According to the American Society of Plastic Surgeons, fillers continue to top the most popular nonsurgical treatment list—right behind neurotoxin injections—in the No. 2 spot year after year. With close to 3 million filler injections performed last year and 96 percent of those being performed on female patients, it’s safe to say our love of fillers isn’t going anywhere anytime soon. So, what’s next in the world of volume-boosting injectables? Expert injectors predict next-level fillers to be more sophisticated, approved for use in more areas and sometimes even longer-lasting.
Chin enhancements got a big win with the recent FDA-approval of Juvéderm Voluma for use in the chin. This marks the first time a filler has been approved to be used on the face outside of the lip and cheek areas. “Voluma is typically used in the cheeks and midface, so it’s exciting to have data and an actual indication for the chin as well,” says Denver dermatologist Joel L. Cohen, MD. New York dermatologist Julie Russak, MD adds, “Using it on the chin and along the jawline can help recreate the strong support structures of the face.”
While injectors have been using fillers off-label for years, clinical trials are in the works to ensure their FDA-approval for use in other areas of the face where physicians are already frequently injecting. “Going forward, I think we can expect to see filler studies specifically on filling the temples, the hollows below the eyes and the jawline,” explains Dr. Cohen. According to Beverly Hills, CA dermatologist Ava Shamban, MD, a jawline filler is on its way. “There is a product being used in Europe called Juvéderm Volux that is in trials here in the United States for use on the jawline.
Thanks in part to masks, eyes have been a new focal point for many patients. “The demand for under-eye filler has increased and is the result of patient’s desire for lower eyelid rejuvenation without the need for surgery,” explains Boca Raton, FL oculoplastic surgeon Steven Fagien, MD. “However, I advise to proceed with caution. I’ve also seen inappropriate patient selection and poor execution and product choices, leading to undesirable results.” Dr. Russak says, “The fillers used in this area must have a very low viscosity to avoid the Tyndall effect, which can tint the area blue. The product must be very thin, smooth and pliable. You don’t want a thick, robust filler in an area with very thin skin.”
While brands like Juvéderm and Restylane have become synonymous with hyaluronic acid (HA) fillers, a new family of volume enhancers called RHA 2, RHA 3 and RHA 4 distributed by Revance—they have been available in Europe for years—have now entered the conversation stateside.
“These fillers are excellent for blending facial lines and contouring the face without over-volumizing,” says Dr. Fagien. According to Dr. Shamban, the production process is what makes them notable in terms of movement and longevity. “What sets them apart from first-generation hyaluronic acid fillers is fewer chemical modifications and cross-linking in longer chains of HA. The less chemical proteins, modifications and additional processes required in manufacturing ultimately yield a purer, cleaner product that most closely resembles the native hyaluronic acid in our body for both flexibility in usage, natural results and longevity.”
A new filler, Restylane Kysse, was approved for the lips last year, and doctors agree that in addition to offering less swelling, it gives lips a more pillowy feel. “I agree with the data,” says Dr. Cohen, referring to a “Kissability Study” conducted by parent company Galderma in which 73 percent of patients’ partners reported a more natural or kissable feel. “It’s a very soft product that allows us to address volume and etched-in lines with little swelling.” Dr. Russak adds that it’s a solution for lip lines without adding projection. “It’s great for softening perioral rhytides, but it can also lift the lip to create a sharper contour.”
While HA fillers continue to be the most commonly used due to their versatility and reversibility—they can be dissolved with an injectable called hyaluronidase—other long-lasting fillers, like Radiesse and Sculptra Aesthetic, are also being injectedin novel ways. “Using diluted Radiesse to correct cellulite laxity is something that is becoming more commonplace,” says Dr. Cohen. “We’re also using very diluted Sculptra Aesthetic in combination with a laser treatment to address skin texture and sun damage on the décolleté.”
Your own fat cells are what eventually cause the improvement in volume.—Dr. Rogers
Microfat graft injections are another long-lasting alternative to temporary fillers. “Filler fatigue is a big reason why patientsseek alternatives to hyaluronic acid fillers,” says Beverly Hills, CA plastic surgeon Leif Rogers, MD. “Renuva is an injectable treatment, but it’s technically not a filler. While Renuva does give an immediate increase in volume due to the collagen growth factors and fluid contained in the injection, it’s actually causing the growth of your own fat cells over time. After 12 to 16 weeks, Renuva completely dissolves and only your own fat remains. Your own fat cells are what cause the improvement in volume.
Dr. Russak explains that superficial microdoses of HA filler injected in specific patterns can improve fine lines. “In Europe, it’s called the ‘microdroplet technique.’ Very thin filler is injected in microdroplets under the skin, creating more of a biomodulatory effect than a filling one.” Injectors place the filler in different patterns to strengthen the weakest areas on the face, like around the mouth to avoid lip lines. Dr. Shamban says we can expect to see supporting data soon suggesting the improvement in overall skin quality as a result of using the microdroplet technique.
Off-label use can be safe when done by an experienced doctor who specializes in that off-label treatment. Always see a board-certified dermatologist or plastic surgeon who can produce research showing efficacy of the off-label use, has been trained on the off-label use, or performs it regularly.
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