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Surgeons Discuss Best Practices for Facial Rejuvenation

More FDA-approved dermal fillers provide options for anti-aging treatments

American Society for Aesthetic Plastic Surgery

American Society for Aesthetic Plastic Surgery
March 16, 2015

The American Society for Aesthetic Plastic Surgery (ASAPS) hosted a panel discussion about best practices and uses for injectables, including the newest FDA-approved options, today at The Aesthetic Meeting 2015 in Montreal, Canada.

The panel discussed the latest advances, including the ways various dermal fillers can be utilized to produce optimal results for targeted areas. There are 13 FDA-approved dermal fillers currently on the market, providing aesthetic plastic surgeons with the ability to customize anti-aging treatments to patients' needs.

"The filler choices are dictated by a patient's unique aging pattern, the anatomical area to be treated and physiochemical properties," said ASAPS member Dr. Z. Paul Lorenc.

"Stackable treatments," a facial rejuvenation concept pioneered by ASAPS member Dr. Julius Few, combines dermal fillers with ultrasound technology like Ulthera and procedures including laser resurfacing to restore volume and lift and tighten the skin.

"The combined synergistic triple threat is minimally invasive, and allows patients to return to their everyday activities within a day or two," said Dr. Few. "It is ideal for patients in the early to moderate stages of aging, and you don't have to be overly-aggressive with any of the components as they all feed off of one another to create the desired effect."

Targeting various facial zones using different dermal fillers indicated for each respective area is a popular practice that surgeons are now using to produce natural-looking results with a longer shelf-life.

"The days of using only one product on the entire face are over," said ASAPS member Dr. Jackie Yee. "What works best in one region might not produce the desired result in another region. It is imperative to use the entire toolbox of injectables now at our disposal in order to produce the best possible result tailored to the individual patient."

Restoring volume treats the target area but has a ripple effect through the entire face. The variety of filler options also enables aesthetic plastic surgeons to treat previously neglected facial areas.

"Adding volume to the mid-face region, for example, will require fillers to be injected into the temple and forehead to balance out a patient's facial features," Dr. Yee said.

Companies are mirroring this trend by manufacturing tailored dermal products. Juvederm Voluma is the first FDA-approved filler designed specifically for mid-face rejuvenation, which Yee uses to sculpt and lift creating a very natural non-puffy contour with minimal swelling. It can last 18 to 24 months and is dissolvable. Restylane Silk was recently approved by the FDA specifically for lip definition and augmentation. Yee utilizes this product to address what is referred to as "the barcode," or the smoker's lines around the mouth, and to add definition to the lip and augment the lip size.

"It's easy to control so as to avoid the overly-inflated duck lips," Dr. Yee said. "Radiesse just obtained approval from the FDA to include lidocaine in the mix, making it a painless option to treat a wide variety of areas, including the nasolabial region.

According to Dr. Yee, Radiesse is also a great option for the hands, as it is opaque unlike other fillers, and can therefore conceal what some of her lighter-skinned patients refer to as their "cadaver hand appearance" as they age.

With more companies seeking FDA approval to expand indications for their products, companies and teaching plastic surgeons are allowed to demonstrate to their colleagues how best to use various dermal fillers to treat previously neglected areas. Prior to obtaining FDA approval, manufacturers were restricted in educating plastic surgeons about off-label yet beneficial uses of their products. As a result, some patients ended up with undesirable results.

"Seek a board-certified plastic surgeon with significant experience using fillers because nothing replaces predictability of results as good training," Dr. Lorenc said.

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