Dr Tim Pearce
Most of the big brands you’ve heard of have FDA approval, and one easy test is to look at the price – FDA approved fillers tend to be more expensive. However, this doesn’t necessarily mean that non-FDA approved products are inferior – it just means we don’t know enough about them, particularly regarding filler longevity and long-term outcomes.
CE approval, which many practitioners misunderstand, doesn’t really mean much in terms of human bodies or aesthetic results. It’s essentially equivalent to a toothbrush manufacturing approval – it simply means the materials are approved and the process is clean. Because fillers are classified as medical devices rather than drugs, they don’t undergo the same rigorous testing for interaction with human tissue.
Ideally, what practitioners need with any filler product is a five-year study showing what happens over time. Currently, most products only have six-month studies, if they have any at all. Even FDA approval focuses more on medical aspects than aesthetics:
Experience with different products reveals how they behave long-term. For example, Juvederm Ultra 2 for fine lines in upper lips demonstrates this clearly: while it looks acceptable on the day, seeing the same patient two years later often reveals unexpected puffiness in the top lip. This isn’t necessarily due to patients seeking treatment elsewhere; rather, the product attracts moisture over time.
Different products exhibit varying levels of water attraction. For instance, Dr. Harris uses Juvederm Ultra 3 in very low volumes (0.3 mils maximum) specifically because of its significant water attraction. Using larger volumes – for example, putting 1 ml of Juvederm Ultra 3 in someone’s lips – likely won’t look good in six to nine months unless they have very good structure or break down products quickly.
In contrast, products like Juvederm Volift or Volbella appear to hold their shape better and show less water attraction over time. This understanding comes only through long-term observation of product behavior in actual patients.
Different manufacturers make various claims about their products. For example, Restylane might comment on another product’s lack of cohesivity. While these comparisons can be intriguing, personal experience with each product over time provides the most valuable insights into how they actually perform in patients.
It typically takes about two years to get to know a product properly. Most experienced practitioners have only used two or three types of products throughout their careers, understanding them slowly over time. This deep understanding proves more valuable than having access to numerous products without truly mastering any of them.
Consider the analogy of an artist who creates masterpieces using a barbell – it’s not about the tool itself, but rather about truly understanding how to use that tool to create beautiful results. The same principle applies to dermal fillers; you can achieve amazing results with any quality product, but you need to understand that product intimately.
Understanding your chosen product range requires:
Success in aesthetic medicine isn’t about having access to every available FDA approved filler. Instead, practitioners should focus on thoroughly understanding their chosen products. While FDA approval provides important safety assurance, it doesn’t guarantee long-term aesthetic outcomes. The key lies in developing deep familiarity with your chosen products through careful observation and long-term patient follow-up.
Remember that the most successful practitioners aren’t those with the largest product selection, but those who thoroughly understand their chosen products and can use them skillfully to create beautiful, lasting results. Each practitioner needs to figure this out through personal experience with their chosen products, as long-term aesthetic data remains limited in our field.
The truth about product selection and mastery is that it takes time, patience, and careful observation. Don’t be swayed by marketing claims or the latest product launches. Instead, focus on truly understanding the products you choose to use, their behavior over time, and how they interact with different patient tissues and anatomical areas.
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Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
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