Combination Products Ease Facial Correction

MIAMI BEACH — Less pain on injection, less postprocedure swelling, and greater convenience are among the advantages of hyaluronic acid and lidocaine combination products, according to two studies and a live patient demonstration at the South Beach Symposium.

Prevelle (Mentor Corp.) and Dermal Gel Extra (Genzyme Corp.) come premixed with lidocaine, thus saving preparation time for physicians who might otherwise mix in their own anesthetic. Prevelle is approved for correction of moderate-to-severe facial wrinkles and folds via injection into the mid- to deep dermis. Dermal Gel Extra (DGE) is under FDA review.

Prevelle and DGE are fully hydrated, unlike existing hyaluronic acid fillers that absorb water and increase in volume after injection. "Prevelle is like Captique with lidocaine, versus Restylane [Medicis Pharmaceutical Corp.] and Juvéderm [Allergan Inc.], which are underhydrated," said Dr. Stephen H. Mandy of the department of dermatology at the University of Miami. His disclosures include Allergan, Bioform Medical Inc., Galderma Laboratories LP, OrthoNeutrogena, Procter & Gamble, Sanofi-Aventis, and Stiefel Laboratories Inc.

Dr. Mandy and his associates assessed 45 patients in a randomized, controlled, patient-blinded comparison between Captique and Prevelle. Although participants reported pain with both fillers, there was no swelling and very little erythema. "Pain at injection was lower with Prevelle, greater than 50% less, and improves over 45 minutes."

Dr. Mandy also participated in a multicenter safety and efficacy study. The split-face comparison between DGE and Restylane included 140 patients at six U.S. centers. Although he was unable to share data, he said, "I can tell you there is less volume and less pain with [DGE], with volume filling as great as Restylane at 9 months." He added that it takes much less volume to get maximum effect, "so we should fill very conservatively."

DGE is a "very robust" filler material, Dr. Mandy said. "You can feel the difference as you inject it."

"The nice thing about the Prevelle product is the price point," said Dr. Susan H. Weinkle, a dermatologist in private practice in Bradenton, Fla. Her disclosures include Allergan, Bioform, DermAvance Pharmaceuticals Inc., Medicis, Procter & Gamble, and Stiefel.

"This is a great product for a first-time patient, [one who may be] needle-phobic or concerned about pain," said Dr. Gary D. Monheit of the department of dermatology and ophthalmology at the University of Alabama at Birmingham. Dr. Monheit's disclosures include Allergan, Dermik Laboratories, Genzyme, Medicis, Mentor Corp., Merz Pharma, and Stiefel.

Dr. Monheit injected the first patient volunteer at the meeting, a woman with asymmetrical lips and a history of lip correction. "She could benefit from a lift to the malar crease," he noted.

Use a fanning technique for volume effect on the mid-face, Dr. Monheit said. Start with injections along the nasolabial fold. "Then I like to advance to the modiolus to see the commissures go up."

As lidocaine takes effect, subsequent injections become easier, Dr. Monheit said. Prevelle "requires very little manipulation afterward—it has an even flow."

"It is important to stop [during the procedure], get a frontal look, and make sure you get same volume on both sides," Dr. Monheit said. Remember this filler is not hydrophilic, "so what you see at the end is what you will get."

Patient follow-up is important, Dr. Weinkle said. Ask patients to come back in 2 weeks to check the results, including symmetry. "Don't charge them if you use another small amount. It's all about patient retention." n

MIAMI BEACH — Less pain on injection, less postprocedure swelling, and greater convenience are among the advantages of hyaluronic acid and lidocaine combination products, according to two studies and a live patient demonstration at the South Beach Symposium.

Prevelle (Mentor Corp.) and Dermal Gel Extra (Genzyme Corp.) come premixed with lidocaine, thus saving preparation time for physicians who might otherwise mix in their own anesthetic. Prevelle is approved for correction of moderate-to-severe facial wrinkles and folds via injection into the mid- to deep dermis. Dermal Gel Extra (DGE) is under FDA review.

Prevelle and DGE are fully hydrated, unlike existing hyaluronic acid fillers that absorb water and increase in volume after injection. "Prevelle is like Captique with lidocaine, versus Restylane [Medicis Pharmaceutical Corp.] and Juvéderm [Allergan Inc.], which are underhydrated," said Dr. Stephen H. Mandy of the department of dermatology at the University of Miami. His disclosures include Allergan, Bioform Medical Inc., Galderma Laboratories LP, OrthoNeutrogena, Procter & Gamble, Sanofi-Aventis, and Stiefel Laboratories Inc.

Dr. Mandy and his associates assessed 45 patients in a randomized, controlled, patient-blinded comparison between Captique and Prevelle. Although participants reported pain with both fillers, there was no swelling and very little erythema. "Pain at injection was lower with Prevelle, greater than 50% less, and improves over 45 minutes."

Dr. Mandy also participated in a multicenter safety and efficacy study. The split-face comparison between DGE and Restylane included 140 patients at six U.S. centers. Although he was unable to share data, he said, "I can tell you there is less volume and less pain with [DGE], with volume filling as great as Restylane at 9 months." He added that it takes much less volume to get maximum effect, "so we should fill very conservatively."

DGE is a "very robust" filler material, Dr. Mandy said. "You can feel the difference as you inject it."

"The nice thing about the Prevelle product is the price point," said Dr. Susan H. Weinkle, a dermatologist in private practice in Bradenton, Fla. Her disclosures include Allergan, Bioform, DermAvance Pharmaceuticals Inc., Medicis, Procter & Gamble, and Stiefel.

"This is a great product for a first-time patient, [one who may be] needle-phobic or concerned about pain," said Dr. Gary D. Monheit of the department of dermatology and ophthalmology at the University of Alabama at Birmingham. Dr. Monheit's disclosures include Allergan, Dermik Laboratories, Genzyme, Medicis, Mentor Corp., Merz Pharma, and Stiefel.

Dr. Monheit injected the first patient volunteer at the meeting, a woman with asymmetrical lips and a history of lip correction. "She could benefit from a lift to the malar crease," he noted.

Use a fanning technique for volume effect on the mid-face, Dr. Monheit said. Start with injections along the nasolabial fold. "Then I like to advance to the modiolus to see the commissures go up."

As lidocaine takes effect, subsequent injections become easier, Dr. Monheit said. Prevelle "requires very little manipulation afterward—it has an even flow."

"It is important to stop [during the procedure], get a frontal look, and make sure you get same volume on both sides," Dr. Monheit said. Remember this filler is not hydrophilic, "so what you see at the end is what you will get."

Patient follow-up is important, Dr. Weinkle said. Ask patients to come back in 2 weeks to check the results, including symmetry. "Don't charge them if you use another small amount. It's all about patient retention." n

MIAMI BEACH — Less pain on injection, less postprocedure swelling, and greater convenience are among the advantages of hyaluronic acid and lidocaine combination products, according to two studies and a live patient demonstration at the South Beach Symposium.

Prevelle (Mentor Corp.) and Dermal Gel Extra (Genzyme Corp.) come premixed with lidocaine, thus saving preparation time for physicians who might otherwise mix in their own anesthetic. Prevelle is approved for correction of moderate-to-severe facial wrinkles and folds via injection into the mid- to deep dermis. Dermal Gel Extra (DGE) is under FDA review.

Prevelle and DGE are fully hydrated, unlike existing hyaluronic acid fillers that absorb water and increase in volume after injection. "Prevelle is like Captique with lidocaine, versus Restylane [Medicis Pharmaceutical Corp.] and Juvéderm [Allergan Inc.], which are underhydrated," said Dr. Stephen H. Mandy of the department of dermatology at the University of Miami. His disclosures include Allergan, Bioform Medical Inc., Galderma Laboratories LP, OrthoNeutrogena, Procter & Gamble, Sanofi-Aventis, and Stiefel Laboratories Inc.

Dr. Mandy and his associates assessed 45 patients in a randomized, controlled, patient-blinded comparison between Captique and Prevelle. Although participants reported pain with both fillers, there was no swelling and very little erythema. "Pain at injection was lower with Prevelle, greater than 50% less, and improves over 45 minutes."

Dr. Mandy also participated in a multicenter safety and efficacy study. The split-face comparison between DGE and Restylane included 140 patients at six U.S. centers. Although he was unable to share data, he said, "I can tell you there is less volume and less pain with [DGE], with volume filling as great as Restylane at 9 months." He added that it takes much less volume to get maximum effect, "so we should fill very conservatively."

DGE is a "very robust" filler material, Dr. Mandy said. "You can feel the difference as you inject it."

"The nice thing about the Prevelle product is the price point," said Dr. Susan H. Weinkle, a dermatologist in private practice in Bradenton, Fla. Her disclosures include Allergan, Bioform, DermAvance Pharmaceuticals Inc., Medicis, Procter & Gamble, and Stiefel.

"This is a great product for a first-time patient, [one who may be] needle-phobic or concerned about pain," said Dr. Gary D. Monheit of the department of dermatology and ophthalmology at the University of Alabama at Birmingham. Dr. Monheit's disclosures include Allergan, Dermik Laboratories, Genzyme, Medicis, Mentor Corp., Merz Pharma, and Stiefel.

Dr. Monheit injected the first patient volunteer at the meeting, a woman with asymmetrical lips and a history of lip correction. "She could benefit from a lift to the malar crease," he noted.

Use a fanning technique for volume effect on the mid-face, Dr. Monheit said. Start with injections along the nasolabial fold. "Then I like to advance to the modiolus to see the commissures go up."

As lidocaine takes effect, subsequent injections become easier, Dr. Monheit said. Prevelle "requires very little manipulation afterward—it has an even flow."

"It is important to stop [during the procedure], get a frontal look, and make sure you get same volume on both sides," Dr. Monheit said. Remember this filler is not hydrophilic, "so what you see at the end is what you will get."

Patient follow-up is important, Dr. Weinkle said. Ask patients to come back in 2 weeks to check the results, including symmetry. "Don't charge them if you use another small amount. It's all about patient retention." n