In 1997, Dr. Klein was injecting collagen, as Cosmoplast®. It was the only filler available in the USA at that time. The results were limited to lips and smile lines and only lasted about 2-3 months. In addition, the source was bovine, which was a concern for possible allergies from the protein of the remote concern of mad cow disease.
In 1998, Dr. Klein trained in tumescent liposuction and then fat grafting for global face rejuvenation. At that time, Dr. Lisa Donofrio was showing the best results of anyone in the country. SAFE®, or Structural Autologous Fat Enhancement required getting the fat from the patient first via liposuction. To place the fat in the patient's face, first we did nerve blocks and used a cannula to place the fat. What cannulas were then (safe) and what microcannulas are now (like a blunt needle) are two separate things.
Because of the blunt force used to pass a cannula through the skin there was a great amount of swelling and bruising at the end of the procedure. Extra fat was frozen, as the procedure was done in stages spaced weeks apart for best results. This is labor intensive, and not all patients have adequate donor sites on their bodies. The patients required a driver to get home.
In the early 2000's, Restylane® was the first Hyaluronic Acid (HA) filler to hit the market in the USA. It was revolutionary, a big change in the aesthetic world. Then Allergan developed the Juvederm® line. HA filler products are made with different characteristics, but it didn't take long before we were starting to be able to treat the whole face, and the results are immediate.
Dr. Marla Klein participated in the half-face studies which compared Allergan's Juvederm® products against Restylane®. Each product line has its own pros and cons.
In 2004, Sculptra® received its first FDA approval for the treatment of lipoatrophy, and later for cosmetic use. Dr. Klein was so impressed with Sculptra® that by 2005 she stopped doing liposuction and fat grafting. Oddly enough, the plastic surgeons are talking about fat grafting now as if it is something new. Dr. Klein prefers to call Sculptra® a collagen stimulator to separate it from the general group of HA fillers.
Radiesse® is technically a filler, but it is calcium hydroxyapatite and is not made from hyaluronic acid. For this reason it cannot be dissolved when the injector runs into a problem. It is for this reason, that this is not Dr. Klein's favorite filler, but she does use it sometimes. PMMA is never used at Klein Dermatology & Associates.
Dr. Klein trained other physicians on how to do Hyaluronic acid (HA) fillers as part of the Allergan National Educational Faculty from 2002-2012.
Now, in 2022, we have HA fillers from Revance Aesthetics, a Swiss corporation with a headquarters in Nashville TN and they manufacture the products in the USA. These are the RHA1 (Redensity), RHA2, RHA3, and RHA4. I love the results from these fillers. They are a very smooth product, and nice to work with, with outstanding results. They are supposed to last 18 months.
I can tell Revance has listened to experienced injectors and they have created a filler that looks the most natural around the mouth when the patient is talking and expressing emotion. Please ask me more about the RHA fillers.
There are both on-label (FDA approved from studies) and off-label uses (other creative things we do) for various fillers.
Injecting fillers is a very artistic task, so results can vary incredibly from injector to injector.
The photo adjacent is from 1 Voluma to Cheek, 1 Voluma to temples, 1 Juvederm Ultra XC under eyes and some Botox in the forehead and 11's.
Example Uses 2022:
No longer done due to many reports of blindness when injected into these areas: