Twenty years ago, if you wanted to get rid of wrinkly, sagging skin, there was basically one way to do it–going under the knife for a face-lift. But today, a range of dermal fillers can be injected into those crow’s feet, marionette lines, thinning lips and furrows between the brows, taking years off the face–and all can be done during your lunch hour, with no invasive surgery and little recovery time. “Fillers have dramatically changed the game,” says Dr. Ariel Ostad, a New York dermatologist. Doctors say patients who regularly urestse fillers can put off a face-lift for at least a decade. “In 20 years, I may not be doing face-lifts at all,” says plastic surgeon Dr. Kevin Tehrani, also based in New York.
Of course, there’s always a downside. Fillers are temporary (lasting anywhere from a few months to a year), bruising and swelling is common and some patients can have allergic reactions. And then there’s backlash from plastic surgeons like Dr. Sherrell Aston, who says, “Does it seem logical that one can repetitively put foreign substances in the delicate facial tissues and not have problems later?”
Nor are they miracle-workers. “If there’s too much sagging, fillers won’t work,” says Beverly Hills, Calif., plastic surgeon Dr. Garth Fisher, noting that sometimes only a face-lift or eye lift will get the job done. Fillers work under the skin to replace elasticity and plump up sagging skin, as opposed to the old techniques, which tended to tighten and flatten the appearance of the face. The look, when done right, is more youthful and natural than what was previously attainable; done wrong, though, faces look out of proportion and contour problems like lumps become noticeable. Still, professional women (and men) are increasingly seeking newfound youthfulness–and market competitiveness in a youth-oriented culture–with today’s popular dermal fillers. In other words, the question is rarely “Should I?” but rather “Which one?”
Restylane, Perlane, Juvederm and Prevelle Silk are made of hyaluronic acid, a naturally occurring substance essential to plump and youthful-looking skin. Non animal-based hyaluronic acid dermal fillers came on the world market with the introduction of Restylane in 1996. Before Restylane, dermal fillers were made of animal products such as bovine collagen (derived from cows), silicone (sometimes toxic), or body fat (a live and sometimes unpredictable substance). Hyaluronic acid dermal fillers are often a better option. Because the body already produces the chemical naturally, it hardly ever causes an allergic reaction, and it gives a smoother, more natural appearance.
The doctors agreed that while the optimal age for a patient to begin getting fillers is in the 40s to early 50s, all had treated younger patients on a case-by-case basis, depending on their situations and expectations. “In a place like Hollywood, people want to look good in the 20s and 30s,” says Dr. Fisher. “It’s easy to get frown lines just by expression, or exercising hard.” But getting doctors to concur on much else isn’t easy. All have their opinions on the various fillers, and often they differ. Take Evolence, which contains porcine collagen. Dr. Ariel Ostad says it’s “amazing” because it doesn’t cause bruising. But Chicago dermatologist and cosmetic surgeon Dr. Edward Lack, formerly president of the American Academy of Cosmetic Surgery, says Evolence is a “me too” product that has “no advantages” over what is already on the market.
And while Dr. Fisher feels that Perlane lasts longer than Restylane, Dr. Lack disagrees. Medicis Pharmaceutical , which has the license to market Restylane and Perlane in North America, prefers to stay out of the fray: “We only promote what is on label,” says spokesperson Kara Stancell. Perlane is FDA approved to last for only for six months, while Restylane is approved for lasting up to 18 months (with repeat injections). While some products, like Radiesse, claim to promote collagen reproduction, Dr. Tehrani and Dr. Lack make the case that any injection will generate collagen, since the body produces collagen to wall off the foreign substance. The truth is likely somewhere in between: When you’re dealing with patients’ individual skin textures, age, sun damage and genetic and metabolic factors, not to mention a doctor’s preferences and skill with injectables, the filler that works best is judged on a case-by-case basis.
It is good to ask your doctor why he or she recommends a particular filler for you, if it is FDA approved for the area in question (although most doctors do use fillers for off-label areas), and how many times he or she has injected it (30 to 50 times is a good benchmark indicator that the doctor has sufficient expertise with that filler). Because every filler has a slightly different consistency, a doctor should understand how to deep to inject it, be comfortable with the type of needle to use and other factors associated with that filler. According to the American Academy of Cosmetic Surgery, fillers like Restylane and Perlane have seen a 110% increase in procedures performed in the past three years. Botox, which doesn’t fill wrinkles, but reduces the muscular contractions that cause them, has seen a 115% increase. Face-lifts, on the other hand, have only seen a 20% increase in the same time period.
The average price for fillers is $800 per session, according to the AACS. Compare that to a face-lift, which can run into the tens of thousands. “In this economy, some people don’t want to pay [for] a facelift,” says Dr. Fisher, who charges approximately $50,000 for a visage overhaul. “But they still want to look good for job interviews.”