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The Filler Face-Off
What they are, how they work, and which one is right for you


March 2018

From wrinkles and sagging cheeks to thinning lips and under-eye circles, most people aren’t thrilled with the aging process. The good news? With advances in injectable fillers, the solution to many of these problems is just a needle prick away. That means you can get that younger, more rested and rejuvenated look in very little time — and for not too much money.

Fillers: What they are and how they work

“Fillers are excellent ways to make improvements to the contour of your face,” says Dr. Mark Blake, a board-certified plastic and reconstructive surgeon at the Clinic of Cosmetic Surgery. “Before coming in, I would like my patients to understand that fillers correct or improve only part of the aging process, like volume loss and some types of wrinkling. They are not a complete solution for aging skin.

“I believe it is important to manage a patient’s expectations from the very beginning,” he continues. “They should also know that fillers are temporary, and that the manner in which a treatment is planned can affect how long it lasts.”

Today fillers are generally divided into two groups: hyaluronic acid fillers and collagen stimulators. “Hyaluronic acid fillers are the most common type of filler,” says Blake. “Hyaluronic acid is a compound that acts like a sponge absorbing fluid — and therefore plumps up the area in which it was injected. (These fillers) can be reversed and normally last anywhere from six months up to two years. The other types of fillers, (collagen stimulators), help stimulate your skin’s natural collagen production and work subtly (and) gradually over time for a more youthful-looking appearance. They can last between two and five years. With hyaluronic acid fillers, correction is visible almost immediately, while collagen stimulators take up to eight weeks to notice improvement.”

A third type of procedure, known as fat harvesting, uses a patient’s own fat from one part of the body to reshape another. Unlike fillers, fat harvesting must be performed by a plastic surgeon and involves using liposuction to take unwanted fat from a patient’s abdomen and then inject it into

the patient’s face to make he or she look younger. Since the fat being used comes from the patient, the results typically last longer than fillers.

Another factor to keep in mind is the difference between Botox and fillers. Botox is a neurotoxin, which blocks the action of nerves on muscles. It is used to target muscles that form wrinkles and temporarily paralyze them. Unlike a filler, which plumps up the muscle, Botox relaxes the muscles that soften the wrinkle. 

Choosing the right filler for your face

There are many dermal filler products on the market, and each is used for a specific area of the face. Finding the right one depends on multiple factors, such as your individual skin type, how elastic your skin is, and how much sun damage you have. “There are fillers that are specifically designed for use in the lips as well as ones for fine wrinkles on the face,” explains Dr. Alex Colque, medical director of Skiin Anti-Aging Lounge. “The advances in filler technology are the varying degrees in the cohesiveness of the filler. A more cohesive filler adds volume, and a less cohesive filler will give you less volume but a more smooth contour in areas where you would like that effect. Your doctor needs to take all of these factors into consideration and choose the filler that is right for you.” Some of the most popular fillers used today include:

— Juvederm: The Juvederm family includes Juvederm Vollure XC, Juvederm Ultra XC and Juvederm Voluma XC, among others. These are all hyaluronic acid fillers. Vollure XC is used to add volume to facial tissue, thus smoothing wrinkles, and is especially effective on thin skin areas around the mouth and nose. Ultra XC is used to fill lips, while Voluma XC is recommended for adding volume to cheeks. The effects of Juvederm can last from six months to up to two years.

— Restylane: These hyaluronic acid fillers are used to correct moderate to severe facial wrinkles and folds. The Restylane family also includes Restylane Silk, which was the first FDA-approved product specifically designed for lip augmentation and to smooth wrinkles around the mouth. Restylane Lift is used to fill sagging cheeks and other mid-face contour deficiencies. In a single injection and without follow up, Restylane and Restylane Silk usually last up to six months. With repeat injections every six to nine months or so, select Restylane products have been shown to last as long as 18 months.

— Sculptra: As one of the most popular brands on the market, Sculptra was originally used on HIV patients who had experienced loss of facial fat due to the medication they were taking. Today Sculptra is used to plump cheeks and increase the thickness of facial skin, helping to eliminate folds and wrinkles. It works by promoting the formation of new collagen. For best results, you’ll need several treatments about three weeks apart, depending on the severity of the facial aging. 

— Radiesse: A collagen stimulator, Radiesse is used for treating severe facial wrinkles and to plump up sagging cheeks. Results have been proven to last a year or more.

One final note: No matter which option you use, Blake says the risks of complications arising from the use of fillers are minimal. “The most common risks are injection-site reactions, like bruising and swelling,” he adds. “These typically resolve a day or two after treatment. Sometimes (fillers) get a bad rap because of overdone celebrities, but when performed correctly, fillers look very natural and are a great way to improve one’s self image.”


This story ran in the March 2018  issue of: