FILLERS AND SAFETY
With the introduction of fillers including Restylane, Lift, Voluma, Sculptra, Radiesse, Bellafill and one’s own fat we can now rejuvenate and sculpt the face in ways never possible before. No longer do we have to fear the complications of solid implant displacement, extrusion, infection and bone erosion.
The manufacturers offer live demonstrations of physicians injecting patients in “off label” areas. For the most part they do not limit sales to trained individuals. Anyone with a medical license can purchase most of the fillers except Sculptra and Bellafill; use them in areas which may be more dangerous than others. The FDA has only approved Restylane and Juvederm products to be injected to the lips. Sculptra and Voluma may be used to augment the cheeks. Otherwise the only place that the FDA has received enough clinical evidence to approve filler injection is to the smile lines. Although we may never see loss of tissue from injection in the brow or smile lines or loss vision from injection near the eyelids, they have been reported. Caution must be exercised in these areas. Slow low pressure injection as the needle is being extracted should uniformly be performed. Familiarity with the use of hyaluronidase is essential. Patients need to be informed that these complications although rare may occur as many may opt not to take the chance.
If we keep things safe and patients happy we will continue to have the freedom to use these products as we seem fit without government regulation. Inexperienced, inaccurate and poorly trained injectors will cost us more than rising liability premiums.