Toxins and Fillers: The Next Generation

When it comes to toxins and fillers, the future is now, and staying on top of the most effective toxins and fillers is of paramount importance for the aesthetic professional. Modern Aesthetics® editors reached out to several experts to get insight on how they are staying ahead of treatment trends, as well as sharing success stories from their practices.

JENNIFER LEVINE, MD

How do you stay up to date on the latest techniques, technology, and treatment options?

I get to travel to national and international conferences at least once a month, where I have the benefit of sharing my knowledge with, as well as learning from, my peers. I also participate in studies of the latest technologies and treatment techniques, as well as review studies completed by my peers.

Would you like to share any notable success or patient transformations that you are proud of?

I love creating beautiful results; it is so meaningful to me to be able to give a patient a meaningful change with little to no downtime. I use neuromodulators in both the upper and lower face to create a lifting effect as illustrated below.

What do you see as the future direction of toxin and filler treatments? Are there any emerging injectable treatments you find promising or exciting?

I think we will continue to see the evolution of toxin treatments to the lower face–masseter, depressor anguli oris (DAO), and mentalis platysma.Combining neuromodulators with hyaluronic acid (HA)/CaHA (calcium hydroxylapatite), sculptra will become more popular for skin quality and also repositioning. There are also hybrid injectables coming to market. Skin priming, and the combination of regenerative procedures such as PRF/exosomes with biostimulatory fillers are another exciting area.

RUTH E. TEDALDI, MD

What do you see as the future direction of toxin and filler treatments?

Toxin injections will become like toothpaste brands with standouts for less migration, less immunogenicity, being longer-lasting (which we already have), and multi-factorial with respect to ability to cause not only neuromuscular blockade but also having profound effects on skin quality (which we also already have)! They will be available at the corner CVS with injection by the pharmacist, much the same as our vaccines. The biggest change will be the use topically which will not require a professional for administration.

Fillers will change with their incorporation of elasticity stimulation stem cell injection, which will truly turn back the hands of time.

Are there any emerging injectable treatments you find promising or exciting?

I am very intrigued with the newest formulations of synthetic elastin and how the incorporation of these agents will change the nature of injectables from space occupying and even biostimulating to resemble the more youthful qualities of stretch and release.

Can you provide an overview of the most used injectable treatments in your practice and why?

My practice has curated itself into seekers of the most natural and least obvious change—merely to look and feel better, but not perceptibly different. To that directive, most come for wrinkle relaxation with neuromodulator but not paralysis and it is most commonly done with the addition of minor elevation of the lateral mid face with HA fillers. Frown lines are gently lifted with minimal HA fillers and lip volume is gently restored centrally only with the lightest and least firm HA. All together self-esteem is augmented!

CHRIS C. SUREK, DO, FACS

What recent advancements or innovations in toxin or filler treatments have impacted your practice and how?

The continued influx of new soft tissue fillers into the market has expanded my ability to further customize treatments for my patients. As an injector it is paramount to ensure you select the correct gel rheology and the correct anatomic plane. If these two are not congruent then suboptimal outcomes can result.

How do you stay up to date on the latest techniques, technology, and treatment options?

I am a life-long learner. The best injectors I know are constantly reading, attending meetings, and reviewing new trends, products and devices. We owe it to our patients to be as educated and up to date as we can be to ensure we are giving them the best version of ourselves and our skillset. I am fortunate to lecture and teach in a variety of educational events and I always learn something new each time. Education is paramount as an injector.

Would you like to share any notable success or patient transformations that you are proud of?

This patient (pictured above) has been in my practice for several years. In the photo on the left, I have done lip enhancement for her, but had not addressed her midface or posterior jawline. She desired a more sculpted jawline and midface with an enhanced ogee curve. The photo on the right is very recent and was taken following a series of injection sessions and utilization of a variety of products to help enhance facial shape based on her personal aesthetic desires.

What do you see as the future direction of toxin and filler treatments? Are there any emerging injectable treatments you find promising or exciting?

There is so much to be excited about in the injection world regarding toxins, fillers, and even biostimulatory agents. Many products are now coming “on-label” in more advanced and technically challenging injection areas (i.e. infraorbital hollow, temple and jawline), which opens the door to more opportunities and options for injectors to perform comprehensive shape restoration and/or shape enhancement on their patients. I am excited about the potential for newer toxins with unique times for onset of action and/or duration, as well as injectables that may combine hyaluronic acid with other products or biostimulatory agents. There are a lot of amazing things coming down the pipeline in the future! I love the innovation and forward thinking of this industry.

Disclosures: Dr. Levine reports the following relationships: Consultant for Allergan, Benev, BTL, Cynosure, Galderma, Merz, Mint Threads, and Revance.

Dr. Surek reports the following relationships: Consultant for Allergan, Cypris Medical, and Galderma.

Dr. Tedaldi reports the following relationships: Allergan (Master Trainer); RegimenPro (Chief Medical Officer); Revision (Medical Advisory Board); Revance (Medical Advisory Board).