Consider silicone approach

For a great many patients and physicians alike, however, silicone still carries the stigma it acquired after complaints of complications arose from use in breast implants, and some malpractice insurers still won't cover any complications from its use.

"The insurance issue, alone, prevents many dermatologists from using silicone," Dr. Wirtzer, medical director of Mid Valley Dermatology and Cosmetic Surgery Center in Sherman Oaks, Calif., points out.

"In my opinion, the incidence of problems with silicone may be even less than with the temporary fillers," Dr. Wirtzer tells Dermatology Times.

Potential complications

Complications from temporary fillers can include problems such as hypersensitivity that can last weeks, months or longer with Zyderm or Zyplast (Inamed). Nodularity, bluish papules with superficial placement, and a risk of inflammatory or immune response, and even overlying skin necrosis have been reported with use of Restylane (Q-Med).

Silicone complications can also include nodularity and irregularity, although those problems are often the result of poor technique and using "too much, too soon," Dr. Wirtzer says.

Other silicone complications can include a granulomatous inflammatory reaction, but Dr. Wirtzer reports that in the approximately 15,000 treatments he's performed over 20 years, he's only treated one atypical inflammatory granulomatous response that responded poorly to conservative treatment and still persists. He acknowledges that he also had a handful of cases of superficial placement in his earlier years of treatments.

Positive survey results

To find out the satisfaction rates among his own patients, Dr. Wirtzer conducted a survey of those who received silicon for lips, marionette folds, scars and other treatments between 1997 and 2005.

Among 864 surveys sent out, 218 patients responded. Among them, 91.2 percent reported that they were very satisfied or satisfied with the treatment, and 91.1 percent say they would recommend the treatment to others.

"I thought it was worthwhile to evaluate my patients' response on such a controversial treatment, and I think when you're dealing with patients who are 91 percent satisfied, that indicates that it's a good, useful treatment," Dr. Wirtzer says.

He points out that 11 percent of the respondents reported some complications, but most, including eight reports of "bruising" and single reports of cold sores and flu-like symptoms, didn't actually represent legitimate complications, Dr. Wirtzer notes.

"If I were to send this out on collagen or Restylane patients, I don't think I would get as high a level of satisfaction," he adds.

Keys to successful application

The key to having full success with silicone is making sure to pay careful attention to technique, and to treat conservatively, Dr. Wirtzer explains.

"I've had patients come in who received treatments in places like Mexico and they had only one treatment with a large amount of silicone."

Instead, Dr. Wirtzer's approach is to inject monthly or every other month, and to inject small amounts to get gradual improvement.