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    Top 5 dermatology controversies

    William P. Coleman, III, M.D.There are five controversies rattling today’s dermatology community, causing some dermatologists to think twice about commonly used products, services and procedures, according to William P. Coleman, III, M.D., editor in chief of Dermatologic Surgery, clinical professor of dermatology and adjunct professor of surgery (plastic surgery) at Tulane University Health Sciences Center, New Orleans.

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    Dr. Coleman was co-moderator of a session on dermatologic controversies at the October 2015 American Society of Dermatologic Surgery (ASDS) annual meeting in Chicago. He shared the controversies and other dermatology experts weighed in with their thoughts.

    #1: Filler Fact or Fiction?

    “One of the most powerful controversies in cosmetic dermatologic surgery is whether non-dissolvable fillers are safe. As more fillers are used to volumize, there is concern that vascular occlusion is becoming more common,” Dr. Coleman says. “In some cases, this may lead to skin necrosis, but in rare cases causes blindness. Hyaluronidase can be used to dissolve hyaluronic acid (HA) fillers, but has much less effect on non-HA fillers. HA fillers can also be dissolved to correct unintended asymmetries or overcorrection so they are inherently safer.”

    Derms speak up

    Derek H. Jones, M.D.FDA-approved non-dissolvable fillers are, for the most part, safe when used on-label. But adverse events do and will occur in a minority of patients, according to Derek H. Jones, M.D., clinical associate professor of dermatology, University of California, Los Angeles, and founder and director, Skin Care and Laser Physicians of Beverly Hills.

    READ: FDA:Stop using unapproved dermal filler

    “In areas at high-risk of problems, such as the lid cheek junction or tear trough, only HA fillers should be used as they are dissolvable,” Dr. Jones says.

    Jeremy B. Green, M.D.Non-dissolvable fillers are safe and play and important role in clinical dermatology practice, according to Jeremy B. Green, M.D., a Coral Gables, Fla. Dermatologist.

    “It is reassuring to have the ability to dissolve hyaluronic acid (HA) fillers, and it gives first-time filler patients a level of comfort that the product can be reversed if they are not happy with the appearance. This fear is usually rooted in the overfilled celebrity stereotype. Nonreversible volumizers, like calcium hydroxylapatite (CaHA Radiesse) and poly lactic acid (PLLA Sculptra), are an indispensable part of our aesthetic toolbox and should not be feared because they are 'irreversible,'” Dr. Green says. “I have a subset of patients, they tend to be active, fit people who seem to metabolize HA fillers quite quickly. With these folks, volumizing with CaHA or PLLA offers long-lasting natural results. Injecting with cannulas and having an intimate knowledge of facial anatomy can also mitigate the risk of intravascular injection.”

    NEXT: Big fat debate: Non-invasive replacing liposuction?

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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