Jeffrey D. Hoefflin, MD

Avoid sculptra (Poly-L-Lactic Acid) toward correction of infraorbital hollowing or volume correction. The product was originally intended for significant fat loss in the nasolabial fold region in patients who were immunocompromised. Extended applications have included malar or cheek augmentation. However, it's unpredictability, possibility of granuloma formation, and multiple injection requirements should preclude it's use in areas of excessively thin tissues, such as beneath the eye. The product can last as long as one to several years.

Orthoneutrogena, the aesthetic divison of Johnson and Johnson, is about to release a collagen based product called 'Evolence.' It recently (June 2008) received it's FDA approval for moderate wrinkles in the nasolabial folds. However, my experience thus far dictates that it will certainly give the other alternative hyaluronic acid products (Juvederm, Restylane) some good competition. Evolence doesn't require collagen skin testing, it's touted as lasting six to twelve months, it's results are soft and natural, and is associated with less bruising and swelling. Off-label FDA use demonstrates because of it's soft characteristics, that it might be a very good solution from volume depleted lower eyes or tear trough deformities. It is one of the few products that I've used that is easily malleable or can be molded into it's final desired form. The general public release date is for late August. Discuss with your physician the FDA guidelines, their level of comfort, and recommended treatments.