NEWS |
NEW METHOD TO AID FILLER CHOICE
W
ith booming interest in dermal fillers for minimally invasive treatment of facial lines and wrinkles, plastic surgeons are looking for evidence to help them
choose the product that will give the best results for their patients. A new, validated method for providing standard ratings of cohesivity for currently available hyaluronic acid (HA) gel fillers is reported in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The pilot study was conducted by Dr. Hema
Sundaram, a dermatologist in Rockville, MD; Samuel Gavard Molliard, a scientist in Geneva, Switzerland; and colleagues. Ratings of cohesivity and other biophysical properties are important not for identifying the single ‘best’ filler, but rather for choosing the product best suited to each procedure being performed.
Data on cohesivity to guide filler choice Injection of dermal fillers is rapidly increasing in popularity. Fillers are used to reduce facial lines and wrinkles, restore volume, and fullness and a youthful shape to the face. According to ASPS statistics, dermal filler injection is one of the most common minimally invasive cosmetic procedures, with 2.3 million procedures performed in 2014. In the US alone, the value of the filler market is more than $1 billion, based on statistics from the Cosmetic Surgery National Data Bank and other market research. Hyaluronic acid dermal
fillers are most commonly used because they are natural, gel-based products that are highly compatible with the body. A wide range of HA fillers are available, and plastic surgeons try to match their individual properties to the purposes for which they will be used. But there’s a lack of scientific data to support this matching process,
10
FAT GRAFTING OPTION FOR CALF AUGMENTATION
WILL HELP PLASTIC SURGEONS CHOOSE THE BEST PRODUCT
including the rheologic (flow-related) properties of the various available products. One key property is cohesivity, defined as the capacity of a material not to dissociate — in other words, how well it ‘sticks together.’ The researchers developed a standard test for comparing the cohesivity of HA dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology. A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale. On testing of six FDA-approved fillers, cohesivity
Ratings of cohesivity and other biophysical
properties are important not for identifying the single ‘best’ filler, but
rather for choosing the product best suited to each procedure being performed.
scores varied across the full range of the scale: from ‘fully dispersed’ to ‘fully cohesive’. Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one. But that doesn’t mean that products with higher cohesivity scores are always the best. Rather, the goal of the ranking system is to ‘provide a scientific rationale for the intuitive selection of different products for specific clinical objectives.’ In other words, to help plastic surgeons choose the filler with properties that are most suited to the precise purpose for which it is being used. For example, fillers with higher cohesivity may be a better choice for more superficial placement, or placement in mobile areas such as around the mouth or eyes. Products with lower cohesivity may be effective for use as ‘deep volumizers’, according to Dr. Sundaram and coauthors. The researchers believe
that having comparative data on cohesivity, as well as other rheologic properties, such as elasticity and viscosity, is an advance that can make dermal filler procedures more sophisticated and successful. This information will be increasingly useful as new FDA approvals increase the availability and variety of filler products.
October 2015 |
prime-journal.com
A study published in the Aesthetic Surgery Journal, showed that fat grafting for correction of slender calves, (either for purely cosmetic purposes or for discrepancies in appearance between legs due to deformities, infections, or trauma,) is a viable alternative to traditional implant-based calf augmentation. ‘Autologous fat augmentation offers a number of advantages over calf implants, including liposuction in adjacent areas to improve calf contour, smaller incisions, additional augmentation through subsequent fat grafting, durable results, lack of foreign body reaction, and precise patient-specific adjustments not possible with off-the-shelf implants,’ notes Dr. James E. Vogel, corresponding author and ASAPS member. Over a 5-year period, 13 patients
underwent calf augmentation and reshaping with autologous fat grafting. Ten patients underwent bilateral calf augmentation, and three cases were performed for congenital leg discrepancies. Fat was harvested from the abdomen, lateral thigh, medial thigh, waistline, flanks, axilla, upper back, and hips. Irrespective of the fat harvest site, liposuction was also performed at the knee to improve contour. ‘Local anesthesia was injected prior to
fat transfer to utilize the smallest amount of effective anesthetic volume and to precisely place it into the muscle resulting in less sedation and more rapid postoperative recovery,’ explains Dr. Vogel. A mean of 157 cc of separated fat was
transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Injections were first performed directly into the calf muscles and then into the subcutaneous calf tissue. Four patients underwent a second round of autologous fat injection for further calf augmentation because they desired additional volume. Fat volume was judged to be sufficient when the calf was minimally firm but not tense. At a mean of 19.6 months of follow-up, durable augmentation in calf contour was documented by comparison of standardized preoperative and postoperative photographs.
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