Dec 11
10
Filler up!
In my practice, I have many patients who come in for cosmetic consultation because they would like to look younger or less tired. They have heard about Botox and collagen and lasers, but can’t exactly put their finger on what it is that bothers them or what they really want. In many cases, the problem is loss of facial volume, which the patient frequently doesn’t even recognize.
It’s an unfortunate fact of life that as we enter middle age, our faces start to lose some of the fat and subcutaneous tissue that once gave us the soft rounded contours of childhood. This loss of volume is most noticeable in the cheeks, lower face, and lips. Gravity causes sagging, but loss of volume causes sinking. Our faces are little like a deflating balloon. For example, many patients complain of “smoker’s lines” around their lips, even though they’ve never smoked. These lines are frequently the result of loss of lip volume. As the lips deflate, the surrounding skin starts to crease. Likewise, many people are bothered by the smile lines or “nasolabial folds.” However, these grooves are often the result of sagging and sinking of the cheeks. Thus, the best treatment is to address regional volume loss and not just an isolated line or wrinkle.
Facial volume loss can be a particular problem with slender patients, or patients who have recently lost weight. So, what can we do besides intentionally putting on pounds? (Not a great choice, right?)
A group of injectable products called “fillers” can be used to restore lost volume, and are commonly used in the “smile lines,” lips, and marionette lines (the creases from the mouth corners to the chin.) They can also be used for facial contouring and restoration of the cheeks and jawline. There are several groups of fillers now available in the US.
Collagen was the first filler to be widely used. It was very popular in the 80’s and 90’s, but did not have a long duration and could only be used very superficially. It is no longer available. The hyaluronic acid fillers, including Restylane, Perlane, and Juvederm, are now some of the most popularly used agents. Hyaluronic acid is a complex sugar that is normally found in our skin and joints. It is the substance that gives our skin its suppleness by binding water. The hyaluronic acid fillers are non-animal derived, and have no requirement for skin testing. The chance of allergic reaction is extremely small and they are very safe. They generally last 6 to 9 months.
Radiesse, a suspension of calcium hydroxylapetite microspheres in a gel carrier, is a volumizing filler that has a somewhat longer duration than the hyaluronic acid fillers. The microspheres form a scaffold that supports and stimulates new growth of collagen. Over time, the spheres gradually break down and are naturally absorbed by the body. These injections are very safe, and the effects can last up to 18 months, depending on the area treated. It usually requires two treatment sessions, 8 weeks apart, to get final results.
Sculptra is a stimulatory filler which gives long lasting results ( up to 3 years,) but it requires several treatment sessions and results are not immediate, as with the other fillers. It is most often used for pan facial filling. Sculptra is composed of poly-L-lactic acid, and, like Radiesse, provides a scaffold for new collagen formation.
Finally, volume restoration can also be done with own’s own fat (autologous fat grafting.) This is obviously a more involved procedure, as it requires liposuction to harvest the fat from another part of the body, but can offer great results when performed by an experienced physician.
New filling agents are on the horizon. We are now seeing some technologies that allow a patient’s own tissue (skin, blood) to be harvested and processed into collagen and growth factor-rich concentrates to be injected into problem areas. It is an exciting time for non-invasive rejuvenation! When done well, fillers can give middle aged womdn a natural, refreshed look without looking artificial.
If you’re not ready for surgery and want to look a little more rested and refreshed, fillers could be a good option. Talk to your dermatologist or plastic surgeon to see what would best fit your individual needs.
