What's New in Fillers

There are a great number of fillers available, many of which are not currently approved in the US. The next major new filler scheduled to be approved is Evolence, a porcine derived collagen which was developed in Israel. The advantage of the original bovine collagen filler was its very smooth flow. Disadvantages were its short duration of effect and the need for a skin test. Evolence is said to persist  for a year but, unfortunately it appears to lack the smooth flow of the  earlier collagens. It does not require a skin test.  The company has  introduced a second generation product, Evolence Breeze, which may overcome some of the shortcomings of the original product. Until it is released, it remains an unknown.      

Improvements in injection pain control have been a significant advance in the use of fillers. Innovations, including the mixing of anesthetic with local anesthetic, have made the injection much more comfortable. These are the comments of a new patient injected with Restylane this past week. About a year ago she had Restylane injected in the same area by another physician. A year ago she experienced considerable pain with the injections: "I just could not believe hoe i could not feel anything this time. I'm just in awe. I mean it was like night and day. I can't even begin to tell you the difference." When asked to rate her discomfort with the treatment this time with the treatment last year, she rated last year as a 9, on a scale of 1-10. This time she rated it zero.

Several companies will be coming out with anesthetic premixed with their fillers. The mixture will not contain epinephrine. Many of us are already doing this and are including epinephrine in our mix, hoping that it will reduce bruising as well.

Anther, more controversial topic is the injection of filler from inside the mouth. there is no question it can be done successfully. Those who advocate it claim it reduces pain and bruising. Those opposed say it may result in an increased risk of infection. The jury is still out on this, but currently we are not doing it.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA