Toronto based dermatologist and president of DASIL (The Dermatologic & Aesthetic Surgery International League), Dr Sheldon V Pollack, discusses the evolution of dermal fillers – and the movement towards achieving a more natural, subtle improvement of facial features.
With the approval of the injectable, Bovine Collagen (Zyderm) in the United States in 1981, a new era of facial rejuvenation was born. No longer would certain individuals with mild signs of ageing need to undergo surgery, and suffer its potential adverse outcomes. Rather, a visit to the dermatologist and a few minutes of treatment could deliver an immediate freshening effect.
Now, more than 30 years later, those initial forays into improving the appearance of crow’s feet, worry lines of the brow, and deep nasolabial folds seem primitive. Treatment of lines and wrinkles has evolved to include the correction of diminished facial volume related to senescent fat and bone loss, as well as the resultant sagging of the overlying skin.
This change in how we use injectable dermal fillers required a thoughtful understanding of how faces age – and a new pattern emerged some 10 or 15 years ago. We now know that “re-inflation” of fat-deprived cheeks, chins, jaw lines and temples (often combined with the careful use of neuromodulators), can subtly restore a look of rested health and vigor to middle-aged men and women.
The evolution in the use of facial fillers continues. This was apparent at the recent Dermatologic & Aesthetic Surgery International League (DASIL) annual Congress, convened in Sun City in September 2014. There, experts met to discuss (among other things), non-invasive aesthetic treatments for the ageing face using neuromodulators and dermal fillers.
The consensus expressed in many of the lectures pointed to the directions in which the dermal filler evolution is proceeding.
First, there is a movement towards a more natural, subtle improvement of facial features – instead of the more obvious, over-zealous filling of areas of fat loss. “Less is more” is the credo expressed by many of those lecturing on the subject. It is known from market research that the goals of patients presenting for dermal fillers are to look “natural”, “rested”, and “healthy”.
Many patients express concern that they will look “overdone” after their treatments. Our job is to resist the temptation to be overly aggressive when using facial fillers. A patient should not look “different” when they leave the office… just “better”.
Effective treatment requires building a reputable, solid relationship with patients. This enables the patient to trust their treating physician will provide precisely what they want.
In order to do so, the physician must outline his or her treatment plan and its rationale – after first listening carefully to what the patient is saying.
Personalised treatment, rather than a “cookie cutter” approach to filling is necessary. Inherent in a successful doctor-patient relationship is the demonstration, by the physician, that he or she truly cares. This can be achieved by asking all filler patients to return for follow-up in about one month, to be certain that they are pleased with their outcomes. In my practice, patients are not charged for minor “touch-ups” that may be performed at that follow-up visit.
A second aspect of modern filler use, expressed by several speakers at the DASIL meeting, suggested that we should consider not only the outcomes of our filler treatments – but even more importantly, understand how these outcomes actually affect our patients. Ultimately, we are affecting self-esteem. Even if we think that our result has been stellar, we have not succeeded in our treatment if the patient does not share this view. It is therefore important that the aesthetic physician understands what precisely would make the patient benefit the most from the filler treatment. Our goal is to help the patient achieve an improvement in his or her self-esteem… not to change his or her looks.
Interestingly, some patients (particularly those in whom filler treatments would be of little value) will gain increased self-esteem by simply being told that they look fine – and therefore can go forego such treatment (for the moment, at least). They then leave the office happy and self-confident, ready to face the world with a boost in their self-esteem!
This non-treatment can represent the most ethical and noble form of medical practice.
Finally, part of the evolution of facial fillers has been the development of new products.
Among the most notable of these are “bio-stimulants”, which stimulate the skin to produce new, long-lasting collagen.
This is opposed to routine fillers, which temporarily provide fullness but must be replaced as they are degraded by the body. Biostimulants can be used in combination with dermal fillers to provide a combination of both short-term filling and sustained collagen deposition.
It is possible (and likely) that future products will combine both of these effects in the same syringe. And so the evolution continues!
This article was written by Dr Sheldon Pollack.