They can plump sunken cheeks, downplay folds around the mouth, fill wrinkles and fight other offending signs of aging. But the many choices available for injectable dermal fillers can be overwhelming. The numerous options that can last longer or stall the breakdown of collagen have shifted the question from “should I?” to “which one?” for many seeking smaller facial tweaks. “There is no one size fits all when it comes to fillers,” said Dr. Jeannette Graf, assistant clinical professor of dermatology at Mount Sinai Medical Center and director of dermatology at Omni Aesthetic MD in Manhattan. “The best injectable for a person is what feels most comfortable in the injector’s hand.”
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The first-generation collagen-based dermal fillers that began more than three decades ago were limited to smoothing fine lines and wrinkles and required multiple touch-ups. The new fillers, both short- and longer-acting, can lift and sculpt cheekbones, jawlines and even the nose. To stop wrinkles in their tracks, doctors are also injecting a person’s own fat cells or blood platelet cells in place of, or in addition to, cosmetic fillers. (See: vampire facials).
The most commonly used injectables, such as Juvéderm, Restylane and Belotero, are made of hyaluronic acid, a sugary substance that occurs naturally in the skin. This mixture can lift skin folds around the mouth, fill a forehead crease, plump up a cheek or a lip and erase under-eye puffiness and bags. The results are immediate and can last between six and nine months, said Dr. Sami Khan, director of cosmetic surgery at Stony Brook University Hospital and medical director of Stony Brook Medicine’s Bellavie MedSpa, where his 20-something patients request “lip augmentation” while 40-somethings and those older seek wrinkle smoothing. Dr. Katy Burris, assistant professor of dermatology at Hofstra-Northwell School of Medicine, pointed out that patients who are dissatisfied with the results of a hyaluronic filler can have the effects reversed with an enzyme hyaluronidase.
Other popular fillers, like the mineral-based Radiesse, can erase pitted acne scars, tame nasolabial folds that extend from the corners of the nose to the corners of the mouth and clear “marionette lines,” creases that run from the corners of the mouth down to the chin. Unlike the hyaluronic acid fillers, Radiesse can last up to two years and stimulate collagen growth but is not reversible. For the chemically-averse, fillers composed of fat cells harvested from your own thighs or buttocks, or platelets from your own blood, can be mixed to form a gelatin that can be injected as a single treatment or as a supplement to cosmetic fillers. Results of these natural injections are immediate though they may or may not be permanent.
Hyaluronic acid, Radiesse and other fillers are also playing roles in plumping bony hands, perking sagging earlobes, refining and reshaping noses and as foot fillers to take the pain out of wearing high heels. Not surprisingly, fillers are in demand by women and men of all ages. Last year, nearly 2.5 million injections were administered, up 274% from 2000, according to the American Society of Plastic Surgeons. Also, most of these treatments can be performed during a lunch hour, said Dr. Burris. After the injection sites are marked on the face, the area is cleansed and numbed to ease the temporary discomfort. The actual injections take just a few minutes. Common side effects can include bruising, swelling, redness and lumpiness under the skin. Dr. Burris cautioned that the injectable fillers are not without greater risks
as well. One inadvertently injected into a blood vessel could cause skin discoloration, peeling and even blindness.
“This is not a benign procedure and people don’t think it can be harmful because it’s not surgery,” said Dr. Alan Matarasso, private practice and aesthetic surgery board vice president at the American Society of Plastic Surgeons. “This is a technique issue. Even if the physician is qualified to handle injectables, sometimes things happen.” Experts warn that there are limits to what fillers can achieve. Dr. Matarasso said patients attempting to avoid surgery overdose on fillers and wind up looking “overdone with too much volume in the cheeks…when skin is loose, you have to take it out. When you have lost facial volume, you want to replace that.”
Fillers can cost $700 to more than $1,200 per syringe. Moderate to severe volume loss could require two or more syringes. Dr. Graf noted that cost should not be a factor when considering fillers. “You are paying for skill. If you have a limited budget and you need a lot of filler, you’re better off using good skincare.” If the time comes to pursue the treatment, consult a board-certified dermatologist, plastic surgeon, ear, nose and throat specialist or ophthalmologist (“the core four”) who regularly perform the procedure. “There is something to be said about someone doing a thousand injections a year versus 10,” said Dr. Matarasso. Make sure the physician has an injectable filler “crash cart” stocked with emergency medications, should something go wrong. To help the process, bring a photo of a younger you that shows the hoped-for results. Most of all, make sure the doctor’s expectations meet yours. Like most relationships, the doctor and patient must be simpatico.