Physician discusses newly emerging toxins, fillers, injection techniques

MIAMI — While there are multiple new toxins and fillers in development around the globe and new techniques in use, it is important to research each product to understand its qualities and outcomes, according to a speaker here.

“We know now that there is not a cookbook standard dose for every person,” Gary D. Monheit, MD, said here at South Beach Symposium 2017. “We have to look at the gender, look at the patient expressing himself, and see the muscle mass, the action, the pattern, what area you’re treating and what is the anatomic variation.”

Gary D. Monheit, MD

Monheit began his presentation discussing the newer technique of microneedling, in which small doses are placed in areas that were often avoided previously due to side effects such as ptosis or lip asymmetry. A physician uses micro doses to affect contour, skin texture and pore reduction.

Some of the toxins currently in development that Monheit discussed included CROMA, a product with a similar profile to Botox, which just completed phase 3 for efficacy and safety in Europe; Evolus, a Korean toxin with a similar profile to Botox, which is in phase 3 in the U.S.; and a liquid toxin from Galderma, designed with no animal, human or accessory proteins, which in phase 2 in Great Britain.

“Fillers are the other building block we have; it’s the second thing we’re using in this country,” Monheit said. “We’re injecting in all planes of the face. We have volume replacing, face-lifting zones, contouring, wrinkle line filling — the real issue is that we don’t all use the same products and the most important thing is the elasticity and viscosity [of the product]; understand what you’re using and understand the crosslinking and how it affects the firmness of the filler.”

Monheit discussed the emerging “families of products,” or multiple products for varying depths, uses or planes of the face, that have been in Europe for some time and are now being developed in the U.S.

Allergan is using both Hylacross and Vycross technology and has developed such products as Volbella for lips, fine structure and fine lines, and Voluma for the deep plane. Galderma has developed its Restylane lines, including Silk for the superficial plane, and its recently FDA-approved Emervel series, which has a balanced technology for every level of injecting.

“And it’s not to say that you should have every one of these products, every family, because there’s a difference in the way the feel on the syringe is,” Monheit concluded. “Voluma injects very quickly, Restylane is a little more pressure, Hylacross takes a lot more pressure, and each one of these products you can feel the difference in the syringe. You’ve got to adjust what you’re doing to not only how you inject, but where you’re putting it, and you want to put the right product in the right place.” – by Talitha Bennett

References: Monheit GD. Neurotoxins: What’s New in Techniques and Products. Presented at: South Beach Symposium 2017; Feb. 9-12; Miami Beach, Florida.

Disclosure: Healio.com was unable to determine whether Dr. Monheit has a direct financial interest in the products discussed in this article or if he is a paid consultant for any companies mentioned.