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.

The original collagen fillers, Zyderm and Zyplast, were bovine derived products that were FDA approved in 1982, and quickly became the fillers of choice. They were particularly useful in the lips, where their smooth flow characteristics made them easy to work with. Eventually, because of their relatively short duration of action, they were, for the most part replaced by the longer acting hyaluronic acid fillers. These fillers are longer lasting than bovine collagen but, because of their affinity for water, when injected into the lips, they can be associated with significant swelling for several days.
Initially there were reports of development of a porcine derived cross-linked collagen filler (Evolence), which did not need a skin test and which was reported to last up to a year, it was hoped that this new filler would combine the smoothness of bovine collagen with durability that equalled or exceeded that of the hyaluronic acid fillers. It was subsequently reported that this filler was associated with less swelling immediately post injection, when compared to the hyaluronic acid fillers. If all of this were true Evolence would be a contender for the optimal filler for the lips.
Unfortunately, there appear to be problems with the use of this filler. It does not appear to flow as smoothly as the bovine collagen fillers. Furthermore, there have been reports of the frequent development of long lasting lip nodules associated with this filler. A report from Vancouver, Canada stated that 16 of 20 patients injected with Evolence developed lip nodules. Certainly, there have been reports of nodules developing in the lips with other fillers, but not with anything approaching this frequency. Furthermore, hyaluronic acid filler nodules are very easy to manage, and this does not appear to be true of the Evolence nodules.
There are still people claiming to get good results with Evolence in the lips, especially with aggressive very early massage of the product.
Until this filler is better established, my recommendation would be to stick with the hyaluronic acid fillers. A few days of decreased swelling is not a good trade off for an increased risk of difficult to deal with nodules.

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