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To rock the boat or not: A BioAlcamid Dilemma

Mar 5, 2009

Hi Doctor, I have been trying to combat facial wasting since 2001, when I took my first scary trip to Tijuana for NewFill treatments. Those first treatments were disappointing -- I ended up with nodules in my temples at the time. When Sculptra got FDA approval, I went to a doctor in Los Angeles who worked on the U.S. trials. He was able to break down the nodules with steroids and a lot of painful "mincing" of the nodules with a needle. Eventually, I started to look pretty good with new Sculptra treatments (the secret for me was diluting Sculptra more than "usual" for my skin, as I had excellent response to collagen growth -- this avoided any new nodules, other than tiny bumps at the injection sites.) Unfortunately, after two years, my Sculptra treatments started to have diminishing effects. They began to last no more than 6 months, which was prohibitively expensive. In December of 2006, I finally resorted to something more permanent (i.e., cost-effective), and drove to Vancouver, Canada for BioAlcamid. I recently read the Spanish report (May 2008) about the potential for long term adverse effects with the use of BioAlcamid, but have been fortunate so far to have no problems. My only complaint with BA is that, unlike Sculptra, if you're older (I'm 46), thinning skin can show injected "packets" of gel more than an overall skin thickener like Sculptra. As a result, I am lumpier than I'd like to be. My Sculptra doctor is afraid to use Sculptra on top of BioAlcamid (he does not want to infect the "packets"), so he will not treat me. I am therefore in a bit of a dilemma -- if I wanted to remove the BA to go back to (expensive and temporary) Sculptra, is that "rocking the boat" and putting myself at more risk of infection than leaving it alone? Is there any other temporary filler that can be used to thicken skin over BA "packets"? Or am I just up the creek? I have learned through direct experience that everybody reacts differently to facial fillers, and as far as I know there is only one BA study showing adverse effects, but I would appreciate your thoughts on the subject. There is a lot of advice out there, but much I would consider either biased or outdated. Getting my hands on current, objective research is much harder than it seems it should be. What would YOU do if you were in my situation? Thank you very much!

Response from Dr. Pierone

Hello, and thanks for posting.

Yours is a difficult situation, but these are my thoughts.

Bioalcamid has fallen out of favor because a number of studies have documented the risk of adverse events from this agent. Probably the most troubling issue is the risk of late infections that may pop up years after the implant was placed. Does this mean that someone previously treated with Bioalcamid should have it removed? No, since most people do fine with this implant. But there are safer ways to correct lipoatrophy, so anyone considering this agent should look to other options.

In your situation, there is a risk that infection will be introduced into the Bioalcamid implant if another facial filler is used to cover the lumpiness. However, the magnitude of this risk has not been quantified. My personal view is that careful injection of either Radiesse or Sculptra over a Bioalcamid implant could be performed with a low risk of infection. But the doctor performing the injections must be skilled and experienced in order to safely perform this procedure.

I hope that this information helps and best of luck to you!

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