The field of cosmetic dermatology, especially in the area of soft tissue augmentation, continues to be in constant evolution with newer products, materials, and innovations in technology. Many of these product technologies emanate from other parts of the world than the US; they become available and widely utilized before making their way across the Atlantic to receive FDA approval.
In the area of injectables, a number of newer filler formulations have been made available. Changes in hyaluronic acid (HA) production have been made to incorporate patients' demands as well as the market's. Teoxane Laboratories' Teosyal RHA range, which has been FDA approved since 2017 but not yet commercialized, allows the HA a degree of dynamism owing to the preservation of the natural bonds, making it ideal in areas of motion.
Another breakthrough is the use of mepivocaine rather than lidocaine as an anesthetic. This can be seen in the new Vivacy line of Stylage HA fillers. This need has stemmed from the fact that Allergan holds the patent for the use of lidocaine in the US and manufacturers who use it have to negotiate with the company before commercialization.
Other manufacturers have decided to not use butanediol diglycidyl ether (BDDE) as their crosslinker, opting for a different molecule altogether: polietilen glycol (PEG). The cross linker, which is incorporated in Matex Lab's Neuvia line of HA fillers, has been shown to cause a lesser degree of an inflammatory response when injected. Matex also makes other innovative filler combinations and has a product that combines both HA and calcium hydroxylapatite (CaHA) that does not just fill an area but will also stimulate collagen production.
Speaking of CaHA, injectors have found many innovative off-label uses for Radiesse. By hyperdiluting the material at a ratio of 1:2 to 1:6, depending on the skin texture, researchers from Brazil and Europe have shown that Radiesse acts as a true collagen stimulator, especially in areas of laxity, such as the neck. These exciting offerings in the areas of fillers may soon be available in the American market.
Botulinum toxin has also seen a surge in interest with the recent FDA approval and launch of Jeuveau (prabotulinumtoxin type A) from Evolus. The toxin is the only one in the US market that will be a 900kD biosimilar to Allergan's Botox (onabotulinumtoxin type A). The toxin, which is manufactured by South Korea's Daewoong and has been available for years in Asia and marketed as NABOTA (Natural BOtulinum Toxin type A), will be the first Korean toxin to be commercially available in the US. Evolus will market its product only for the aesthetic market and not therapeutic. This move may allow the product to be priced less and thus potentially be a true competitor to the leading brand.
Enjoy the Ride
Technology continues to evolve in this field and there is never a dearth of new materials and treatment modalities to come. The ability to provide more options for our patients than what was available 10 years ago will allow for a better experience and overall result. One has to simply wait, soak in the experience, and make sure to enjoy the ride.