Wrinkle removal and facial contouring with a dermal filler has become the must have alternative to a face lift for many women.
Many facial plastic surgeons now offer a “liquid facelift” based entirely on injectables avoiding the need for the downtime and pain of surgery.
Things have moved on quite a bit since I originally wrote this article a few years back so I’ve done a complete update combining several other articles into a useful guide to dermal fillers reflecting main trends in the market for 2012.
Originally collagen fillers were used to plump out wrinkles and add volume to facial features – the collagen extracted from human or bovine tissue. Nowadays – dermal fillers based on hyaluronic acid lead the market and if you see a plastic surgeon in 2012 you are certain to be offered one of the these new generation fillers rather than a collagen filler.
Why hyaluronic acid?
Haluronic acid is a naturally occurring substance in the body – your skin is made up of 40% hyaluronic acid which enables it to be absorbed more easily without rejection when injected. It also has a great surgical track record. It has been widely and safely used in non cosmetic surgery – especially cateract operations – for many years.
As a dermal filler it has several important advantages. A 2007 research study by the University of Michigan Medical School showed that hyaluronic acid fillers (Restylane was used) not only fill out the dips in the skin which show as wrinkles but it can also stimulate the natural production of fresh collagen over time.
Range of fillers increasing all the time
Dermal fillers using hyaluronic acid come in a range of consistencies and are injected using very fine needles into or under the skin where the wrinkles and sagging are found. Generally, the thicker fillers will be used for the deepest wrinkles and folds and will be injected more deeply into the tissue of your face.
New fillers are coming onto the market all the time but Restylane, Juvederm and to a lesser extent Perlane are still the most commonly used hyularonic acid fillers. There is more experience with these products and they are known to be generally reliable and effective.
Restylane SubQ is the thickest gel filler which is used to replace lost fat in gaunt cheeks and is injected just under the muscle in the cheek. Restylane and Hydrafill are used to fill out medium to fine lines and wrinkles. Perlane is a product for deeper wrinkles and Restylane Lipp is a lip filler for restoring plumpness to thinned lips.
Latest trend to a more ‘natural’ look
As fillers became more popular some famous faces started to look over-filled and smoothed to the point where all expression was gone.
Cheekbones became too prominent and pouts over emphasised. Combined with overly heavy use of botox the look was anything but attractive – even A list celebs like Madonna suffered to a degree. Whilst Madonna has pulled back from the brink to a more natural look – there are still plenty of bad examples around in 2012.
Dr Ben Benham a leading US dermatologist quoted in a British newspaper article earlier this year criticised the “chipmunk” look favoured by Carla Bruni: “A lot of celebrities these days look the same. They all have the puffy cheeks and cat-like eyes. What they should do is just do a bit so it just makes them look like a younger version of themselves and not a 50-year-old trying to look 25.”
Selection of the right dermal filler as well as the skill of the cosmetic surgeon make the crucial difference. According to Benham – Bruni’s look is the result of Radiesse which is a heavier type of filler when Sculptra (see below) would give the more natural look much more sought after nowadays.
According to another feature reported in The Times Style Magazine May 2012, whether you end up with an expressionless moon like face or a lighter rested look depends on where you live – London is the place for more natural interventions and Paris is the capital of heavy filler use. Ultimately though – it is the client’s decision.
But it is buyer beware – ask for a big change and you may get it!
Reversing the effects with hyaluronidase
One of the benefits claimed for hyaluronic acid fillers compared to the old style collagen filler is that are reversible if something goes wrong.
The hyaluronic acid can be removed by the use of an enzyme – hyaluronidase – to correct problems or unwanted results. The effect is to dissolve the filler so removing unwanted effects.
Sounds simple and reassuring but some words of caution are needed. Depending on the reason for using hyaluronidase in the first place eliminating the filler may take time. Overfilling can take at least a couple of days to remove whereas small areas of lumpiness can disappear more quickly.
You should also be aware that hyaluronidase is not FDA approved currently for this use and so there have been no clinical trials undertaken. Having said that – It is widely and apparently safely used by most good physicians and may be offered if needed as a branded product like Widase or Vitrase.
Practical details
Having a dermal filler injected into your face shouldn’t be too painful – providing you go to an experienced facial plastic surgeon or qualified dermatologist who offers the right kind of pain relief – ice packs, numbing cream, and dental blocks or topical anaesthetic.
Treatments around the nose or lip areas – very common for treating thinning lips, smoking lines or nasal fold lines – are usually more painful.
Time taken will vary but compared to surgery is minimal – usually around 45-60 minutes depending on which filler is used and where it is injected. Recovery time is also a lot quicker than surgery – anything from a few hours to a few days.
After effects
With any facial filler you may get redness and swelling and occasionally mild bruising which can happen around the site of the injection and should disappear in around 2 – 3 days. Skin reaction may last longer around the lips where there is little flesh and the skin is tender.
Quite a few people experience small lumps and areas of bumpiness after having a filler treatment which causes disappointment with the end result and much anxiety. For some this can be treated simply with facial massage to even out the filler under the skin without needing to remove it and start again.
There can be other unwanted results from hyaluronic acid fillers that are more problematic and widely reported in the forums. One of the worst is a blueish tinge or discoloration that can develop around the site of the filler and appears to be difficult to get rid of.
Most plastic surgeons report only extremely rare allergic responses to hyaluronic acid facial filler. The one contra indication you need to be aware of is the herpes simplex virus – if you get cold sores around the mouth the skin trauma of the injection may trigger a response and a fresh outbreak (as can microdermabrasion or skin peels). Tell your doctor your medical history and they may be able to provide additional protection.
Good advice is do your due diligence and take a look at some of the issues reported by people who have had fillers. The best site online for this is RealSelf.com – which has a very active membership as well as reports and replies from experienced plastic surgeons.
Alternatives to hyaluronic acid
Sculptra (based on poly-L-lactic acid) is another injectable dermal filler which is used as an alternative in certain cases. The main difference is the lasting effect of the filler (up to 2 years) and the fact that a series of injections are needed – usually 3-4 at monthly intervals – to achieve the anti aging effect.
The Sculptra injections stimulate the body to produce its own collagen and create elasticity and volume – for instance where the lower cheeks have a sunken look. Over time the Sculptra disappears from the body and natural collagen creates the plumping effect. Physicians claim that this type of filler can be effective for patients who want a gradual rejuvenating effect or more subtle changes to their facial features.
Sculptra has only relatively recently won FDA approval (2009) to treat facial atrophy – the loss of facial fat that commonly occurs with aging so experience with this product is still building. Check out what specific experience your surgeon has using Sculptra before you agree to the treatment and get a look at before and after photos from that he/she was specifically responsible for.
Costs of Sculptra vary but will be around $1000 per vial and you generally need one vial per treatment – so the total cost could be as much as $3000-4000. Bear in mind that if the treatment takes well your results will build over time and last longer than hyaluronic acid fillers like Juvederm or Restylane ($550-750 per syringe) which will need topping up much more regularly.
Use a skilled aesthetically trained surgeon
As with all anti aging treatments like this choosing an experienced board registered facial plastic surgeon is more important than cost – always do your homework and check out and get quotes from at least three in your area. Skilled physicians can make the difference between extreme disappointment and the results you want.
A skilled doctor can actually save you money in the long run – a lot of filler can be wasted by poor injection technique – for example injecting the filler too deep so there is little or no effect. Much time, money and anxiety can be wasted on corrections for poor technique.
Whoever you choose and whatever dermal filler is recommended – any good doctor will tell you that your lifestyle choices will have a big impact on how your skin looks afterwards. There is little point paying for expensive treatments if you are going to expose your skin to the sun, continue smoking and eating poorly.
So, take the opportunity to make some positive changes if you need to. Eat an antioxidant rich diet, use high factor sunscreen, get regular aerobic exercise and use the best anti aging skin care you can afford.
You’ll find that all of these things make a big difference to how good you look – whether you pay for a dermal filler as well or not!
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