Two new cosmetic injectable fillers are arriving on the shelves: Evolence (Johnson and Johnson) and Prevelle Silk (Mentor). Today we will talk about Evolence and tomorrow we will address Prevelle Silk. Obviously, whenever a new filler hits the market, we are always interested in what this filler has to offer. Evolence has perhaps garnered the most attention in the media as a new, “longer lasting” injectable filler.

What is Evolence? Evolence comes from Israel and is a porcine product (that is, it comes from a pig). Reportedly, even though it is not “kosher” since a pig cannot be kosher, the killing of the animal follows prescribed rabbinical techniques for animal slaughter. The touted benefit of Evolence is that it may be lasting a bit longer than Restylane like close to a year. There is also reportedly less swelling during the first 3 days that follow the injection compared with Restylane and Perlane because hyaluronic acid products swell more in the first few days. Two major problems so far have already been bandied about (but may not be entirely accurate): it is hard to mold the product after the initial first few minutes to hours and it provides a lumpy injection. Speaking with a colleague of mine who has used the product, the latter criticism may be inaccurate because the product can be more evenly delivered when it is injected with the right needle, pressure, and depth. Finally, the big question out there is will an animal product create an early or late allergic reaction to it? No matter what data the company presents, I am still skeptical of the safety in regard to this issue.

Here are the reasons that I do not have any interest in offering the product (at least not for now): (1) I try not to use any animal products — not necessarily for humane purposes — but due to patient safety with the use of animal products as mentioned above (2) I really like how hyaluronic-acid based products like Restylane and Perlane are 100% reversible if you don’t like the result. That adds significant flexibility. (3) I don’t see a lot of swelling in the first few days with hyaluronic acids because I don’t put them in areas that lead to significant distortion like the lips. Since I use hyaluronic-acid products for volume balancing primarily, many patients actually do not mind the swelling because it looks closer to the volumes that I would use for fat transfer. In the long run, trading 2 to 3 days of mild swelling is worth it for a product that is not animal-based and can be easily reversed at any time. (4) The longevity that I have seen with Perlane is in many cases over a year, which competes effectively against Evolence. Also, I don’t believe that the product will last a year. I may believe it in a year from now when I talk with my colleauges not the company. For all of these reasons, I do not see any reason to use Evolence in my practice. I am not here to condemn a surgeon who decides to use the product but I am not going to be an early adopter on this one.

Here is a video log that I shot summarizing my thoughts on Evolence