As a GP of some 15 years’ experience, having seen numerous unremarkable products launched upon the pharmaceutical playing field (both aesthetic and non-aesthetic), I am a natural sceptic. As such, and speaking candidly, whenever any new product is thrust to the fore of the market, I am instinctively (and perhaps logically in today’s world) wary and consider, “How much better could this possibly be than what we have already adopted and administer? If something isn’t broken, should we really try to fix it?”.
In the UK, the plethora of available dermal fillers is both a blessing and a curse. We’re no doubt all aware that a number of the products available are poorer quality, extremely cheap, and carry a high risk of side effects to boot. Unfortunately, these very product ranges are often the go-to choices for the untrained, nonmedic injector, aiming to provide treatments for the lowest possible price. However, there are an abundance of high-quality injectables on the market, that in experienced and skilled hands, are able to produce excellent, longlasting results.
When the first news about new dermal filler MaiLi reached me from Sinclair Pharma; I conjectured in all honesty whether a new brand of HA filler was even needed. In so much, barring the odd faulty syringe aside, we weren’t dissatisfied with the products we already utilised in our nationwide clinics. However, after reviewing the clinical trial data, and gaining a far deeper understanding of the unique technology behind the range, as a clinician, I was curious and more than happy to trial all of the modalities it includes.
If you find yourself wondering how to choose which product is right for your clinic, you might find my experience with introducing MaiLi into the Consultant Clinic helpful. When selecting brands to treat with, I use several strict criteria to help me provide the best possible results for my patients; these including the product’s safety profile, its efficacy, and its longevity. I’ll use MaiLi as an example to demonstrate my criteria:
• Safety: Is the brand CE-marked, and does it come with robust safety data from clinical trials? MaiLi is CE-marked, biocompatible, and has a side-effect profile comparable to similar HA fillers under evaluation conditions with a 12-month follow up.
• Efficacy: Look at direct comparison studies versus market-leading products. For example, MaiLi has been shown, under trial conditions, to have greater projection power than the market-leading brand, but with a lower G’ prime. This means superior volumisation, with a softer, more pliable, and more natural feeling product. Plus, the OxiFree technology used in the manufacturing of the product uses lower levels of BDDE than existing fillers.
• Longevity: Data from clinical studies along with my own personal experience over time are key to my decision about treating with a new product. Pre-launch clinical studies for MaiLi showed a significantly greater patient satisfaction rating at 12 months compared with the market-leading product. Our clinics across the UK have been using the product for nine months now, and have experienced only positive patient feedback, but particularly in respect of duration. In fact, the majority have commented on how well their filler (in all facial compartments) appears to be lasting.
Of course, there is more that influences product selection. Price, profit margins within the business model, the mean budget/ per capita spend level per treatment of patients, along with personal experiences and knowledge of the manufacturer or distributor are of paramount importance and never to be underestimated. Having worked with Sinclair Pharma before, as a trainer for the Perfectha and Ellansé filler ranges, I had significant experience of their after-sales care, product queries, and expert clinical support from world-recognised, respected clinical experts.
When administering products in the significant numbers the Consultant Clinic uses on a daily basis, it’s crucial to have that solid bedrock of confidence that a fastacting, multi-faceted international team are behind each and every one of us. If we need an answer or support, it’s usually needed quickly to smooth the workings of a busy clinic. It’s often one of the most important considerations to our practice.
The data suggested that MaiLi would be softer than other leading products, give greater projection with less product, and have a potential for enviable longevity. Having piqued my interest, like all of us wanting to stay ahead of the market and provide the best options for our patients, this data proved to be more than accurate in my day-to-day clinical practice, both short and long term. Primarily, the feature that struck me as especially unique to this range was the softness, appropriate rheology and malleability of the products. Simply put, they are beautiful to use. If you are injecting 12 hours a day, almost constantly, for practical reasons alone, this is golden. Whenever our group trial a product, among the initial buzz from the doctors is the question, “Is it easy to inject?”. Even the most volumising filler in the MaiLi range (the aptly named Extreme), is extremely easy to mould into place, even when placed relatively superficially. This is injecting gold to the career aesthetics doctor, and something that we all absolutely must trial for ourselves before beginning to work with any new injectable.
In our clinics, our patients don’t tend to focus on the brand of filler that we use, for several reasons. Firstly, they have usually spent an average of 18 months following (read: avidly stalking) our social media platforms and have become well versed in which products we aren’t aligned with and would never use, and why. Secondly, they see our consistent daily output of high-quality before-and-after photos, 180-degree videos of the same natural results, and the option of independently contacting these patients (with their signed consent of course). This garners trust in our clinic and brand. The significantly wide selection of patients demonstrated – of all ages, races, genders, skull shapes and classifications – instil a deeprooted confidence and feeling of safety.
Our patients know that whatever product we choose for them will have been carefully considered and selected owing to its high quality and safety, and will (expectations duly managed) give them the results they are hoping for. As such, introducing a brand into the clinic does not mean we have to persuade our existing patients to try something new. As long as my colleagues and I, and more importantly, the patients, are happy with the results, then the transition is a smooth one.
This doesn’t preclude patients being curious and asking questions about the products I’m administering. I have explained that until we venture forth to try another option, our previous choice of filler is always, in my opinion, the best on the market in the UK. This is how we evolve in practice, and how we stay ahead of the game and push out of complacent comfort zones. MaiLi has simply raised the bar of what is possible to achieve with facial remodelling using HA. Great results can usually be achieved with most decent fillers in the hands of a skilled and experienced injector, but true excellence, delivered patient after patient, day in day out, requires the use of something that is genuinely exceptional.
Individual clinics may choose to offer different brands of fillers with different price points, depending on the clinic’s specific location and the economic status of its patients. Others choose to use only premium products, and to charge accordingly. Attempting to price match with other clinics, particularly non-medics using what we consider comparatively sub-standard products, is a race to the bottom and will quickly lead to an unprofitable business. Maintaining high standards, using the best products, and unapologetically raising prices periodically (and especially post-Brexit and post-covid), will attract and retain high-quality patients that are happy to pay for excellence.
I use MaiLi almost exclusively now, but it is not a bad idea to keep some of your existing products in stock for those patients who absolutely insist they want what they’ve always had, those that you know will not tolerate any variation in their results, and simply as a safety net during the transition period as you gain experience and confidence in your new filler. If you do choose to offer a variety of products, ensure that your more budget-friendly range still has excellent efficacy and safety, and take care not to make it appear too “cheap”. Explain that although the product is highly effective, your premium filler has superior longevity and has a more natural feel once integrated into the tissue, and often carries a shorter downtime owing to a lesser inflammatory response, for example.
Promoting both the product and quantity used to achieve a more balanced overall facial result (and I emphasise, only where appropriate), can have a significant impact on both clinic turnover and patient satisfaction. A good example of this is a patient that books in for lip filler but has a poorly balanced profile due to class I bite and recessive chin. It’s important to explain (with diagrams and photographic examples of previous work if necessary) that 2ml of filler in the chin – that can last between one to two years – will balance the face far more readily than 1ml in the lips. This will produce a far happier and more contented patient who values your expertise and advice. The clinic and brand benefit, but more importantly the patient will more than likely attend again in the future for further treatments, as well as recommend you to their closest circles.
Launch events can be an effective way to introduce new products to your existing patients, while simultaneously promoting your clinic and attracting incremental new business. Your local injectable representative should be only too happy to facilitate assistance and promotional material. Ensure you advertise the event well in advance on all your social media platforms (or whatever your medium of choice) as well as in clinic, and send personal invitations, and “call to actions” to your regular patients. Live demonstrations of treatments, accompanied by explanations of why your new product is the best choice, will provide your patients with more attractive and tangible information than can be achieved with a PowerPoint presentation. However, avoid incentivising medical aesthetic treatments, for example by advertising special offers or discounts. Conflict with “The Keogh Report” aside, it attracts only a certain demographic that are loyal to price and not brand, and in my opinion, diminishes the appearance of medical professionalism.
“Explain that your premium filler has superior longevity and has a more natural feel once integrated into the tissue, and often carries a shorter downtime owing to a lesser inflammatory response, for example”
Choosing a new product for your clinic is not a simple task, and not one that should be carried out without significant due diligence. Ultimately, we each have our own unique way of working, so it’s important to choose the product range that is the perfect fit for your clinic’s machinations, your patients’ budgets, and with which you feel most comfortable as an injector.
My final advice: maintain the highest standards possible to give the best overall experience, don’t ever compete with sub-standard injectors on price, never undervalue your skills and experience, and use the highest quality products to give the best possible results.
1. Betemps JB, Marchetti F, Lim T, Hadjab B, Micheels P, Salomon D, Molliard SG. Projection capacity assessment of hyaluronic acid fillers. Plast Aesthet Res 2018;5:19. http://dx.doi. org/10.20517/2347-9264.2018.24
2. Molliard SG, Bétemps JB, Hadjab B, Topchian D, Micheels P, Salomon D. Key rheological properties of hyaluronic acid fillers: from tissue integration to product degradation. Plast Aesthet Res 2018;5:17. http://dx.doi. org/10.20517/2347-9264.2018.10
DR GARETH O’HARE
Dr Gareth O’Hare is a a graduate of Leeds University School of Medicine. He has a background in general practice and has been an aesthetics doctor for 11 years. He joined Consultant Clinic in 2019, and works in its Leeds, Liverpool and Greater Manchester clinics. He is a brand ambassador for the MaiLi range of fillers from Sinclair Pharma.