If you’ve been in a dermatologist’s waiting room lately, you probably saw promotional material about injectable dermal fillers, which “erase” wrinkles, furrows and depressions without plastic surgery. Such cosmetic treatments have become such a booming and highly profitable business that it now takes many weeks to get an appointment for routine skin problems at some dermatology offices.
Dermal fillers, often called facial fillers, plump up areas that have, with aging, lost fat and other structural components. (In contrast, products such as Botox reduce wrinkles by paralyzing facial muscles.) Most commonly treated are the creases connecting the corners of the mouth to the nose or chin, “crow’s feet” near the eyes and lines on the forehead and between the eyebrows. Certain fillers are used to contour the face to produce fuller lips or cheeks, for example, or are injected into other body parts, such as the back of the hands. Some are being used by people with HIV who lost facial fat as a side effect of some older medications.
Facial fillers: the old and the new
More than 150 injectable fillers are used worldwide, but only about 15 have been approved in the U.S. These fall into four general categories: human fat (taken from elsewhere on the body); collagen (a structural component of skin); hyaluronic acid (another natural skin component) or newer synthetic polymers. Not all are approved by the Food and Drug Administration (FDA) as wrinkle fillers or for all areas of the face or body, though doctors use them “off-label” for such purposes. The compounds have different cosmetic effects and last for varying amounts of time; each has pros and cons.
Collagen fillers, the first to be approved, are no longer marketed in the U.S., presumably because they last only two to four months and are more likely to cause allergic reactions.
Most popular now is hyaluronic acid (such as Restylane and Juvederm), which is naturally present in the skin and in other tissue. It breaks down harmlessly in the body after six months to a year and is less likely to cause allergic reactions.
The latest generation of fillers contain synthetic materials. These include Sculptra, which works by enhancing volume, and Radiesse, which acts as a scaffold for the body’s collagen. They are considered semipermanent because their effects last two to five years. A permanent filler called Artefill, made from microscopic plastic beads suspended in bovine collagen, is FDA-approved for filling in certain kinds of wrinkles.
Before you use facial fillers
While serious side effects are uncommon, all fillers have potential risks. During the first 24 to 72 hours after the injections, there may be localized swelling, redness, bruising, bleeding, lumpiness, allergic reactions and infections. Some of these risks can be reduced by proper technique. For instance, while even the best doctor can leave a bruise, this is less likely if the substance is injected slowly and at the correct depth. Longer-term problems include bumps, discoloration, skin thickening and scarring. More rarely, the filler can leak through the skin and migrate beyond the injection site. Some people find the injections painful, even with local anesthesia.
Fillers that are more permanent sound good, but not if you dislike the results. And don’t assume that the newest fillers are best, despite the enticing ads—doctors have less experience using them, and less is known about longer-term safety.
If you are considering treatment with a filler, look for a dermatologist or cosmetic surgeon who will discuss the pros and cons of the FDA-approved products appropriate for you and who is experienced with the filler you choose. Keep in mind that not everything can be fixed well with a filler. And poor results may be difficult or impossible to correct. Start with a more temporary filler to see if you like the results before proceeding to a longer-lasting one.
Lastly, fillers are expensive, though not as costly as cosmetic surgery, which is also much riskier. A single syringe-full costs hundreds of dollars, and you may need more than one syringe per session, more than one session per treatment (usually weeks apart) and then more treatments months or years later. Insurance doesn’t cover fillers, except possibly to treat a scar from an accident or injury.