Volumizing agents, fillers combine to combat signs of aging

Los Angeles - Research shows that people lose a little volume all over the face starting at an early age. Fillers and volumizing agents, though, can work together to target specific areas of the face showing signs of aging and volume loss.

“By age 30, a person may have already lost 5 cc (or roughly 1 teaspoon of volume),” says Rebecca Fitzgerald, M.D., a dermatologist who practices in Los Angeles. “A new trend is using fillers, including Sculptra Aesthetic, in younger patients so that we can replace the volume that has been lost, as closely to where it has been lost, and as soon as it’s been lost. This may be an effective strategy in obtaining natural results and just looking like you’ve aged well.”

Gaining favor in many dermatology practices is the use of various injectable products in ways that best address a patient’s concerns.

“The available injectable and volumizing agents are not stand-alone products. They all work better in combination with each other; everything brings its unique advantages to the table,” Dr. Fitzgerald says.

Sculptra Aesthetic (injectable poly-L-lactic acid, Sanofi-Aventis) is a facial injectable that is used to help correct shallow to deep facial wrinkles, and folds that appear with aging. It is thought to act by stimulating growth of new collagen.

Global process
“More and more attention is being given to the role of volume loss in the clinical changes observed in the face as it ages,” Dr. Fitzgerald says. “It is now being recognized that volume loss is occurring slowly in all tissue structures of the face - the craniofacial skeleton that supports the soft tissues such as fat and muscle and skin that wraps around it.

“Although the sequence of events in aging is somewhat predictable, the pace of change is unique to each individual. We now recognize the face does not age as one homogeneous object, but, in fact, even different areas of an individual’s face can age at independent rates,” she says.

Dr. Fitzgerald says addressing even subtle changes in facial volume can improve a patient’s overall appearance.

“Although we notice our folds and lines first as we age and think that erasing these will erase an aged or tired appearance, we are increasingly recognizing that these folds and lines are often the culminations of a long, slow, global process of aging. Addressing more subtle areas of aging, such as hollows in the temples, can change facial shape and proportion and can create very subtle and natural results,” she says.

Adding volume
Dr. Fitzgerald has been using Sculptra since 2004, when she worked at a large HIV clinic at an HMO on the West Coast. Shortly after this time, studies demonstrating fat compartmentalization in the face were published in the literature.

“You could see so strikingly in those patients where the volume was missing. I began to realize that some patients who were coming in for cosmetic reasons were losing fat in the same areas as these HIV patients, but it was much less obvious,” she says. “Once I was keyed into it, my cosmetic results began to improve.”

Sculptra is suspended in water and is easy to work with.

“One of the great advantages of Sculptra is that you can replace a little bit of volume all over the face in multiple levels. And that, of course, is how we age - by losing a little bit of volume all over the face at multiple levels,” Dr. Fitzgerald says.

The product also lasts for a long time. “Sculptra is the only product that has been FDA (Food and Drug Administration) approved to last for up to 25 months, and it is a very fast-growing procedure among plastic surgeons,” she says.

The methodology for Sculptra has evolved considerably since the early HIV studies were carried out more than a decade ago. Most of the initial problems were technical and now most dermatologists are beginning to realize this, according to Dr. Fitzgerald.

Following the simple, yet critical, technical considerations for Sculptra will improve outcomes. “Make sure Sculptra is diluted greater than 5 cc, it is hydrated greater than two hours (preferably over night), and that it is not placed superficially or in muscle,” she says.

“Overall, it is also helpful for dermatologists to take advantage of all the new advances in the understanding of the pathophysiology of aging, in terms of changes in the underlying craniofacial skeleton, muscle, the fat and the skin in order to use products, including Scultpra, for very site specific augmentation. That way, you know you are replacing the volume where it has been lost,” Fitzgerald says.

Disclosures: Dr. Fitzgerald is consultant, advisory board member and speaker for Sanofi-Aventis, speaker and trainer for Allergen, speaker and trainer for BioForm Medical, and investigator for Obagi.