples to the cheeks. It is also one of the longest lasting products, lasting up to two years from the time of injection,” Dr. Hessler says.

Number 5: Dr. Hessler says she loves treating the temple area and other more subtle areas of hollowing. She chooses Restylane Lyft (Galderma), Juvéderm Voluma or Sculptra Aesthetic (poly-L-lactic acid filler, Galderma) to treat those areas.

“The hollowing in the temple can lead to a gaunt, aged appearance, and filling this area can provide a subtle but noticeable rejuvenation,” she says.

Disclosure: Dr. Hessler is an injection trainer for Galderma and Allergan. She is on Galderma’s advisory board.