Exchanging Clinical Information and Treatment Protocols about Dermal Fillers.

Is anyone using Perlane for the lips? How is that working out? How long does it last? Are you using the 27 gauge syringe?

Do you mix lidocaine with the Perlane?

SANTA MONICA, Calif. – Patients who may desire lip augmentation the most – those with thin lips – can be the trickiest to treat, and physicians should use particular caution in injecting around the vermillion border, said Roberta D. Sengelmann, M. D., at the Skin Disease Education Foundation’s Cosmetic Dermatology Seminar 2008.
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“If the patient has a long, thin upper lip, you really don’t want to treat the white roll."
- Roberta D. Sengelmann, M.D.
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Patients with long, thin upper lips, in particular, should not be treated along the vermillion white roll, Dr. Sengelmann warned.
“If the patient has a long, thin upper lip, you really don’t want to treat the white roll,” said Dr. Sengelmann, a dermatologic and cosmetic surgeon in Santa Barbara, Calif., and St. Louis, Mo.
“If you treat the vermillion and not the pink lip on such patients, it will only look like you’ve lengthened the lip,” she said. “Treat the pink area instead to see if you can lift the lip up.”

Thoughts? Comments?

From: dailydermpearls.com

Dr. Emmett:
I ahve not used Perlane for the lips but would try it myself if asked upon. I use Radiesse for the vermillion white rolls using 30 inch needle. Therefore, I would try to use the 30 inch needle first and push the Perlane very slowly thru. This would give you much better control. I would go deeper than since Perlane is thicker than Restylane or Juverderm. I don't mix Lidocaine with any of fillers that I use.
JEE:
I agreed with what Dr. Sengelmann said. I would definitely try to see how much I can augment the lip body first before going for the white rolls in these patients. Putting some Botox to the DAO might also enhance the "lifting" effect

I would definitely use the Perlane deep. The Perlane is not going to soften up enough and if the pt kisses someone they will be able to feel it. I do not use it in the lips but have talked to other and they are right on the muscle.

Allergan is saying that 30% of Radiesse's effect is gone in 3 weeks because the gel carrier is reabsorbed.

Radiesse says that it takes 2-3 months for this to happen AND by that time enough collagen is stimulated to keep the volumizing effect.

Is Allergan lying about Radiesse because they give 62% more filler per syringe ( 0.8 cc vs 1.3 cc)?

Bottom line is: How much volumizing effect is there 3 weeks, 3 months, 6 months and 9 months after injecting the NL folds with Radiesse vs Juvederm vs Perlane.

Does anyone know?

Is this filler WAR going to get nasty? Stay tuned. I love it when the big boys fight.
I am pissed at Allergan for trying to influence my injecting habits with B_LL Sh_T, and false information.

Right now, I believe Radiesse and I think Allergan is Lying.

Hey Allergan, how about giving us more volume if you want us to use your product.
Stop treating us like idiots. We are not idiots (maybe we are)!

Has anyone noticed that Allegan is not as nice to us anymore? They are treating us like children. I can't wait for Relaxin to come out.

How long do the following fillers last in the NasoLabial Folds (on average):

Juvederm Ultraplus:

Perlane:

Radiesse

Tell me what you think and then tell me what you know. Thanks.

Hi I am a newbie to this. I am a physician and have completed a training course. More is always needed. I am looking for advice on the best way (Safe and economical) to get supplies of Botox and fillers. I am considering Botox (no option) Juvederm and radiesse. I live in Canada and wonder whether I would be better getting the product through a pharmacy or direct from the company at least initially. I may be going into a laser eventually. Suggestions welcome.

Get it directly from the company. They have reps all over, so just contact them through their website. I don't think you can get it through a pharmacy. They will also provide training. Try to get as many training videos as you can and watch experienced injectors.

How can we pay a physician to do botox, fillers for a medspa in NY. Are we allowed to pay them as an independent contractor?

If you are not doing any type of insurance such as medicare there is really no issue. My lawyer was going over this with me regarding me taking laser services into a derm office (they are all afraid of light and declined my offers for free money) and contract physician will not be an issue with the OIG. They do not like the rental space deal that docs do.

It's my understanding that a non-physician can't sub-contract to a physician. It makes sense to me because that would be like a non-physician selling a medical service. The work around I've heard is that the physician collects the fees and pays whomever a rent or promotion fee. To be fare I don't know if thats proper either, but just a potential work around I've heard of.
-M.D.

I think the rules on subcontracting in the UK are similar, but I'm personally amazed about how much is done with "no" physician experience here in England. Botox is a classic example of people jumping on the bandwagon...

My analysis of the press release below. One point on the WSRS Scale is NOT clinically significant. All these patients had a repeat injection and they are making it sound like restylane lasts 18 months. This is pure BOLONEY. Juvederm's data is pure BOLONEY and now Medicis is putting out the same non-sense which will inflate our patient's expecations so we will underperform and look bad. Thanks alot, Medicis and Allergan! You are not too smart. MDR.

STUDY DEMONSTRATED RESTYLANE® EFFECT LASTED 18 MONTHS IN 95% OR MORE OF PATIENTS WITH ONE REPEAT INJECTION

As a valued Medicis Aesthetics customer, we want you to be among the first to see new information about Restylane®. Recent clinical data demonstrated that at 18 months after initial treatment of Restylane®, at least 95% of patients who received a repeat injection had at least a 1 grade of improvement over baseline on the Wrinkle Severity Rating Scale (WSRS). Restylane® is the only hyaluronic acid dermal filler whose FDA-approved label includes duration data up to 18 months.

Study Description
The duration of Restylane® effectiveness was demonstrated in a randomized, evaluator-blinded study of 75 patients at three U.S. centers. The study used a bilateral (split-face) comparison design. Patients received treatment in both nasolabial folds at baseline, but were randomized for retreatment in one nasolabial fold at 4.5 months, and retreated in the other side at 9 months. The primary effectiveness endpoint was the number of patients with at least one grade improvement in the WSRS, a five-point scale to measure visual severity of wrinkles where five is the most severe rating (extreme), from baseline, as evaluated at the 18 month visit.

I haven't found much posted on users experience with Artefill and the newly approved Evolence. I have been using fillers for over 4 years and currently use 75% Radiesse and 25% Juvederm (best for lips and tear troughs). I'm hesitant to try Artefill because of the past issues with Artecoll and there doesn't seem to be any new benefit to Evolence.

12.5 | InnovaMed

My filler habits are almost identical to yours, InnovaMed. I would stay far away from Artefill. I hear it is great most of the time, but when there is a problem, it is a big problem. Why take the risk? I have not been convinced that there are any advantages to using Evolence. What will it's nitch be? Will it be a better filler, longer lasting with more volume than Radiesse? Will it be smoother and earier to inject than Juvederm? Great questions though. New filllers are coming. Where will they fit in? I will use them if they are as good, last longer and give MORE VOLUME per syringe AND come in BETTER SYRINGES !!!!!!!!!!!!!!!!!!! The other place that a new company may find traction is if the provide better training for beginner and intermedicate injectors. The training is currently very poor in my opinion. Are you listening Allergan, Medicis, Johnson and Johnson?

12.6 | JEE

Evolence is too thick, it can bunch up and move around for weeks until it sets in. The only advantage of Evolence is that it does not bruise as much but the whole moving around is not good and the company reps will admit to this phenomenon as well if you ask them. It has also been known to form nodules particularly in the lips.

Evolence is a Collagen type filler and is being marketed by Johnson and Johnson. There are some "issues" with it. Probably just for expert injectors now and I hear that you need specific training from company before they will sell it to you. That's about all I know. We need to blog about this because J&J is HUGE and this filler WILL BE a player because of the size and influence of J&J!

Just a note about training. My partners and I initially paid and traveled to be trained in filler injections. They went to Toronto and I went to Phoenix (we live in IL). In 2004 we started with Restylane. Medicis assinged us to a "corporate" rep who was in another state. I believe it's because we are not a "core" specialty. We never had a personal visit or any offer of training. At one point she offered to do a "phone conference" with us. When we decided to get into Radiesse (about 9 months before FDA approval for wrinkles), the rep was at our office and giving us additional training. Since then, we've had very experienced Radiesse trainers at our office several times to show us new techniques, etc. Kudos to Radiesse, it's probably why we use as much as we do. When Allergan launched Juvederm, we abandoned Restylane. Only then was Medicis interested in trying to keep our business!

Has anyone used fillers for a non-surgical rhinoplasty? If so, can you share your technique?

We recently had a Radiesse trainer in our office to teach injection of noses and hands. If you use Radiesse, call your rep and have them send a trainer out. I've always found them to be excellent.

Please share your experiences with Artefill. Anyone?

I've never worked with Artefill and would love to explore this product further (and potentially add this to my practice if I hear/read positive remarks). Anybody here willing to share notes?

What are the best fillers for the nose?

I use Juvederm Ultra 4 for filling in defects and straightening noses. Works well and is gently moldable.

I prefer HA's like Perlane/ Juvederm ultra plus. These are moldable, reversible and provide immediate results

I, too,have a good experience with Radiesse from Merz. It is a good product for the nose.

Radiesse is a good product for noses. I find HAs tend to be more deformable and don't keep the shape you want to create. Noses need more than just filling in dips - it's about more subtle things like how light reflects off the nasal bridge and nuancing the tip of the nose. Have been using cannulas for a few years now but I find the finessing still requires a needle.

I use Radiesse to fill the nose and it is quite easy with bilateral infraorbital blockage anesthesia.