The future of fillers

You don’t know how safe a filler is until it has been used 100,000 times. Are patients guinea pigs for the filler industry? Do we still need new fillers at all? If so: how many, which ones, for which purposes? Report from a summit in Stockholm.

Treatments with fillers are booming. New fillers are coming onto the market on a regular basis. Is this even necessary and how safe are they? A high-level summit on these questions was held recently in Stockholm as part of the BTS (“Beauty through Science”) congress. Led by congress president Per Hedén, leading researchers from the competing big players Allergan, Galderma, Teoxane and Merz discussed goals and problems in the use and development of fillers. The perspective of users, i.e. physicians, was represented by three doctors, including Munich-based dermatologist Dr. Patricia Ogilvie. “This was a unique, outstanding opportunity to discuss structural issues beyond commercial interests,” she said, praising the debate.

Unfortunately, for patients who rely on fillers, the discussion was not always reassuring. On the positive side, it was abundantly clear how much the companies are investing in the future. Ten to 25 percent of total sales – not just profits – go into proprietary research. In addition, there is no question that all the companies mentioned meticulously investigate problems that arise. Also praiseworthy: All the heads of research openly commented on the doctors’ critical remarks.

What to do in case of complications with fillers?

The main criticism of Jan Jerbeck, Stockholm surgeon, was the anonymity of filler manufacturers from the patient’s point of view. Because doctors, not filler producers, are in contact with patients, all anger ends up with them after complications. “I, too, used to use Artecoll,” Jerbeck explained. Using this permanent filler from the Artes company is now discouraged because it often causes visible and palpable nodules. “When my patients first started having complications, they wanted to kill me, not the manufacturer.” With this structure, rogue companies that put immature products on the market don’t take much risk to begin with. As long as there is no lawsuit, all the trouble stays with the consumers and with their customers, the doctors. In fact, even Per Winlöf, product developer at the renowned company Galderma, had to admit: “We can still do so much research. We won’t know how a filler really reacts in the skin until it has been used 100,000 times.”

+ What we must remember: With new fillers, patients are guinea pigs, despite all the previous research. If you want to be on the safe side, insist on proven preparations.

Surgeon Per Hedén’s focus was on the durability of the fillers. In a patient whose nose he had corrected with a filler, Hedén found the entire injection material four years later during a surgical nose correction – even though, according to the manufacturer’s instructions, it should have been degraded a long time ago. “Why do fillers sometimes last so long? We still don’t know a lot of things.” Dr. Patricia Ogilvie added that durability has two faces with fillers. “There are the visible effects, but there are also residual molecules in the tissue that you can’t feel or see.” What came up in this context: It would be exceedingly risky for filler manufacturers to explore these residual molecules. If it became apparent that a filler left permanent traces in the tissue, U.S. approval would be lost immediately. Here, permanent fillers are generally prohibited.

+ What we need to remember: If the visible effects wear off, traces of the filler may well remain. The more precisely you document for yourself which filler was injected, the better prepared you will be in the event of any complications.

Munich dermatologist Patricia Ogilvie and Per Hedén also stressed that not even the effect of proven fillers in the skin has been fully researched. “Why are there still granulomas, what triggers them?” asked Per Hedén to the company representatives – and they had no answer. “Let’s face it,” Patricia Ogilvie cautioned, “we know the fillers very well, and we see what happens to the skin after injection. But the way to get there is like a black box. There’s not a scientific explanation for every phenomenon.”

+ What we need to remember: No matter how often we hear or read that filler treatments are 100 percent safe – they are not.

Text: Angelika Brodde
Photo: Master1305/