When choosing the right fillers, knowledge is power

Key Points

"The sheer number of fillers in the U.S. aesthetic market can make it challenging for cosmetic physicians to find transparency in terms of choosing the optimal filler for a given aesthetic indication," says William Philip Werschler, M.D., F.A.A.D., F.A.A.C.S., clinical professor of dermatology and founding member of Spokane Dermatology Clinic and Werschler Aesthetics, Spokane, Wash. Dr. Werschler discussed fillers and their variety at MauiDerm 2011 in February. "Knowing their varying technologies and understanding the dynamics and nuances of each filler is important, as different fillers can be considered optimal for different indications," he says.

No two filler products are exactly the same, and often, products are differentiated by their technologies. These differing technologies and varying features will often translate into different benefits for cosmetic patients. As the palate of fillers continues to grow, they need to be effectively categorized so physicians can make better and clearer choices among them.

Initially, fillers were categorized based on their longevity of effect, as their cost and safety profiles were relatively equal. Today, however, many fillers try to differentiate themselves from the competition through new and novel technologies.

According to Dr. Werschler, the mechanism of action of a filler is likely the most useful methodology of characterization.

"Fillers today basically either replace lost volume or they stimulate tissue growth, and this distinction helps you better understand their mechanism of action," he says. "Fillers can be additionally discerned by their longevity of effect, if they are particulate or nonparticulate, biodegradable or not, and where to use or not use them. Accordingly, you can choose fillers for a particular patient, depending on the patient's needs and aesthetic goals."

Initially, fillers were used for the sole purpose of filling lines and wrinkles. As physicians learned that skin aging was much more than just surface contour, texture and irregularity, however - and that aging also involved volume loss and facial shape alteration - newer product were engineered to address these aspects of aging skin.

According to Dr. Werschler, Sculptra Aesthetic (poly-L-lactic acid, Sanofi-Aventis) is one good example of a filler that can very effectively address volume replacement.

Sculptra Aesthetic works differently from other fillers in that it is a pure stimulatory filler which, after injected, will stimulate the growth of collagen. Therefore, it should be chosen according to the aesthetic end result desired, Dr. Werschler says.

"Sculptra taught us that filling lines and wrinkles was one method of improving the landscape, but another method is to revolumize the face. Our realization of the importance of volume replacement in the aging face was soon followed by the dawn of volumizing fillers such as Sculptra, effectively expanding our aesthetic treatment approaches from simple wrinkle- and line-filling to global volume enhancement," he says.