The "Wow" Effect

There are precious few procedures that we perform where, immediately after the procedure, we can hand the patient a mirror and their typical response is "wow". The injection of filler is the outstanding example of this phenomenon. The results are immediate and frequently very impressive. The final result, however, is more of an art, rather than a science. This is especially true now that filling has evolved from plumping up a specific groove to re-contouring the face, producing a more youthful facial structure. This is very operator dependent and it is unusual to see physicians who are not members of "core" cosmetic specialties (dermatology and plastic surgery) venture into this arena.

"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

Sculptra Article: New York Times

There will be an article about Sculptra published in the New York Times on Thursday September 24. I have been interviewed for the article and, unless I'm edited out, you can read my thoughts about the topic.

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

Finally a Use for Sculptra?

Sculptra has been one of the products that we have used and discarded. The advantage of Sculptra is that it is the longest lasting of the fillers, frequently lasting 2 years or more. The disadvantages of Sculptra have been many: it requires a series of injections and was slow to produce visible improvement; it can be expensive and it has a propensity to develop nodules, sometimes starting more than a year after the material was injected. Because there were other fillers that were less expensive, relatively long acting and produced immediate improvement without the same propensity for nodule formation, there seemed little reason to use Sculptra. Now there is a report from Brazil that describes new uses for Sculptra that allow it to treat problems that previously had no good solution.

Evolence: The New Filler in Town

Evolence was approved by the Food & Drug administration in late June 2008, and is now being rolled out across the nation. It is a porcine (pig) collagen based product which has been available in Canada and Europe for about 2 years. It is much longer lasting than the original bovine (cow) collagen or the human based collagen that is now available as well. It has a number of advantages and at least one significant disadvantage.

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.

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 Secrets of Natural Looking Filler

As the use of fillers becomes more prevalent and the uses of fillers more widespread, the goal of creating a natural look with fillers has become increasingly attainable. We now know that the best use of fillers is the replacement or creation of volume, rather than the simple filling of lines and grooves. Most people want to look better and younger, rather than look like someone else. Therefore, it is a good idea to have an idea of what is the goal that you're aiming for.

Six-inch Heels

As you may have read, the hottest fashion item this Fall is six-inch or higher heels. They have thick soles as well and make the wearer look more like a superhero than a dainty woman. At the Prada 2009 fashion show in Milan in September, two models tripped and others staggered. Reportedly models were crying in fear, backstage.

The Filler as Time Bomb II

Below is an email received today relating a patient's experience with Sculptra. Next is a follow-up email.

Dear Dr. Bock,

Is there any procedure that you may be aware of to remove these horrible "foreign body objects" per the dermo who saw me after the plastic surgeon got done with me.

They appeared five months after my first Sculptra treatment.  They are underneath both eyes.  Seems they were caused by my "normal healthy" reaction to having three Sculptra injections (Sculpta sounds so much nicer than Polylactic Acid, a better ring).

I'm not an HIV male, just an under-informed and angry (just what I don't want to be) in shock female who remembered when doctors seemed to help not harm.

ps:  The Plastic Surgeon did however manage to easily remove $5000 from my wallet but can't do a thing about removing these scars.  Sorry about my tone.  Truly any safe corrections you may know?  Of course, I also had zero results of any increased volume.  Guess I have "faulty collagen" too boot!  Who knew...

Thanks much for coming out against this product that should should never have been allowed on the market in the first place.

There should be more docs like you who just say no to this scam.