FPSAM - Roundtable 2021 - 1

EXPERT PANEL DISCUSSION
Fillers in the Lower Third of the Face
with Emphasis on Lips and Chin
Moderator: Steve H. Dayan, MD1,2
Participants: Sebastian Cotofana, MD, PhD,3 Kay Durairaj, MD, FACS,4
Sabrina G. Fabi, MD,5 and Frank Rosengaus, MD6
1Director, Denova Research, Chicago, Illinois, USA.
2Clinical Assistant Professor, Department of Otolaryngology, University of Illinois, Chicago, Illinois, USA.
3Department of Clinical Anatomy, Mayo Clinic College ofMedicine and Science, Rochester, Minnesota, USA.
4Facial Plastic Surgery/Head & Neck Surgery, Vice Chairman Head & Neck Surgery Huntington Memorial
Hospital, Los Angeles, California, USA.
5Goldman, Butterwick, Groff, Fabi and Wu, Cosmetic Laser Dermatology, A West Dermatology Company,
San Diego, California, USA.
6Facial Plastic Surgery, Ultimate Medica, Me´xico City, Me´xico.
Dr. Dayan: This expert roundtable discussion, sponsored
byGalderma, focuses specifically on the topic of
fillers in the lower third of the face with emphasis on
lips and chin. We are honored to conduct this important
conversation with four globally recognized
experts: Dr. Sebastian Cotofana, Dr. Kay Durairaj,
Dr. Sabrina Fabi, and Dr. Frank Rosengaus.
I would like to begin the conversation by speaking
directly of hyaluronic acids (HAs), in particular
NASHA, nonanimal stabilized hyaluronic acid, and
then moving on to XPresHAn.
First let us talk about NASHA: it is the first FDAapproved
HA in the United States; it was approved
in 2003. What is interesting about NASHA is the
low cross-linking; only 1% cross-linking with 1,4butanediol
diglycidyl ether. It is also nonanimal
stabilized. There are three different types ofNASHA
that are FDA approved: Restylane Lyft, which has
the largest microparticles; Restylane, which was the
original Restylane, which was FDA approved, now
with L, including lidocaine, and Restylane Silk,
which is a smaller product. They are all 20mg/cc, the
particle size is what varies between them. They all
have different G primes.
With all of this in mind, I would like to invite the
panelists to answer a few initial questions. Dr. Rosengaus:
how important are these different particle
sizes, and their respective G primes, to you when
you are treating patients?
ª 2021 by American Academy of Facial Plastic and Reconstructive Surgery, Inc.
Dr. Rosengaus: It is important, and one of the main
aspects to differentiate and talk about with respect to
each of the products youjust mentioned.We have been
able to simplify as much as possible both the rheology
and the way we describe how these products interact
with the patient. One of the main relevant characteristics
remains the G prime, which is the product resistance
to a deformation force being applied to it. So,
in essence, G prime means the support, the capacity to
lift the tissues. The particle size relates directly to the
G prime. In general, the higher the particle size the
higher the G prime, and the uniqueness of NASHA is
that it has one of the highest G primes on the market.
This is very useful not only for definition but also for
targeted projection and lifting.
Dr. Dayan: Dr. Kay Durairaj: When injecting a
filler into the lower third of the face, do you think
about the different G primes in the HA products
you use? Is that important to you?
Dr. Durairaj: Yes. It is very important. I don't make a
single injection without looking at the G prime and
thinking about those vectors of force and lift. The first
decision I make when I'm seeing and injecting a
patient is exactly how much power of lifting I need
in the specific tissue along with the quality of the
tissue. I consider which G prime and filler thickness
is going to be best to utilize in each anatomic
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