Seattle — New fillers, including even more hyaluronic acid (HA) fillers, as well as new toxins are expected to enter the U.S. market within the next year, according to William Philip Werschler, M.D., F.A.A.D., assistant professor of clinical medicine and dermatology, University of Washington School of Medicine, Seattle.

"Consumers will have more choices, and physicians will have more choices," says Dr. Werschler, who also has a private practice in Spokane, Wash. "It will likely lower the prices for consumers and force more competition, especially among the hyaluronic acid manufacturers.

"The more products that are available, the better for everyone," Dr. Werschler says. "There will be nice additions to the palette of fillers that are already available (in the United States)."

"It has been filed with the Food and Drug Administration (FDA), and it is anticipated it will be available later this year in the U.S.," Dr. Werschler says. "It is a hyaluronic acid that is very similar to Juvéderm (Allergan)."

Technology advances

There are significant improvements in the technology that provide for an improved level of tissue integration, however. Essentially, Belotero uses a production process called "cohesive polydensified matrix (CPM)."

The CPM process gives the product the ability to "auto-equalize" itself in the soft tissues into which it is injected. "This reduces the lumps and bumps that can sometimes occur with HA injections, and even further reduces the need for the use of hyaluronidase," Dr. Werschler says.

The shortcoming with Belotero is that lidocaine is not part of the formulation, as it is with some hyaluronic acid fillers, such as Juvéderm XC and Restylane L and Perlane L (HA, lidocaine; Medicis). The presence of lidocaine in those fillers increases patient comfort, Dr. Werschler says.

"There will initially be a market disadvantage, but mixing of lidocaine at the time of injection as has been commonly been done in the past will still be an option, although this will be off-label until FDA-approved," he says.

Another hyaluronic acid filler that Dr. Werschler describes as part of the Restylane family is SubQ, made from a nonanimal stabilized hyaluronic acid substance (NASHA). It is not approved for use in the United States. SubQ has been used for breast and buttock augmentation, offering noninvasive avenues for cosmetic procedures for those sites.

"It is pretty popular for techniques like breast augmentation, and it has a duration of about one year," Dr. Werschler says. Patients undergo an injection termed a "breast-bump" of about 100 ccs into each breast with SubQ. This results in about one cup size expansion. Celebrities have been reported to have undergone injections with SubQ. "There are rumors that Medicis will try and bring it into the (U.S.) market," Dr. Werschler says.