n by Louise Gagnon OF THE CHRONICLE
Restoring volume, tightening skin, and correction of fine lines are all highly feasible tasks for dermatolo- gists and plastic surgeons and cosmetic physicians who have ready access to an ever-widening land- scape of fillers in the Canadian marketplace. “There has been an evolution,” explains Dr.
Mark Lupin, a dermatologist in Victoria, BC, and clinical instructor in the Department of Dermatology and Skin Science in the Faculty of Medicine at the University of British Columbia in Vancouver. “We used to put fillers where the wrinkles appeared or in the nasolabial folds. Now, we treat the full extent of the face. There is almost nowhere [on the face] that we do not go with fillers. If we did not treat [the patient] globally, we would be doing our patient a disservice.”
The variety of fillers allow clinicians to target
different areas of the face, taking into account fac- tors like thickness or thinness of the skin and laxity of the skin, explains Dr. Lupin, adding the viscosity and cohesivity of the filler also weighs into the deci- sion of which filler is appropriate for which site on the face. To treat fine lines of the face, Dr. Lupin selects Restylane Fine Lines or Juvéderm Ultra. To treat a delicate area like a tear trough, he may choose Teosyal Redensity. To produce volume or to treat more deep structures, Dr. Lupin would select a volu- mizing product like Juvéderm Voluma, Perlane, or Teosyal Ultimate.
The plethora of fillers is an exciting opportu- nity for clinicians to optimize facial rejuvenation. “It is like an artist who chooses colours on the palette,” says Dr. Lupin. “You choose the colours that give the best results.”
One of the newer approach in skin rejuvena- tion is an attractive option to patients because the key component is their own blood.
The Selphyl system for platelet-rich fibrin matrix has a track record of safety and efficacy for treating wounds and sports injuries. It now has become increasingly used in the cosmetic arena. “It’s a phenomenal product in the right
patient,” declares Dr. Scott Barr, a plastic surgeon in Sudbury, Ont., director of Barr Plastic Surgery,
and consultant with SKIN Medispa. “Patients like the concept of stimu- lating collagen pro- duction [with platelet-derived growth factors]. It is my go-to product for pigmentation correction, improv- ing skin texture, and reducing hol- lowness in the tear trough.”
Platelet Rich Plas - ma (PRP) product worth mentioning said Dr. Yves Hébert is the RegenKit from Regenlab (Switzer - land), distributed in Canada by Clarion Medical Technologies.
“The Regen -
Kit is another sys- tem designed to prepare Auto -
Fillers The state of 2012
logous Platelet Rich Plasma (PRP) by centrifuga- tion of peripheral blood in a vacuum tube, using a thixotrophic gel for cell separation and citrate as anticoagulant,” explained Dr. Hébert, a Montreal general practitioner, Director of Médecine Esthétique in Montreal, and President of the Canadian Association of Aesthetic Medicine. He is also a member of the editorial board and guest edi- tor of this issue of THE CHRONICLE OF COSMETIC MEDICINE + SURGERY.
“In all, the system is easy to use and produce four to five mL of PRP from nine cc of blood. Platelets are vehicles for the delivery of growth fac- tors that induce proliferation of fibroblasts, osteoblasts and endothelial cells, promoting and accelerating healing of tissues. Applications in aes- thetic medicine are numerous, from periocular and
perioral rejuvenation to treatment of fine lines and improvement of skin tone.” Like Dr. Lupin, Dr. Barr says patients may ini- tially ask for erasing of some wrinkles or fine lines, but patient education and a global assessment of patients often leads to restoration of the facial bal- ance.
“Skilled and experienced injectors spend time educating their patients and gain their confidence to treat their face,” says Dr. Barr. As a plastic surgeon, Dr. Barr sees surgery as a stand-alone treatment, but notes that in select patients, particularly thinner patients, fillers may be an option after surgery. “You may want to put more volume in the temples, for example, post-operative- ly, to give facial balance,” he notes. Time takes its toll on the skin, and lines that
The Chronicle of Cosmetic Medicine + Surgery
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