T he ideal soft tissue augmentation material (like the ideal spouse) should be permanent, forgiving and not ridiculously expensive. In dermatology, I think we’re getting closer to having the perfect fillers. Among the soft tissue products that are presently available, one newer material known as Radiance has the potential to be a long-term filler. Here, I’ll discuss this filler and offer you insight into how it’s being used off-label to treat a number of cosmetic procedures. Off-Label Uses Presently approved by the FDA for laryngoplasty and as a tissue marker, and most recently (as announced in early March) for use in oral maxillofacial defects, Radiance is gaining popularity as an off-label treatment in the United States for many cosmetic purposes. When used for cosmetic purposes in an off-label manner, Radiance is typically utilized for nasolabial creases, atrophic chins, marionette lines and perioral rhytids. It’s also used for lip augmentation. Properties of Radiance Manufactured by Bioform, Inc., Radiance is a calcium hydroxylapatite matrix in a carboxymethyl cellulose, glycerine and water. The particles range from 25 to 125 microns while they’re suspended in the gel. The gel is absorbed by the body after implantation, and cells from surrounding tissues grow into the scaffolding. For example, when the surrounding cells are fibroblasts, collagen is formed. When they are osteoblasts, bone is produced. The physical qualities of Radiance make it very attractive for cosmetic use. It has a viscosity that’s thicker than Zyplast, so threading is not always possible. However, it flows rather smoothly, so that clumping with resultant nodule formation is minimal. Also, because the product is radiopaque and will show up on X-rays for years, it’s best to make patients aware of this prior to treatment. Areas of Treatment Areas that are presently treated with Radiance depend on the surgeon and his or her experience. I use the product in the nasolabial creases and corners of the mouth. I’ve placed small amounts into perioral rhytids with very nice outcomes. To date, I haven’t used it for lip augmentation because I’m fearful that calcifications or nodules might form. However, if I saw a published study depicting results of a controlled trial using Radiance for this indication, I’d then consider using it for lip augmentations — provided the side effect profile fit my practice style. Other areas that would be appropriate for using Radiance include the cheeks for augmentation and lifting, as well as the chin for wrinkles and chin augmentation. Injection Techniques For optimum injection, it’s best to inject as you withdraw the needle rather than as you advance it. Other injection techniques for this product include good nerve blocks in the appropriate areas. Although each syringe comes with a needle, I use a 25-gauge needle for many of my injections. I’ll use a smaller-gauge needle for lip rhytids. When injecting the corners of the mouth, I try to buttress the area with a triangle of material. When treating the nasolabial creases, I use a serial puncture technique. I inject the perioral rhytids with a small needle such as a 30 gauge, for example. In all instances, I correct — but not overcorrect. In the literature My experience with this product is far more limited than my experience with other fillers, such as Restylane or Cosmoplast. Mostly, I’m waiting for the literature to catch up with the lay press, which I’m sure will happen soon. To date, the only publications that I have seen are not well controlled, and fail to compare the treated group with patients who were treated with a different type of filler. The biggest series I’ve seen was in the Cosmetic Surgery Times and was written by Dr. Tzikas (an ENT physician) who treated 207 patients and followed them for 6 months. His report indicated the following results: • Bruising was moderate in 17% of cases, and minimal bruising occurred in 49% of patients. • Nodule formation was minimal in 36% of study participants and moderate in 8%. • Accounts of erythema were minimal or moderate in 87% of the study participants. One dermatologist with significant experience with using Radiance is Dr. Busso in Miami, and he’s pleased with the results he obtains with this filler. I’ve seen some of his before-and-after photos, and they’re impressive. Once more controlled studies have been published, I’m going to look at the safety and patient satisfaction data with this filler. If Radiance is as promising as it now appears, I’ll be increasing my use of it.
Long-Term Filler Appears Promising
T he ideal soft tissue augmentation material (like the ideal spouse) should be permanent, forgiving and not ridiculously expensive. In dermatology, I think we’re getting closer to having the perfect fillers. Among the soft tissue products that are presently available, one newer material known as Radiance has the potential to be a long-term filler. Here, I’ll discuss this filler and offer you insight into how it’s being used off-label to treat a number of cosmetic procedures. Off-Label Uses Presently approved by the FDA for laryngoplasty and as a tissue marker, and most recently (as announced in early March) for use in oral maxillofacial defects, Radiance is gaining popularity as an off-label treatment in the United States for many cosmetic purposes. When used for cosmetic purposes in an off-label manner, Radiance is typically utilized for nasolabial creases, atrophic chins, marionette lines and perioral rhytids. It’s also used for lip augmentation. Properties of Radiance Manufactured by Bioform, Inc., Radiance is a calcium hydroxylapatite matrix in a carboxymethyl cellulose, glycerine and water. The particles range from 25 to 125 microns while they’re suspended in the gel. The gel is absorbed by the body after implantation, and cells from surrounding tissues grow into the scaffolding. For example, when the surrounding cells are fibroblasts, collagen is formed. When they are osteoblasts, bone is produced. The physical qualities of Radiance make it very attractive for cosmetic use. It has a viscosity that’s thicker than Zyplast, so threading is not always possible. However, it flows rather smoothly, so that clumping with resultant nodule formation is minimal. Also, because the product is radiopaque and will show up on X-rays for years, it’s best to make patients aware of this prior to treatment. Areas of Treatment Areas that are presently treated with Radiance depend on the surgeon and his or her experience. I use the product in the nasolabial creases and corners of the mouth. I’ve placed small amounts into perioral rhytids with very nice outcomes. To date, I haven’t used it for lip augmentation because I’m fearful that calcifications or nodules might form. However, if I saw a published study depicting results of a controlled trial using Radiance for this indication, I’d then consider using it for lip augmentations — provided the side effect profile fit my practice style. Other areas that would be appropriate for using Radiance include the cheeks for augmentation and lifting, as well as the chin for wrinkles and chin augmentation. Injection Techniques For optimum injection, it’s best to inject as you withdraw the needle rather than as you advance it. Other injection techniques for this product include good nerve blocks in the appropriate areas. Although each syringe comes with a needle, I use a 25-gauge needle for many of my injections. I’ll use a smaller-gauge needle for lip rhytids. When injecting the corners of the mouth, I try to buttress the area with a triangle of material. When treating the nasolabial creases, I use a serial puncture technique. I inject the perioral rhytids with a small needle such as a 30 gauge, for example. In all instances, I correct — but not overcorrect. In the literature My experience with this product is far more limited than my experience with other fillers, such as Restylane or Cosmoplast. Mostly, I’m waiting for the literature to catch up with the lay press, which I’m sure will happen soon. To date, the only publications that I have seen are not well controlled, and fail to compare the treated group with patients who were treated with a different type of filler. The biggest series I’ve seen was in the Cosmetic Surgery Times and was written by Dr. Tzikas (an ENT physician) who treated 207 patients and followed them for 6 months. His report indicated the following results: • Bruising was moderate in 17% of cases, and minimal bruising occurred in 49% of patients. • Nodule formation was minimal in 36% of study participants and moderate in 8%. • Accounts of erythema were minimal or moderate in 87% of the study participants. One dermatologist with significant experience with using Radiance is Dr. Busso in Miami, and he’s pleased with the results he obtains with this filler. I’ve seen some of his before-and-after photos, and they’re impressive. Once more controlled studies have been published, I’m going to look at the safety and patient satisfaction data with this filler. If Radiance is as promising as it now appears, I’ll be increasing my use of it.
T he ideal soft tissue augmentation material (like the ideal spouse) should be permanent, forgiving and not ridiculously expensive. In dermatology, I think we’re getting closer to having the perfect fillers. Among the soft tissue products that are presently available, one newer material known as Radiance has the potential to be a long-term filler. Here, I’ll discuss this filler and offer you insight into how it’s being used off-label to treat a number of cosmetic procedures. Off-Label Uses Presently approved by the FDA for laryngoplasty and as a tissue marker, and most recently (as announced in early March) for use in oral maxillofacial defects, Radiance is gaining popularity as an off-label treatment in the United States for many cosmetic purposes. When used for cosmetic purposes in an off-label manner, Radiance is typically utilized for nasolabial creases, atrophic chins, marionette lines and perioral rhytids. It’s also used for lip augmentation. Properties of Radiance Manufactured by Bioform, Inc., Radiance is a calcium hydroxylapatite matrix in a carboxymethyl cellulose, glycerine and water. The particles range from 25 to 125 microns while they’re suspended in the gel. The gel is absorbed by the body after implantation, and cells from surrounding tissues grow into the scaffolding. For example, when the surrounding cells are fibroblasts, collagen is formed. When they are osteoblasts, bone is produced. The physical qualities of Radiance make it very attractive for cosmetic use. It has a viscosity that’s thicker than Zyplast, so threading is not always possible. However, it flows rather smoothly, so that clumping with resultant nodule formation is minimal. Also, because the product is radiopaque and will show up on X-rays for years, it’s best to make patients aware of this prior to treatment. Areas of Treatment Areas that are presently treated with Radiance depend on the surgeon and his or her experience. I use the product in the nasolabial creases and corners of the mouth. I’ve placed small amounts into perioral rhytids with very nice outcomes. To date, I haven’t used it for lip augmentation because I’m fearful that calcifications or nodules might form. However, if I saw a published study depicting results of a controlled trial using Radiance for this indication, I’d then consider using it for lip augmentations — provided the side effect profile fit my practice style. Other areas that would be appropriate for using Radiance include the cheeks for augmentation and lifting, as well as the chin for wrinkles and chin augmentation. Injection Techniques For optimum injection, it’s best to inject as you withdraw the needle rather than as you advance it. Other injection techniques for this product include good nerve blocks in the appropriate areas. Although each syringe comes with a needle, I use a 25-gauge needle for many of my injections. I’ll use a smaller-gauge needle for lip rhytids. When injecting the corners of the mouth, I try to buttress the area with a triangle of material. When treating the nasolabial creases, I use a serial puncture technique. I inject the perioral rhytids with a small needle such as a 30 gauge, for example. In all instances, I correct — but not overcorrect. In the literature My experience with this product is far more limited than my experience with other fillers, such as Restylane or Cosmoplast. Mostly, I’m waiting for the literature to catch up with the lay press, which I’m sure will happen soon. To date, the only publications that I have seen are not well controlled, and fail to compare the treated group with patients who were treated with a different type of filler. The biggest series I’ve seen was in the Cosmetic Surgery Times and was written by Dr. Tzikas (an ENT physician) who treated 207 patients and followed them for 6 months. His report indicated the following results: • Bruising was moderate in 17% of cases, and minimal bruising occurred in 49% of patients. • Nodule formation was minimal in 36% of study participants and moderate in 8%. • Accounts of erythema were minimal or moderate in 87% of the study participants. One dermatologist with significant experience with using Radiance is Dr. Busso in Miami, and he’s pleased with the results he obtains with this filler. I’ve seen some of his before-and-after photos, and they’re impressive. Once more controlled studies have been published, I’m going to look at the safety and patient satisfaction data with this filler. If Radiance is as promising as it now appears, I’ll be increasing my use of it.
