Dr. Solish is often quoted in the media because of
his comprehensive knowledge of the field of
cosmetic dermatology.  Dr. Solish's appearances
have included:
  • Global TV
  • CBC Radio
  • City TV
  • Regular appearances as Resident
    Dermatologist on TV Ontario

FROM: Cosmetic Surgery News, Sept. 2002
Survey Results on the Safest Injectable Wrinkle Fillers:
by Sandra J. Freer of SDA Publishing Inc.
( truncated version)

The mission to find safe and simple injectable fillers for temporary enhancements
to faces and lips has been an ongoing task. Fillers that involved little pain, few
side effects, produced key results and provided a safe and effective material for
this purpose should respect certain characteristics: it should be biocompatible,
non-antigenic, non-pyrogenic, non-inflammatory, non-toxic, easy to use, stable
after injection, non-migratory, long-lasting BUT reabsorbable, natural looking and
not too expensive.

A Canadian survey was conducted of the Q-Med injectable dermal fillers awaiting
FDA approval in the United States - Restylane, Perlane and Restylane Fine
Lines, manufactured in Sweden, are registered trademarked products of Q-Med -
a rapidly growing biotechnology and medical device company which works
globally.

Dynamic products; Restylane was approved in Canada in1998 and Perlane
approved in 2000. These injectable fillers were unanimously voted as the product
of choice, with the added bonus that they do not require a pre-test as do the
bovine based Collagen based temporary or controversial permanent fillers. A
major benefit of hyaluronic acid is that it is chemically identical in all living
organisms and thus has no immunological properties. The value of a material
that has physical and mechanical properties particularly suitable for soft tissue
augmentation and biological characteristics similar to those of dermis was worth
the investigation.

Background qualifications of the Plastic Surgeons and Dermatologists required
each physician to have had experience for a considerable length of time with ALL
the injectable wrinkle fillers available in Canada. Each subject Cosmetic
Surgeon and Dermatologist provided their own independent clinical observations
of the two Q-Med injectable fillers, Restylane and Perlane.

"Restylane and Perlane are desirable among my patients because the longevity
exceeds any of the other non-permanent fillers," reports Dr. Nowell Solish,
Cosmetic Dermatologist and Dermatologic Surgeon at Sunnybrook and
Women's Health Science Centre in Toronto, as well as, an Assistant Professor
at the University of Toronto. "My patients seem to have the highest satisfaction
with these products and I have not experienced any significant adverse reactions
or complications. The products are safe, effective, and non-invasive, resulting in
both high patient and physician satisfaction."

Restylane® and Perlane are produced of hyaluronic acid. The hyaluronic acid
used in Restylane and Perlane is manufactured by biotechnological methods
from a non-animal source. The hyaluronic acid molecular network is stabilized by
introducing minute amounts of cross-links. The stabilization is accomplished
using compounds that are as harmless as possible. Without this modification,
the hyaluronic acid would only stay in the tissue for a few days. Conversely, too
much modification can affect one of the hyaluronic acid's most important
properties negatively. This property is its biocompatibility, the ability of the
substance to be body-friendly. The result is a transparent and viscous gel with a
concentration of hyaluronic acid of 20 mg./ML and is no longer water-soluble, but
retains its affinity for water and its ability to bind and form hydrated copolymers.

"My patients like Restylane and Perlane the best because these products are
easy to use with predictable results." states Dr. Michael Weinberg, Plastic &
Cosmetic Surgeon, President of the Ontario Society of Plastic Surgeons with a
practice in Mississauga, Ontario. I have not seen any adverse reactions to date
in many hundred injections and it is not necessary to perform a skin test before
treatment. Bruising should not be considered an adverse reaction, but a possible
after-effect. The Q-Med products leave no waste and the procedures are quick,
with instant results."

"My patients have maximum results and maximum satisfaction with Restylane
and Perlane. I feel these fillers are better than any of the other temporary
products," declares Dr. Kevin Smith, Dermatologist, Director of the Dermatology
and Skin Care Centre in Niagara Falls, Ontario. "The efficacy of these fillers is
great, they are easy to work with, and have a nice range of consistencies, which
we can mix-and-match to get the optimum effect. As with any injectable,
bruising is possible, but, not common in my experience. Inflammatory reactions
have been exceedingly rare in recent years, with the current highly purified
material; I have never seen an inflammatory reaction to Restylane or Perlane."

"Patient satisfaction is extremely high," Dr Steven C. Bernstein, Assistant
Professor at the University of Montreal and Director of the Department of
Dermatological Surgery of Montreal, Quebec, answered. "Patients appreciate the
instant results, lack of pain, long duration of aesthetic improvement, and the lack
of 'downtime' following the procedure. I appreciate the versatility of this product
line and I am extremely comfortable with the safety profile that I have
experienced to date. The products are extremely effective and long-lasting."

A local anaesthetic cream (lidocaine-prilocaine) could be administered before the
injection, while nerve block anaesthesia of the infraorbital and mental nerves
(mepivacaine 3%, 4ml) has always been used when treating the lips. Common
antiseptic solutions have been used to prepare the skin.

"In most cases it is less expensive to have Restylane or Perlane injected over
time than a product like Artecoll, which, despite its claims of being permanent
needs at least 2-3 treatments plus maintenance. I do not use the so-called
permanent fillers in my practice." articulates Dermatologist Dr. Thomas Kohn,
Assistant Professor of Medicine (Dermatology) at McGill University in Montreal,
Quebec. "It is true that those fillers are permanent as far as the product
remaining in the body, but in my opinion it is misleading to tell my patients that
the cosmetic effect is permanent, since we have not yet found a way to stop the
aging process or the effects of gravity. The plastic beads are permanent and so
are the problems." he adds "With Perlane and Restylane my patients can
maintain the desired cosmetic effect which can change with current fashion
trends, their age, their fluctuating weight and who can predict that the thin lips of
Cheryl Tiegs won't be back in fashion! I want my patients to come back because
they are happy and because I give them realistic information."

"Restylane is a painless procedure and is an easy product to use, with great
physician satisfaction". claims Dr. Earl Minuk, Dermatoligist from Winnipeg,
Manitoba, "Patient satisfaction is higher with these products because they can
walk out and put make-up on right away. Restylane and Perlane are efficient
products and that is definitely a plus."

Physicians observe that the products seem to last longer with repeated
injections, therefore prolonging the period needed to maintain the desired
cosmetic end result.

In conclusion: Non-Animal Stabilized Hyaluronic Acid (NASHA) fulfilled the
expectations of giving a safe and efficient soft tissue augmentation for lips,
wrinkles and facial contours. No pre-testing allows for instant treatments. All the
subject physicians reported the average duration ranged from 6 to 12 months
and that Q-Med's Perlane, Restylane and Restylane Fine Lines are their
products of choice in a highly competitive marketplace.

Please contact Dr. Solish at:

66 Avenue Road (concourse level)
Suite 1, Toronto, ON. M5R 3N8
Enter off Lowther street
Phone: 416-964-8888

Restylane®, Restylane Fine Lines and Perlane are trademarks owned by
Q-Med Esthetics.