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Wednesday
Nov082006

Filler Injections: The old and the new.

From a Wall Street Journal Article: Face Time: The new injectables.

restylane_treatment.jpgOn the Market Now

 Botox: A neurotoxin drug that is by far the most common injectable, with more than three million procedures reported last year. Botox temporarily paralyzes muscles with a series of tiny shots, smoothing frown lines between the eyebrows and crow's feet around the eyes. It is the only neurotoxin approved for cosmetic use in the U.S. Lasts three to four months. Average physician fee: $363. From Allergan Inc., Irvine, Calif.
 
 Restylane: The second-most-common injectable, with about 700,000 procedures in the U.S. last year, Restylane is a filler that plumps up creases under the skin and is mostly used on the lower face. It is made from hyaluronic acid, a natural sugar that binds to water, creating temporary volume. Lasts six months or longer. Average price for all hyaluronic acids: $557. From Medicis Pharmaceutical Corp. (A thicker version, Perlane, is awaiting FDA approval. Medicis is also developing other versions to complement its brand, including Lipp, Fine Lines and SubQ.)
 
 Juvéderm: A new hyaluronic acid in limited release that is going up against Restylane. Doctors like its ease of injection, but competition will focus on relative cost and duration. The cost to physicians is slightly more than Restylane, but retail pricing won't be clear until after Allergan officially launches Juvéderm in January. Allergan's older Hylaform and Captique products don't last as long as Juvéderm or Restylane.
 
 CosmoDerm: A collagen product that, unlike its 18-year-old predecessors, Zyderm and Zyplast, doesn't require an allergy skin test several weeks before treatment. Zyderm and Zyplast are harvested from cows, whereas CosmoDerm and its sister product CosmoPlast are made in a laboratory from human collagen, a natural component of the skin. CosmoPlast is used in deeper lines and furrows. Treatments are also popular in the lip border and fine lines above the mouth. Average fee for all collagen products: $390. Allergan.
 
 Radiesse: Made from tiny calcium particles that create a scaffold for the body's own collagen to grow. Approved for craniofacial surgery. In August, an FDA panel recommended approval for smile-line wrinkles, but the agency hasn't ruled yet. Some dermatologists who use it off-label for cosmetic applications caution that particles can migrate and cause nodules, especially in the lips. Some tests show it lasts perhaps a year or longer. Average fee: $914. From BioForm Medical Inc., San Mateo, Calif.
 
 Sculptra: A synthetic polymer that stimulates new collagen production. Approved in 2004 for treating facial fat loss in HIV patients, but used off-label by some cosmetic dermatologists. It is reported to last a year or more. There have been some reported incidences of delayed small bumps under the skin. Average physician fee: $876. From Dermik Laboratories, a unit of France's Sanofi Aventis.
 
 ArteFill: A permanent implant approved last month for treating smile lines. Early versions of the product, sold in Europe and Canada, caused reactions called granulomas in some patients. Many doctors won't use it, but advocates say it's especially good for acne scars. Results are reported to be very dependent on the medical practitioner's technique. Price hasn't been announced. Artes Medical Inc., San Diego.
 
 Silicone: A permanent, liquid injectable that is making a comeback. Many doctors stopped using it a decade ago, especially after silicone breast implants were taken off the market. It remains controversial, but some dermatologists are using a purified product sold by Alcon Inc. for eye surgery. Like ArteFill, it's an option for permanent filling of facial scars.
 

Coming Soon

 Evolence: A collagen product developed by the Israeli company, Colbar LifeSciences, that was recently purchased by pharmaceutical titan Johnson & Johnson. Evolence is reported to be in late-stage human tests in the U.S. Dermatologists are buzzing about its potential to last a year or more and supplant other collagens on the market.
 
 Puragen Plus: A hyaluronic acid filler, expected to last about six months, about the same duration as Restylane and Juvéderm. Mentor Corp. launched Puragen in Europe last year. Puragen Plus includes an anesthetic, lidocaine, that the company says make the injections less painful than those of other fillers. Mentor hopes to launch in the U.S. late next year.
 
 Laresse: A biomaterial used in spine surgery that has been developed as a filler, expected to last about six months. Launched in the U.K. this summer. Entering U.S. human tests soon, possibly on the market in 2008. FzioMed Inc., San Luis Obispo, Calif.
 
 Aquamid: A permanent filler made from a biomaterial used in contact lenses and other medical devices. Sold for cosmetic use throughout Europe. FDA human tests expected to begin in the U.S. soon. Contura International A/S, Denmark.
 
 Reloxin: A Botox-like drug undergoing human tests in the U.S. Expected launch in 2008. Physicians hope it will break Botox's monopoly and bring down prices. Sold in Europe under the brand name Dysport. At the Palm Desert meeting, preliminary data were presented by a U.K. physician indicating it might not last as long as Botox. Medicis has U.S. rights.
 
 Puretox: Another potential Botox rival. Technology licensed by Mentor from the University of Wisconsin. A researcher there decades ago helped develop the purification process for botulinum toxin that later became Botox.

Reader Comments (7)

I haven't found much posted on users experience with Artefill and the newly approved Evolence. I have been using fillers for over 4 years and currently use 75% Radiesse and 25% Juvederm (best for lips and tear troughs). I'm hesitant to try Artefill because of the past issues with Artecoll and there doesn't seem to be any new benefit to Evolence.

My filler habits are almost identical to yours, InnovaMed. I would stay far away from Artefill. I hear it is great most of the time, but when there is a problem, it is a big problem. Why take the risk? I have not been convinced that there are any advantages to using Evolence. What will it's nitch be? Will it be a better filler, longer lasting with more volume than Radiesse? Will it be smoother and earier to inject than Juvederm? Great questions though. New filllers are coming. Where will they fit in? I will use them if they are as good, last longer and give MORE VOLUME per syringe AND come in BETTER SYRINGES !!!!!!!!!!!!!!!!!!! The other place that a new company may find traction is if the provide better training for beginner and intermedicate injectors. The training is currently very poor in my opinion. Are you listening Allergan, Medicis, Johnson and Johnson?

12.6 | Unregistered CommenterJEE

I am only 30 and have very mild nasal labial folds, and I do stress mild. I had a vial of Restylane injected in them and I don't see any difference whatsoever.

Should I try another product for more visible results?

Advice Seeker -

You probably didn't get enough filler. Did your injector suggest two syringes? It's got very little to do with your age. It has everything to do with how deep your folds are. Our experience is that most patients that aren't satisfied with their fill are the ones that needed more than they were willing to get.

I am 46 years of age, with pretty good skin. Mild sagging and facial atrophy. Not sure whether to get sculptra or prp (platelet rich plasma rejuvenation). Apparently if you like to drink wine, which I do, prp isnt good as your blood cells arent as healthy?

09.1 | Unregistered Commenterjulie

I’ve considered adding Sculptra to our practice after the new FDA approval for nasolabial folds and wrinkles because patients have started asking for it. However I went to the Sculptra website and found this statement:

"Eligibility for purchase and training
Sculptra Aesthetic is available to board-certified plastic surgeons, board-certified facial plastic surgeons, and board-certified dermatologists who have completed Sculptra training offered by sanofi-aventis U.S. For more information about training, please complete the form below."

I could purchase the product through MedicalSpaRx but would have to find a trainer or experiment on my own. Is Sanofi-Aventis really restricting it to “core” physicians? Any recommendations for training if Sanofi-Aventis won't do it?

11.21 | Unregistered CommenterInnovaMed

Good article, gives an overview about the most important actually available fillers. There is now a new astonishing filler on the market (worldwide with the exception of the US) product in the market, its name is CRISTAL, the range consists of 3 products which is enough to cover all indications, as it has a very high thixotropic property and can be easily injected although it has a very high viscosity. And there are no more endotoxins and proteins detectable in Cristal!
Good results, excellent biocompatibility together with a very economic price- thats new in the market

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