One Filler Down

We are used to hearing announcements for new fillers, but we now have an announcement of the disappearance of an FDA approved filler. Artes Medical, the company that makes Artefill, announced its intention to file for bankruptcy. Artefill was the first "permanent" filler approved in the US, although silicone, now available in a medical grade, has been used off-label for this purpose.

Using Fillers Near the Eyes

A recent article in the New York Times raises questions about the use of fillers around the eyes. In my view the article is not a balanced presentation and tends toward a sensationalism unbecoming for the New York Times. For example, the article makes a big point of saying that this is an off-label use of the product. It fails to mention that all fillers get approved for limited applications. For example, Restylane, the most widely used filler, is only officially approved for use in "moderate to severe wrinkles around the nose and mouth". If you get it injected into your lips, it's an off-label use. In fact there is no filler officially approved for injection  into the lips.

The article prominently mentions bumps and discolorations as potential complications around the eye. In fact, they are potential complications anywhere fillers are used. Although they are complications, they are almost always minor inconveniences that can usually be easily corrected. The potential complications of driving a car are much more serious.
That is not to say that serious complications are impossible. There have been very rare reports of loss of vision in an eye when material with material containing particles is injected in the general vicinity of the eyes. This has been reported most frequently with cortisone injections. A warning about this is included in most consent forms, but few physicians actually discuss the issue with patients. I do, and I tell my patients that the risk of this happening is much less than the risk of them getting into a car accident driving to and from the office. To the best of my knowledge this has not yet been reported with any of the approved fillers, and the Times article does not claim that this has actually occurred with these agents.
The use of fillers around the eyes has become routine at such prestigious eye surgery centers as the Jules Stein Eye Institute at UCLA. Their number of lower lid surgeries has been significantly reduced.
My current assessment is that the benefits of this procedure far outweigh the risks and that the risks of lower lid surgery are significantly greater than the risk of filler. Patient satisfaction with this procedure is very high.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA

Eyelid Tightening

As we get older, drooping and wrinkling of the eyelids can be a distressing acquisition. Surgery has long been an option for dealing with this, but it is not a good approach for dealing with fine wrinkling. Generally, if one attempts to pull the skin tight enough to eliminate the fine wrinkling, especially of the lower lid, there is a significant chance that the additional tightening, that occurs as a part of healing, will produce distortion of the eyelid shape. This is known as "round eye" or "scleral show."

The Lure of the New

New fillers are in various stages of development. Each new filler has to establish a niche for itself, to be able to differentiate itself from the already well established fillers. Evolence, which has recently been approved in the US, is the newest of the collagen fillers.