What is the future of Next Generation fillers?
Doctor Answers 1
Great Question. If I had a dream filler it would be ... Restylane-L Infinity or Juvederm Infinity XC
I have actually thought about what I would want as an ideal filler for the future. In theory, fat is the "ideal filler," but before we crown fat transfer as the "perfect filler," let's think about it.
Fat comes from your own body. If there is an infection, the antibiotics can get into the Fat graft and treat the infection. It is soft. There is an (almost) unlimited supply instead of per milliliter syringe. It is permanent, because once the fat graft grows a blood supply it has permanently changed its "residence" from the hips or abdomen to the face.
Here are the Con's. The fat survival is unpredictable, it is currently between 30-50% survival. Hopefully will get even higher. If I were to sculpt the "David" out of clay, but as I sculpt the clay, only 30-50% of the clay will survive. How accurate will my replica of David be? Will it look more like a Picasso? Fat transfer needs a surgery to harvest the fat. Let's say the fat survival is 30%, to get the perfect result, it may take 2-3 sessions. Three liposuction sessions? Everytime you liposuction an area this creates scar tissue. If you try to go back to the same area, it will be much harder to get fat in the same place in the future. When I perform Fat transfer, I only liposuction a small area, an try to leave other areas untouched so it will be easier to get more fat in the future easily.
The fat is the face is now linked to your hips, butt or abdomen. Usually when people gain and lose weight, the body fat grows and shrinks and reacts much faster to weight changes than the native facial fat. Depending on how much fat is transferred to the face, the face can become intimately linked to your body weight, where before the fat transfer, the face may not change as much to the weight gain/loss.
Most people are fitter in their younger years and tend to gain some weight each decade. What will happen over the long term with facial fat grafting? Have we already witnessed this in celebrites such as Kim Novak in the recent Emmy's show? I don't know.
As far as the perfect filler or next generation, if I had a wish list, I would want the filler to be Hyaluronic acid based, so that it can be dissolved if there are any problems. Next, I would want the Hyaluronic acid to be "cross-linked" so well that it is essentially "permanent" unless hyaluronidase were injected to intentionally inject it. This way, the doctor can inject the filler, but also inject an antidote to removed or dissolve the filler. With current permanent fillers, it is a one-way process. Once the permanent filler is injected, it is impossible to remove without surgery. Even with surgery, it would be impossible to get every last bit of the filler. At least with the antidote to dissolve the filler, multiple sessions could be used to "wash" the tissue of the remaining hyaluronic acid. It may take multiple sessions to make sure it is "clean" but it is better than surgery and would not create more scar tissue.
This permanent hyaluronic acid filler would need to come in different densities and G-primes which means different firmnesses, so if the injector wanted to mimic bone, they could used a higher density version and inject it on the bone, like a cheek implant, but use a lower density version on the cheek fat so you can't feel the filler at all.
Will this ever happen? I don't think any of the current companies would release a permanent version of their own filler. Their current business plan is essentially a "repeat consumer" business. If the patient likes the results, they will keep coming back indefinitely. It would need a different company to come on to the market with a super-crosslinked Hyaluronic acid. If they could make it last twice as long, it would already be a significant improvement.
"Off-label" areas for Restylane such as the lower eyelid area, already lasts around 12-18 months and even at the 12-18 month mark, when comparing before and after photos, there seems to be a noticeable amount of filler still present. The rate at which the filler is dissipating is similar to natural aging and the volume loss associated with aging.
If the hyaluronic acid was cross-linked twice as much as it normally is, or perhaps be able to crosslink the ends, so like an "infinity" sign, there are no "loose ends" perhaps, you can have a permanent version of hyalruonic acid. The true test would be whether the hyaluronidase could still dissolve it. If it couldn't, then it would just be another permanent filler, which there are already many options of non-dissolvable permanent fillers.
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