“A redefinition of what is ‘temporary’, ‘semi-permanent’ and ‘permanent’ is now required,” argues DR DAN DHUNNA
With the Keogh review well under way, fillers are in the limelight with some quarters suggesting that they be reclassified as POMs. A recent survey by BAAPS showed that two out of three of their members had seen problems with temporary fillers and half had had to deal with problems from permanent fillers. Worse still, 84% of those having problems with permanent fillers required corrective surgery or were deemed untreatable. So what determines if a filler is temporary or permanent?
Ten years ago I initially used Restylane. Apart from collagen, there were little other “temporary” options and the benefit of no allergy testing and having a potential “eraser” for HA in the form of Hyaluronidase enzyme seemed prudent. The story of Leslie Ash and her infamous “trout pout” had just broken and the thought of “permanent” options (especially silicone), to me were a no-no.
There were other, so called “semi-permanent” products such as Radiesse and Sculptra. Working by directly stimulating collagen production they are non-reversible but break down or are metabolised, giving longevity between 10-18months in my practice.
I found Restylane performed well and duration (depending on the area injected) was about six months. I would get a contingent of patients who swore that the product was still in situ many months – or even years – later as their “line hadn’t returned”.
We now know that this phenomenon is more likely due to secondary collagen development as a result of the filler itself and also somewhat from the injection procedure. However, we also know that depending on the area injected longevity can vary and I have spoken to many a surgeon who believes that they have seen HA filler material still existing in the periorbital region upon blepharoplasty several years after original injections for tear trough treatments were carried out.
As Silicon went out of vogue other “permanent” fillers were launched. Polyalkylimide based Bioalcamid proved initially popular, but to this day we are still seeing problems. The only main contender left in the UK market is Aquamid with longevity reported at five years. Other synthetic “temporary” non HA products also came and went, Laresse and most recently Novobel.
As technology advanced and with the advent of Juvederm Ultra we were all seeing longer durations of HA fillers of upto a year. With the next generation of Allergan HA fillers, my patients were demonstrating longevity with “Voluma” of about 15 months and in some cases 22 months! And with the recently available “Volbella” having a license for upto 12 months in the normally limiting lip and perioral area surely a redefinition of what is “temporary”, “semi-permanent” and “permanent” is now required?
Our patients are very interested in how long their fillers will last and let’s be honest, it is a great “selling point” – but surely the issue isn’t longevity?
As the lines between “temporary” and “permanent” dermal fillers are now already being blurred, I’m sure one day in the not so distant future, HA fillers will last even longer.
The issue (safety aside), must be of potential reversibility. But again, we must be careful what we promise. Hyaluronidase has immense value to us, but the potential side effects of allergy and destruction of intrinsic Hyaluronic Acid as well as migration to unwanted areas leading to back and forth trips to the practitioner’s chair for top ups is a possibility. And as HA fillers become stronger and longer lasting, will there come a time when they will out perform and become resistant to the reversibility we have all been taught to cherish?
Dr Dan Dhunna
Harley St and Midlands
See the original article in the new Aesthetic Connect Magazine: http://www.handipublishing.co.uk/aestheticConnect/aestheticconnect03/ “