LAS VEGAS – Combining the right products and anatomical knowledge translates patient concerns into better outcomes when using fillers, according to Burt Steffes, MD, a dermatologist in Fond du Lac, Wisc.
“If you understand differences in products, you’ll get better results and minimize complications” for different areas, Dr. Steffes said in a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
The physical properties of different fillers impact the results, he pointed out. For example, G prime, a measure of elasticity, varies among fillers; a filler with a higher G prime is more contour stable and is designed to lift tissue, while a product with a lower G prime is designed to spread through tissues and move more naturally with the face.
However, “lift capacity using G prime is only useful across products in the entire family and make up,” Dr. Steffes noted. A recent Allergan-sponsored study emphasized that “product performance is a complex interaction of various properties and tissue interactions not just G prime,” he said ().
Determining the most effective filler to use depends on the location and area to be corrected.
• Tear troughs: Dr. Steffes recommends avoiding hydrophilic products; he prefers Belotero, Restylane, or Restylane Silk.
• Lips: More flexible products such as Juvederm, Restylane, or Belotero can provide patients with the desired result, he noted.
• Nasolabial fold: Juvederm, Restylane, or Radiesse are appropriate choices likely to produce favorable outcomes, Dr. Steffes said.
• Lateral and midface atrophy: For greater lift and cohesivity in these patients, Dr. Steffes considers Perlane, Voluma, Radiesse, or Sculptra as options.
“Fillers are a great way to help people look and feel better,” but complications occur, so be prepared, he said. “You have to know how to recognize and manage complications.”
Proper management starts with staff education. Provide instruction and training to staff (including reception) on how to recognize impending problems. “Have a written protocol available, and keep nitroglycerin paste, hyaluronidase, and aspirin on hand,” he advised.
Cases of swelling may require hyaluronidase to correct, as may lumps and bumps, Dr. Steffes said. Bruising may be managed with ice packs after the fact, but can often be avoided or minimized by using blunt tip cannulas, slow injections, small aliquots, and small-gauge needles, he added.
In cases of extreme complications such as vascular occlusion, start by massaging the area with nitroglycerin paste, and administer hyaluronidase if necessary, he said. However, be sure to proceed carefully if using hyaluronidase in patients with an allergy to bee stings; use it only in an emergency in these patients and treat anaphylaxis if necessary, he added.
Dr. Steffes had no relevant financial conflicts to disclose.
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