PHOENIX A 10-patient experiment comparing Juvéderm with Restylane revealed little difference between the two hyaluronic acid fillers, Dr. Seth L. Matarasso reported at a clinical dermatology conference sponsored by Medicis.
Half of each patient's face was injected with Restylane, the other half with Juvéderm. The only difference observed was "perhaps" a little less edema in the lip area with Juvéderm. Cost, flow, redness, and bruising were otherwise comparable, said Dr. Matarasso, professor of dermatology at the University of California, San Francisco.
"As far as discomfort and appearance, I didn't find it that much different," he said.
Two patients returned for botulinum toxin treatments after 67 months, he added. The durability of the two fillers appeared comparable at that point, he said.
The U.S. Food and Drug Administration approved Juvéderm, a hyaluronic acid gel marketed by Allergan Inc. for "injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds)."
The approval was based on a 6-month, double-blind, randomized controlled clinical trial in which Juvéderm compared favorably to Zyplast, a bovine-based collagen. Juvéderm provided longer wrinkle correction in that trial, but Dr. Mattarasso said that studies comparing it to other hyaluronic acids are needed. "My suspicion is the complication rate will be [the] same as other hyaluronic acids. I don't know what the advantages will be. … I think it is way too early to tell," he said.
He did not recommend switching from Restylane, which is marketed by Medicis, to Juvéderm, based on the results of his small study. Juvéderm may cause slightly less swelling, but Dr. Matarasso said that the limited evidence was not a reason to change products. "I think you should pick a product you feel comfortable with, and then branch out," he said.
The ideal filler does not exist, according to Dr. Matarasso, but new products are giving cosmetic dermatologists "an incredible buffet" from which to choose. The deciding factors ultimately will be how the product feels in the clinician's hands and how much the patient likes it, he predicted.
Theoretically, hyaluronic acid fillers are nonallergenic, but Dr. Matarasso said they can cause hypersensitivity reactions. Juvéderm is contraindicated in patients with severe allergies and/or a history of allergies to gram-positive bacterial proteins.
Hyaluronic acid fillers do not include anesthesia and can cause discomfort, so a topical anesthetiche uses EMLA cream or Betacaineshould be applied before procedures. "Patients don't want a nerve block," he said, and added that patients should be told to expect some edema.
Another new hyaluronic acid filler, Perlane, was approved by the FDA in May ("New Hyaluronic Acid Gel Filler Receives Approval," SKIN & ALLERGY NEWS, June 2007, p. 9).
Clinicians should be aware of products available abroad because patients are returning from overseas trips with complications from injections of fillers not approved by the FDA. "I see a lot of people from the Pacific rim and Australia," he said. "What is astonishing to me is they have injectables, and they don't know what was injected into their face."
Dr. Matarasso has served as a consultant to Allergan and Medicis.
Juvéderm may cause slightlyless swelling, but there's not enough evidence to change products. DR. MATARASSO