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A Wrinkle In Time

By Maryann Hammers
Posted On Dec 03, 2010

Get your filler fix today and be line-free tomorrow

You laugh; you grin. You cry; you frown. You furrow your brow in thought; you raise it in shock. You squint to read a wine list; you pucker up for a kiss—or to blow out the candles on your birthday cake.

And every smile, sorrow, surprise and smooch of your life is etched into your skin in the form of lines, wrinkles, crinkles and creases.

“All these factors—plus smoking, lack of skin moisture, poor hydration, facial animation, genetics, gravity, wind and sun exposure—determine how your skin ages,” says A. Daniel Toland, MD, of the Toland Cosmetic Surgery & Laser Centre in Warner Robins, Ga. “Of course, wrinkles do convey wisdom and experience, but most of us would rather have fewer of them.”

Get Your Fill

Not so long ago, there wasn’t much you could do to erase the lines of a life well-lived. But in the past decade or so, injectable facial fillers have come a long way toward offering a relatively easy, super-fast, minimally invasive way to smooth out the wrinkles, fill in the furrows and plump up the hollows.

These fillers, which are injected just beneath the skin’s surface, are used for filling “laugh lines” (nasolabial folds that run from your nose to your mouth), “lipstick lines” (above your upper lip), and “marionette lines” (from the corners of the mouth to the jaw), as well as for plumping lips. And since few of us love needles, some fillers also contain a local anesthetic, such as lidocaine, to numb the skin and decrease injection pain.

“The main advantage of injectables is their convenience and versatility. Patients look immediately more rested and youthful with quick recovery and no downtime,” Dr. Toland says. “The procedures have few complications and reproducible results. The newer fillers have also demonstrated significantly more durability than their predecessors—six to 12 months or more.

Options Aplenty

Today’s cosmetic surgeons can choose from dozens of brand-name facial fillers, and new ones are continuaslly being developed. Here are some of the most widely used types, as well as some of the most popular trade names, and their uses.

Collagen injections have been used for decades to replace the skin’s natural collagen, lost through aging. Collagen fillers may contain purified human collagen, or the collagen may come from cows (“bovine”—which first requires you to have an allergy test).

Cosmoderm, made from human collagen, is well-tolerated and works well for fine wrinkles,” Dr. Toland says. “But collagen’s big drawback is that its corrections are relatively short-lived, so the bang is not worth the buck.” The FDA reports that collagen is “the shortest lasting of injectable filler materials,” with effects lasting about three months.

Hyaluronic acid (HA) fillers are among the most popular and widely used to restore volume and smooth away folds. These fillers aim to replace our body’s natural HA, a substance that is essential for skin hydration and protection. Restylane, Perlane, Captique, Hylaform, Juvéderm, and Prevelle Silk are examples of HA fillers.

“Hyaluronic acid is an important component of youthful, elastic skin, and the loss of it as we age contributes to the development of wrinkles,” Dr. Toland says. “HA fillers can be used for superficial or deep wrinkles with excellent results and virtually no side effects.” Results usually last from six months to a year.

“I prefer Juvéderm over all the others for nasolabial folds, peri-oral (around the mouth) lines and wrinkles, commissural folds and acne ‘pock’ arks/scarring, as it produces a reliably smooth, long-lasting result,” says James K. Hargan, MD, of the Oral and Facial Surgery Center of Kentucky in and Elizabethtown. “Juvéderm commonly lasts at least 18 months in my practice, and even then the touch-ups require far less product than the original procedure.

Calcium hydroxylapatite is a mineral found in human teeth and bones. The filler Radiesse is made from particles of this mineral, suspended in a water-based gel-like solution. Its effects last about 18 months. “Radiesse is very effective in adding volume to cheeks and brows, temporal hollows and dorsal aspects of hands, nasal deformity corrections or improving ‘jowling,’— one of the earlier signs of facial aging,” Dr. Toland says. “It’s also excellent for nasolabial folds.”

Poly-L-lactic acid, or Sculptra, is a biodegradable man-made material, used in surgical stitches and bone screws. As a filler, it’s administered over several months, with the results becoming apparent over several weeks and lasting up to two years. “Sculptra is excellent for restoring volume in cheeks,” Dr. Toland says.

PMMA(polymethylmethacrylate) is a type of acrylic plastic, but in the filler Artefill, it offers a nearly permanent solution for nasolabial folds. PMMA microspheres (tiny beads) are suspended in purified bovine collagen. After the collagen is absorbed, PMMA beads remain in the body.

“For deep wrinkles in the chin and cheeks, Artefill offers dependable results,” says Robert Grafton, MD, a cosmetic surgeon who practices in Rochester Hills, Mich. “It is expensive—but it lasts more than two years.”

Autologous fat is a patient’s own fat, which can be harvested to fill deep wrinkles or increase facial volume around the eyes. “The fat usually comes from the abdomen or thighs,” Dr. Toland says. “I incorporate a little liposculpting, so the patient gets the benefit of a better looking stomach, legs or hips—plus a better facial or eye appearance.”

In addition to the knowledge that autologous fat is completely natural (after all, it’s your own fat), another advantage of this technique is that the results are long-lasting, sometimes permanent. “In some cases the fat will actually grow. But it may take more than one series of fat grafting to obtain the desired improvement,” Dr. Toland says.

Because the fat-grafting technique is more complex, requiring greater surgical expertise and more time, the cost is higher compared to other facial fillers. “And there’s more potential complications because there are two surgical sites,” Dr. Toland says.

Personal Preference

With so many filler choices, which should you opt for? That question is best discussed with your doctor. “Not all fillers are the same, and not all patientshave the same response to each filler,” Dr. Grafton says. “I prefer different fillers for different areas. For example, for nasolabial folds, I may use up to four products alone or in combination, including fat from the patient, for a nice long-term result.”

Regardless of which filler you and your doctor decide on, it’s best to go easy at first—especially if you are using a semi-permanent product. “Aim for a natural look—you can always add more,” Dr. Grafton advises.