Building Your Practice with Fillers

Abstract

Introduction: The objectives of this article are to (1) evaluate the popular fillers as practice builders and (2) outline a typical practice builder program for the surgeon. Methods: Information was gained from a search of the literature, 25 years of clinical experience, and interviews as well as a survey of 35 physicians to determine present surgeon techniques. Fillers were graded 1–5 to qualify as an income generator (with 5 being the highest). Results: Autologous fat scores were higher than that of the other fillers, although any filler could be in a practice-builder program. All bioresorbable fillers will need additional fill to obtain the desired results, but fat has an added benefit of some eventual permanence. When more than 5 mL of filler is needed, fat has also has the most reasonable cost. The commercial fillers will cost $93 to $200 per milliliter. Autologous fat, even with the added cost of anesthesia, disposables, and a minor operating room setup, will be more economical for the patient in amounts greater than 5 mL. When the surgeon can charge less for the filler itself, there is more room for a fair professional fee. There are 3 instrument systems available for fat transfer on the market. These systems accomplish different goals; thus, all have their position in the marketplace. These systems include the TissuTrans, the LipiVage, and the Coleman type modified liposuction instruments. The latter includes all micro-cannula-type instruments. Since it has been established that fat trauma during transfer should be minimized, the system and technique that will give the least amount of trauma to the fat cell should be the first choice. Conclusions: There is now a resurgence of interest in autologous fat because of the very high costs of commercial substances. Because of public acceptance and the availability and cost of economical raw goods, autologous fat can be a key filler in a practice-builder program. To have a successful goal-oriented program, one must use lipocyte-friendly instruments and put a great deal of effort into training the staff. The program must be organized, advertised, marketed, and reviewed at specific intervals for improvement. NOTE: When speaking of the best practice-builder filler, it is assumed that the surgeon will follow ethical guidelines in choosing the best filler for the patient, not just the filler that fits his or her program.