Fillers & toxins WHAT YOU SAID

WHAT DO YOU CONSIDER THE BEST INVESTMENT STRATEGY FOR NEUROMODULATORS/ FILLER MANUFACTURERS?

Stricter regulations for non-medical injectors. It’s a money making racket with no regard for human health and safety, when is this nightmare going to end?

DO YOU COMPLY WITH PATIENTS’ REQUESTS FOR A SPECIFIC BRAND OF FILLER?

■ YES, USUALLY 19.30%

■ YES, IF I HAVE IT AVAILABLE 35.09%

■ NO, I MAKE THE DECISION 45.61%

Finally common sense is slowly appearing and we should see more regulation and more education.

ARE THERE NEEDS THAT CURRENT SOFT TISSUE FILLERS DO NOT MEET OR AREAS WHERE THEY COULD BE IMPROVED?

DO PHYSICIANS NEED MORE BOTULINUM TOXIN PRODUCTS FOR AESTHETIC USE?

We could greatly benefit from patient education, first and foremost, as well as professional education. Less aggressive marketing will help give our field the noble medical recognition it deserves.

We need more breakthrough innovation.

WHAT ARE YOUR NON-NEGOTIABLES FOR NEUROMODULATOR PRODUCTS – THE CHARACTERISTICS THEY ABSOLUTELY MUST HAVE?

SELECTED

1 ST SAFETY

2 ND DURATION OF EFFECT

3 RD PREDICTABLE RESULTS

4 TH BIOCOMPATIBLE

5 TH EASY TO USE 6 TH AFFORDABLE

DO YOU COMPLY WITH PATIENTS’ REQUESTS FOR A SPECIFIC BRAND OF TOXIN?

■ YES, USUALLY 20.87%

■ YES, IF I HAVE IT AVAILABLE 38.26%

■ NO, I MAKE THE DECISION 40.87%

WHAT ARE YOUR NON-NEGOTIABLES FOR DERMAL FILLER PRODUCTS – THE CHARACTERISTICS THEY ABSOLUTELY MUST HAVE?

SELECTED IN ORDER OF PREFERENCE 1ST = MOST IMPORTANT 6TH = LEAST IMPORTANT

1 ST SAFETY

2 ND PREDICTABLE RESULTS

3 RD DURATION OF EFFECT

4 TH BIOCOMPATIBLE

5 TH EASY TO USE

6 TH AFFORDABLE how she uses toxins, our experts are similarly combining filler products and other treatment modalities (e.g. laser devices, biostimulators, skin boosters, exosomes) to create beautiful results. So it’s hard to imagine what an ideal injectable could look like or even what’s missing when the possibilities are seemingly endless despite a full roster of available products.

HAS MARKETING OVERTAKEN SCIENTIFIC RIGOUR IN THE USE OF INJECTABLES?

‘I think the future lies in hybrid injectables,’ said Dr Shotter. ‘We have a first in this class with HArmonyCa, but I believe others will follow. Products which combine one clinically proven ingredient (such as hyaluronic acid) with another, which provides an independent benefit. That may be collagen stimulation, it may be elastin stimulation, and who knows what else that I’ve not even contemplated.’

‘The number of HA filler brands that have entered the market in recent years, particularly in Europe, has undoubtedly increased significantly,’ said Mr Rhobaye. ‘Although subtle, there are rheological differences between each brand and subtype of HA filler that can be used to treat various indications more effectively than before. Future filler generations may become even more varied and specialised for sitespecific indications, which would be interesting to watch. For instance, high-cohesivity HA gels that can supplement bone support already exist to a certain degree. However, introducing ultra-firm gels that offer more substantial support and resistance to deformation would be very useful (notwithstanding the difficulties in injecting this kind of product and any safety concerns relating to their bio-integration).’

‘The holy grail,’ said Dr Waldorf, ‘is a single filler that is longer lasting, biostimulatory, hydrophobic (to reduce swelling), contains something to reduce bruising, and is reversible.’

The emergence of regenerative medicine

However, the holy grail is, in all likelihood, a long way off. So in the meantime, physicians are continuing to combine their treatment modalities to create the most efficacious results possible, not least with regard to combining biostimulators with the more ‘traditional’ hyaluronic acid dermal fillers. That said, newer, more cutting-edge treatment options are beginning to offer the promise of a different kind of holy grail.

‘We need to embrace bioregenerative technologies, as this is how we can actually help our patients get younger instead of faking younger,’ said Dr Aguilera. ‘The concept of driving tissue regeneration in patients is gaining traction, and the time has come to move our efforts towards personalised regenerative aesthetic medicine.

‘I believe that injectable fillers still have their place in our industry, but as a collateral treatment. Injectable fillers do just that— fill. It is mechanical, and it has an art form, but it does not provoke the scientific curiosity of a physician to seek answers as to why we age. Bioregenerative techniques, however, spark a curiosity of what causes us to age and aims to decode the pathophysiology of the ageing process itself, which we now understand can be reversible and reprogrammed to an extent.’

Indeed, regenerative medicine and stem cell science have come on leaps and bounds in the last decade in other fields of medicine, not least in wound healing, which is intimately linked to aesthetic medicine. While exosome technology itself is still in its relative infancy, its power has already been unleashed on aesthetic medicine — often in combination with HA fillers — to address skin ageing and stimulate the production of collagen and elastin. But given the infancy of the technology, there is as yet no clear consensus on its long-term use for skin rejuvenation or hair restoration, despite the excitement3

The regenerative medicine landscape has progressed at warp speed across the last decade, and all the physicians we spoke to for this article agreed that exosome technology was promising, though they agreed that microneedling is perhaps not the most efficacious means of administration. But, it does offer the possibility of opening the industry into a more personalised form of aesthetic medicine, whereby we’re truly able to reprogramme the skin cells and offer patient-specific treatment paradigms for different tissues. Though, with all treatment options— new or old— it is essential for the industry that they are backed by science and have the data and evidence to support them.

References

1. PRIME Journal. Looking ahead: Industry trends for 2023 and beyond. PRIME Journal 2023; 13(1): 20–23. Available at: https://www.prime-journal. com/looking-ahead-industry-trends-for2023-and-beyond/ (accessed 28 February 2023)

2. Alice Hart Davis. How much filler did Alice’s MRI reveal? UK: The Tweakments Guide, Dec, 2022. Available at: https:// thetweakmentsguide.com/blog/ how-much-filler-did-alices-mri-reveal/ (accessed 28 February 2023)

3. Vyas KS, Kaufman J, Munavalli GS, et al. Exosomes: the latest in regenerative aesthetics. Regenerative Medicine 2023 18:2, 181-194. Available at: https://www. futuremedicine.com/doi/10.2217/ rme-2022-0134 (accessed 28 February 2023)