Skin Fillers for Facial Rejuvenation
Posted Wed, Jan 27, 2010

The dichotomy in the hype of filler products for facial rejuvenation has confused physicians and made intelligent comparisons on the part of the public virtually impossible. In order to understand the confusion in marketing fillers I will divide the protagonists into 2 camps: the manufacturers and salons (medispas) vs. cosmetic surgeons which include sophisticated dermatologists, facial plastic surgeons, plastic surgeons, oral maxillofacial surgeons, and oculoplastic surgeons.
The hype looks like the following:
Manufacturers must sell as much product as possible to maximize profits. In order to increase consumer consumption, marketing revolves around simplistic notions of instant repair such as erasing nasolabial folds- the fold between the sides of the nose and the corners of the mouth and advising frequent re-treatments.
Medispas likewise promote simplistic makeovers which are quickly performed and provide instantaneous results.
These promoters can get away with such obfuscation by exploiting the difference between the forest and the trees. As the saying goes we tend to focus on the trees and not appreciate the forest much as we might not recognizing the elephant in the room.(Kindergarten: How can you tell if there is an elephant in the room. Answer: By the faint odor of peanuts on his breath). A typical patient complains about a line around her mouth and misses the point that her cheeks and eyes are sunken-in which not only causes the line but is the real reason she is looking older. By contrast a child with a scar on her cheek looks youthful and has a scar. (Don’t fall for the “I will just inject filler under your eyes and your circles will go away” either.)
Manufacturers and medi-spas also promote differences in products in order to justify more and less fee schedules for products. They do this primarily by claiming that different products have different longevities which is a concept that is easy for the public to understand. Longer duration of correction should provide lower cost over time and less need to retreat. They conveniently do not explain that in areas of the face with more muscle contraction fillers have shorter duration of action and visa versa. Therefore hyaluronic acid infiltrated into a cheek may last 2 or more years and sculptra may last up to 6 years whereas the same products placed around the mouth may last up to 70% less.
As I have been teaching at MetropolitanMD for the past 10 years rejuvenating eyes, cheeks, and temples not only lasts a relatively long time, the results do make one appear more youthful and healthy. The first step in facial rejuvenation is knowing why one looks older before it is possible to resolve the problem. It is kind of like putting a bigger burger in your sandwich vs. covering it with a larger bun. It’s all in what you want

Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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