Igniting Discovery, Dialogue, and Global Innovation Through International Collaboration

April 2014 | Volume 13 | Issue 4 | Editorials | 386 | Copyright © April 2014

Hema Sundaram MD FAAD

Dermatology, Cosmetic & Laser Surgery, Rockville, MD and Fairfax, VA
Scientific Committees, IMCAS World (Paris), Asia and China Congresses



My participation in the IMCAS (International Master Class on Aging Skin) congresses began at the 2011 annual meeting in Paris, with a couple of short lectures on filler science and combined treatments. It was a real eye-opener to watch presentations and live demonstrations on technologies and techniques that I hadn’t even known existed; to see icons of American dermatology on the podium, beside international thought leaders whom I knew only from their publications. I recall my flight home as a mix of vivid memories, new ideas - and excitement that I had just witnessed a tantalizing glimpse of my own future. It brought to mind a favorite line from the lyrical Irish poet, William Yeats, that education is not the filling of a pail, but the lighting of a fire.
In the ensuing three years, I’ve assisted with coordination of educational content on injectables at the IMCAS Paris, Asia, and China congresses, and participated in sessions on lasers, regenerative medicine, and cosmeceuticals. What strikes me most about IMCAS is that it's the quintessential showcase for international, multidisciplinary collaboration. Dermatologists and plastic surgeons approach the same clinical challenges from different perspectives. There’s an added dimension when the colleagues are from different continents, and have different treatment options available to address distinct patient needs. When the Congress Director, Dr. Benjamin Ascher, founded IMCAS 16 years ago, this model was the exception rather than the rule.
Colleagues to whom I’ve recommended IMCAS have given uniformly positive feedback regarding the value of the experience. A number of the reasons why are exemplified by the fillers programming. The aim is to integrate evidence-based and experiential content; to stay on the absolute cutting edge in science, but to make the sessions as applicable as possible to current clinical practice. This year, the “Fillers – From Characteristics to Recommendations” session featured scientists from five major manufacturing companies discussing hot topics in filler science and safety on over thirty different hyaluronic acid (HA) products. In contrast, the Fillers & Volumetry Teaching Course had a practical, didactic focus, with physician faculty providing illustrative “How I Do It” videos to highlight their procedural pearls. The Injection Cadaver Workshop, coordinated by Dr. Ascher, was an interactive combination of live satellite cadaver dissections to illustrate anatomy and safety; live injections with fillers, toxins, and fat; endoscopic video demonstrations; and expert panel discussion. Other sessions, such as ”What’s Hot in Volumetry”, continued these themes.
Current clinical practice in Europe is the shape of things to come for us in the US. It’s not just about the larger and more varied aesthetic toolbox (an elegant concept that Dr. Gary Monheit taught me). But that’s some of it. Based on the time course of US FDA approvals, we can expect that a filler launched today in Europe will take 5 to 10 years to reach our shores. As examples, Juvéderm Voluma (Allergan, Irvine, CA), which was FDA approved in 2013, received Communauté Européenne (CE) marking without lidocaine in 2005 and with lidocaine in 2009; and Belotero Balance (Merz Aesthetics, Greensboro, NC), FDA approved in 2011, was CE marked as Esthélis/Belotero Basic in 2004. In Europe and other parts of the world, Voluma and Belotero Balance belong to full product families, each member of which has distinct scientific characteristics and recommended clinical applications, whereas they are currently stand-alone in the US.
The evolution of modern volumetry on both sides of the Atlantic may be analogized to the evolution of cars. The starting point - the advent of the first HA filler, for Europe in 1996, and for the US in 2003 (Restylane, QMed/Galderma, Uppsala, Sweden; Valeant Pharmaceuticals, Bridgewater, NJ) can be likened to Henry Ford’s statement that customers could have any car they liked, so long as it was black. Now, we’ve expanded from “one option fits all”. A complete filler family includes a deep volumizer, a “classic” product for mid-level implantation, one for superficial placement, and maybe one or two additional products for specific applications such as lip injection. At present in the US, we have partial families – for instance, the deep volumizer, Voluma, without its classic and superficial partners (Volift and Volbella); and the superficial/classic product, Belotero Balance, without its accompanying deep volumizer, classic, and superficial partners (Belotero Volume, Intense, and Soft, respectively). The Restylane/Emervel family has seven other members that are not available at present in the US. In regard to the tendency to view different products as competitors, the car analogy can be employed: Just as we wouldn’t pit a sedan against a sports car or SUV, so it doesn’t make sense to compare a deep volumizer to a classic or superficial filler. Each has a different purpose. It’s obvious, and intended, that there will be differences.
In Europe, with many more fillers, the car analogy still holds true. Of course, products within the same category are in competition with each other. But, for clinicians, there’s an acknowledgment that each reputable brand is equally valid. It’s