MAUI, HAWAII "If you do Botox, you can certainly do fillers," Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.
Dr. Steinman stressed the importance of developing skills with injectable fillers, noting their ease of use, minimal risk and downtime, efficacy, and high patient and clinician satisfaction. "They're rapidly becoming the 'go to' treatment for lots of types of facial rejuvenation," he said.
Honing skills using temporary fillers, he suggested, is a good way to learn. "I would start with temporary fillers, before you [use] semipermanent fillers, and certainly before you go to permanent fillers," said Dr. Steinman of the University of California, San Diego.
He acknowledged that temporary fillers present a conundrum. For the patient, the problem with temporary fillers is that they're temporary. "They only last 36 or 9 months. My patients don't like it [because] they have to keep coming back," Dr. Steinman noted. But for those who are learning to use them, the advantage of temporary fillers is that they're temporary.
"If you're thinking of doing lips, I would suggest first learning with a temporary filler before you mess up somebody's lips permanently," he cautioned.
More important, if a woman has never had her lips or nasolabial folds face enlarged and she's not sure that she wants it, do not give her a semipermanent or permanent filler since she may not like the results, he said.
A "cool thing" about the temporary filler hyaluronic acid, Dr. Steinman noted, is that it is dissolved by hyaluronidase, which is readily available. In one situation in which a lump had appeared when he was using a hyaluronic acid filler, he was able to eliminate the lump by injecting hyaluronidase.
While learning on temporary fillers, treat forgiving areas first. The easiest way to do that is to treat patients after botulinum toxin type A injections. "They already trust you to stick needles in their face," he explained, "and many of them have wrinkles that won't completely go away."
Dr. Steinman recalled a patient whom he had told, "Your glabellar rhytid is not going to completely resolve with the Botox." As he predicted, she had a good result with Botox but still had a rhytid. "That's a great place to learn," he said.
"There's a synergy between the places I inject Botox and the places where you can learn to inject hyaluronic acid." (See box.) For instance, he said, "Nasolabial folds are an excellent locationand glabellar lines."
Using fillers after Botox is a highly effective, versatile, nonablative, low-risk treatment option that can be useful for resistant resting rhytids.
Use the filler after waiting for maximal botulinum effect. Fillers often last longer when placed after botulinum, said Dr. Steinman, who stated that he had no conflicts of interest.
After learning on more forgiving areas, move on to other areas. He started treating lip patients once he had developed his skills.
"The last place I would suggest you learn is the teardrop of the eyelid," he said. Above all, he urged, "use common sense."
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