There are a lot of fillers out there. It is hard to say exactly which one is best. We use certain fillers as creatures of habit, sometimes, in specific parts of the face because either we trained with those fillers or we have simply had good luck. But I imagine most injectors have a hard time really understanding what distinguishes the current market leaders in the industry. We were recently introduced a new product that has been selected for use in very few practices in certain metropolitan areas and it sort of got her attention. It is called RHA or Teoxane and is manufactured by a company called Revance. This is not a household name, or very familiar to any of us but it has been around the world for at least 5 years and it is pretty cool stuff. What we like about this product and that would what distinguishes it from the other materials on the market are that the naming of the products really applies to the purpose and features of each of the individual fillers. For example, rather than having terms like Ultra or Plus or XC the RHA line is named 2, 3, and 4 to really describe not only what depth they should be injected at but also the material properties of these fillers. For example, #2 is a superficial filler and is easier to manipulate with a syringe and is less viscous. The product designed for a slightly deeper level would be #3 and something that goes into the deepest plane in the deeper dermis is #4. This is not only better for educating patients and documenting what we are doing, but it just makes sense. It is a nice touch that the company has a pleasant aesthetic ‘vibe’ as well, which speaks volumes to the emphasis of the company from the top down on beauty and elegant simplicity. I particularly value this. The marketed features which distinguish Teoxane and RHA from the other market leaders involve the product’s “natural”, “dynamic”, and forgiving behaviors.
As a surgeon I like adding fat to the face because fat, when compared to fillers, is more forgiving and dynamic and it does not have the same structural or architectural impact on the overlying tissue. Think of it as shading with a pencil versus using a Sharpie marker. I find injector “un-forgivability” (think Tyndall effect, bluish discoloration, and “sausages”) as an unacceptable feature of certain fillers, especially when used inappropriately. For example, Radiesse should never be injected into the lips or lower eyelids. In contrast, Teoxane and the RHA line is a very special because it is more dynamic--because it is the first 4-dimensional filler that I can think of. All fillers really are designed to enhance soft tissues in 3 dimensions; however, this product is uniquely produced to also allow for expressions of the face without impacting the way the face naturally moves. What I mean by this is that hyaluronic acid as it occurs naturally, is very watery and you can inject easily through syringes, but it lacks structural integrity and denatures quickly in skin. Therefore, 20 years ago, fillers became highly cross-linked. And by cross-linking these fillers we structurally enhanced their material properties. This enables injectable HA to meaningfully soften wrinkles and efface contours of the face. Traditional crosslinked HA fillers do stand the test of time, but they do not behave like the hyaluronic acid for which they are designed to replace. As we age, we lose naturally occurring hyaluronic acid in the face; yet we cannot inject untouched hyaluronic acid because it does not have the mechanical properties of something more structurally robust. RHA fillers like the Teoxane line by Revance fill the middle ground: we need something in between a naturally occuring hyaluronic acid molecule and something that has been really touched up. And something that lasts over a year in situ. This is what distinguishes Teoxane and RHA fillers from the rest of the market. It is not naturally occurring untouched HA, but it is very carefully manipulated to last longer, and create subtle but important changes, and move with you. This is why we have adopted RHA fillers, Teoxane, into our practice; we are so excited to offer these deluxe fillers to you.
