Restylane
Following the recent FDA approval of Restylane for soft-tissue augmentation, Dr. Zwiren believes that hyaluronic acid-based gels will effectively be combined with Botox®, Microdermabrasion and Chemical peels and have a widespread impact on cosmetic surgery.
We have used Restylane, the newest upstart in the battle against in our practice since FDA approval in December 2003 and we have found them safe and effective.
"These agents will find a special marketplace in the United States," Dr. Zwiren said. "This applies particularly to the baby-boomer generation - many of whom are also seeking convenient safe and effective facial enhancement treatments with Botox® and other minimal recovery type of procedures. The ability of aesthetic physicians to combine treatments with Restylane and Radiance will be a great benefit to the aesthetic consumer."
Hyaluronic Acid Gels
Hyaluronic acid is a naturally occurring complex sugar found in all living cells, including the human body, where it fills the space between collagen and elastin fibers.
Restylane, a product of Medicis Pharmaceutical Corp./Q-Med, and Hylaform, a product of Inamed Corp./Genzyme, are both hyaluronic acid-based cosmetic dermal fillers that have been used abroad since 1996.
Restylane is used for the correction and treatment of nasolabial folds, glabellar lines, periorbital lines, vermillion borders, lips, smile lines and oral commisures.
Hylaform is also used for the treatment of soft-tissue-contour deficiencies, such as wrinkles. Both products do not require patient sensitivity tests in advance in of administration in countries where they are currently marketed.
Mild side effects present
Both Restylane and Hylaform give initial (two to five) days of mild swelling and occasional mild lumping and bumping because the products are relatively desiccated and attract fluid from the individual's tissues.
"Studies have shown that both gels produced moderate to extreme improvement. Both tapered over the next six months. At about six months, more effect was observed with Restylane than Hylaform. Although, the Hylaform doesn't last quite as well as Restylane, the initial effect of both is very satisfactory.
Restylane and the hyaluronic-acid based gels are extremely versatile. They can be used in the lips, various vertical lines, nasolabial folds, used to contour cheeks, build up chin and cheek bones, and to lift the eyebrows.
The FDA wants some restrictions. Earlier, its panel said the gels must be studied on a post-approval basis for safety in African-American populations and those with various skin types. In addition, the companies must make efforts to ensure proper physician training to ensure product efficacy and patient comfort.
Hylaform, derived from an avian source, was given additional restrictions, including a requirement for assessment of avian protein allergies before injection and labeling stating that safety and effectiveness for lip augmentation had not been established.
Choosing a filler
The hyaluronic acid gels may not be the right choice for every patient. High-profile patients or patients with certain conditions, such as HIV facial lipoatrophy, could achieve better results with other fillers.
For example, Dr. Zwiren that high-profile patients may want to choose Cosmoderm and Cosmoplast (Inamed Corp.), which are softer products that cause no lumping, bumping, or inflammation. "Patients who cannot afford even one minute of lumping and bumping in their public life should stay with one of the collagens. Cosmoderm and Cosmoplast are good for people who want no downtime. However they do not last as long as the hyaluronic acid."
By pairing hyaluronic acid with other products, such as Botox®, patients can achieve a better overall effect.
Combo yields lasting results
A recent study published in Dermatologic Surgery, demonstrated that Restylane alone used in the glabellar folds (between the eyebrows) had an 18-week duration of effect. However, when 30 units of Botox® were paired with Restylane, there was a 32-week duration of effect.
The combination can be used for a variety of other facial treatments as well, such lifting the lateral brow and placing filler underneath. "The result is an instant brow lift that is maintained with Botox®.
Looking forward
It is such an exciting time to be in the cosmetic arena because technology has moved along to give people what they want at the time when most people want it. The boomers want treatment that they can have that will not give them any downtime. They want gold-standard with little or no down-time procedures.
