| RESTYLANE SILK | INDUSTRY INSIDER


injectables, should be injected very slowly. Since the products advantage is its ability to reduce more superficial facial lines with greater durability, its physical properties, perhaps make it a little more rigid than some other hyaluronic acid fillers. There can be potentiallymore quickly resolving, yet immediate swelling that can be avoided with some simple maneuvers.


Like most filling agents,


injection techniques vary with each product for best results so this shouldn’t come as a surprise,’ said Fagien. ‘Another advantage is that it doesn’t overbulk, yet injectors must keep in mind that for volume filling, when being utilized for the correction of fine lines plus volume enhancement, Silk should be used in combination with other products for best results.’ Restylane Silk can also be used in


tandem with Restylane and/or Perlane in the same patient as needed. ‘You can use Restylane Silk for the fine line component, and Restylane for deep nasolabial folds for volume. It also works nicely for deep glabellar lines with a neuromodulator to smooth it out first,’ said Fagien. ‘The product seems to flow where it is


needed, as if you were to pour a liquid onto something and it flows into cracks and crevices. If you inject it too quickly when you’re injecting lips, you’ll get more swelling than you are used to seeing. The key is to inject submucosal in the lips. If you are injecting the vermillion, it is important not to inject into the muscle because you will get a lot of swelling,’ said Biesman. ‘As Doctor Kent B. Remington in Calgary says, you should treat it like a princess and be a little gentle with it,’ he said. As we have seen with most injectable


products in the US market, experienced injectors inevitably choose different products for specific indications and discover their own personal preferences for how and where they use each product. In some cases, these may include off-label indications. According to Dr. Biesman, ‘Restylane Silk


is also beautiful in the tear troughs, which is an off label use. I have not seen the Tyndall effect to date, but I have seen a Tyndall effect with most hyaluronic acid products and I suspect it could be produced by this one as well. It injects nicely, Restylane has been my go to product for tear troughs for a long time. It is too early for me to say whether Restylane Silk will become my first choice for tear


One of the important points is that


it is the first and only injectable filler that has a specific FDA indication for upper lip enhancement and the


smoothing of wrinkles around the mouth.


results and we can treat lip lines with greater precision and subtlety.’ Another benefit of Restylane Silk that


practitioners point out is the support of the Galderma organization and its portfolio of dermatology and aesthetic products behind it. ‘I am extremely impressed by the


infrastructure that Galderma has built in a very short period of time. From my own observations, they are very serious about growing the marketplace overall which is what all of us really hope for. What physicians want most are good quality products with research behind them and companies that are focused on growing the market. The Galderma team is doing a lot of listening and taking suggestions from experienced injectors. It’s a solid team of good people,’ said Biesman.


On the horizon Targeted dermal fillers attract the interest of many practitioners due to the unique design of the products to address specific indications, especially the delicate eyelid region and the lips. For example, Teoxane® Laboratoires’ PureSense Redensity [II] is a hyaluronic acid-based gel created to target


troughs, but it is entirely possible,’ he said. Miami-based dermatologist Jill Waibel


said, ‘Restylane Silk provides excellent results in reducing the appearance of the fine rhytides of the upper lip. The addition of lidocaine allows for a relatively comfortable experience for patients. Restylane Silk provides smooth, natural


the tear trough area. The next lip filler that is anticipated to


make its way to US shores is Allergan’s JUVÉDERM® VOLBELLA® with Lidocaine. Part of the JUVÉDERM range of dermal fillers, VOLBELLA was specifically tailored for the lips for a natural look and feel and gained a CE Mark in 2013. A clinical study showed that JUVÉDERM® VOLBELLA® with Lidocaine is well tolerated and has been demonstrated to provide a smooth and natural improvement in lip fullness that lasts for up to 1 year. In addition, the treatment is associated with high patient satisfaction, with 86% of patients reporting maintained improvement in the look and feel of their lips after 9 months and 57% of patients still reporting maintained improvement after 1 year5


. This new wave of fillers offer a greater


level of sophistication for skilled injectors who have advanced the state of what was once simply considered line filling to pan-facial sculpting and volume restoration. The number of syringes as well as the range of products that may be used for any given patient is subject only to the injector’s aesthetic judgment and the patient’s tolerance for needles, downtime, and budget.


Further information


restylaneusa.com/enhance-lips/first-fda- approved-product.aspx


References


1. U.S. Food and Drug Administration. Restylane Silk Injectable Gel - P040024/S072. Silver Spring, MD: U.S. Department of Health and Human Services, 2014. Available at: tinyurl.com/n2lbfdh [last accessed January 22, 2015]


2. Restylane. The first and only FDA-approved products for lip enhancement. Lausanne, Switzerland: Galderma, 2014. Available at: restylaneusa.com/enhance-lips/first-fda- approved-product.aspx [last accessed January 22, 2015]


3. Restylane. About the Restylane® Family of Products. Lausanne, Switzerland: Galderma, 2014. Available at: www. restylane.ca/AboutRestylaneProducts.aspx [last accessed January 22, 2015]


4. Merz Aesthetics. Beletero. Merz Aesthetics, 2014. Available at: www.belotero.com/the-benefits-of-balance/ [last accessed January 22, 2015]


5. Eccleston D, Murphy DK. Juvéderm® VOLBELLA® in the peri-oral area: a 12 month prospective, multicenter, open label study. Clin Cosmet Invest Dermatol. 2012;5:1–6


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