Radiesse Efficacious as Soft Tissue Filler

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.