New, emerging fillers hint at innovations in treating volume loss

This article is part of the Vegas Cosmetic Surgery and Aesthetic Dermatology Show Coverage.

As more filler products come on the market, it’s important to look at the science to distinguish them, according to Hema Sundaram, M.D., who spoke at the Vegas Cosmetic and Aesthetic Dermatology meeting in Las Vegas.

Science is driving the development of these products, she says, and this offers physicians new ways to combine fillers for optimal treatment.

Dr. Sundaram described several fillers currently available or coming down the pipeline and the potentials that each have in the treatment of volume restoration. Much of the science centers around a product’s stiffness, or G prime. G prime is a measurement of gel hardness and an important consideration in the appropriate use of a filler. Products with higher G prime measure are optimal in deeper tissue, while those more fluid products with lower G prime are better suited to superficial placement.

Belotero Balance, which was approved in 2011, is a cohesive-polydensified-matrix hyaluronic acid designed for superficial implantation. With a low G prime, it is softer and more spreadable, she says. Therefore, it is useful for treating the lower and upper eyelid, fine rhytids, nasolabial folds, and in the lips for precise definition.

The technique Dr. Sundaram suggests for superficial injections is called the superficial blanch technique.

“It’s very counterintuitive to how we inject Restylane (Medicis) and Juvéderm (Allergan),” she says. “The hub of the needle graces the surface of the skin, we see a transient blanching forming a couple of minutes after injection, and you can even see sometimes the silver gray of the needle through the skin as you're injecting.”

Another filler doctors can look for probably by the end of the year, she says, is Juvéderm Voluma. It is a cross-linked hyaluronic acid mixed with 0.3 percent lidocaine. Juvéderm is currently pending approval by the Food and Drug Administration for restoring volume in the cheeks.

Juvéderm Voluma is going to be useful for deep implantation for volumizing, molding and sculpting, Dr. Sundaram says. It’s more elastic then the current Juvéderm products and will offer a different type of volumization, she adds.

Last, Emervel, which is CE marked in Europe and is currently being studied in the United States, is a range of five products based on Optimal Balance Technology. The products have variable cross-linking and gel calibration and are designed for superficial to deep implantation. This will provide doctors with more ways to perform pan-facial volumizing, filling and superficial fine-tuning, she says.

The Emervel line (Galderma) is the first hyaluronic acid product line based on rheology, or flow, offering specific products for specific applications by variations in G prime and viscosity.

The emerging concept centers around rheologic tailoring, Dr. Sundaram says: Selecting the appropriate product based on science. And as more of these products become available, physicians will be able to take a more integrative approach to volume loss through layering, she says.