"A very animated, expressive individual will develop lines much sooner," says Beverly Hills dermatologist, Dr. Nathan Newman. " Botox and fillers are a good way to prevent the lines caused by these expressions from becoming deep creases."
The advantages of fillers outweigh the risks, according to experts such as Dr. Neal Schultz of DermTV.com. Fillers are generally cost-effective (starting at a few hundred dollars), easy to administer and natural looking. Schultz says. The effects generally last four to 12 months. The risks? Fillers can cause occasional bruising, mild pain or discomfort when injected and, in rare circumstances, allergic reactions.
Increasingly popular, brand-named fillers can be classified into several categories: collagen, hyaluronic acid (Juvaderm and Restylane), calcium-based (Radiesse) and poly-L-lactic acid (Sculptra). However, new kinds of fillers — including synthetic and permanent options, stem cell and blood-based fillers — have recently debuted on the market, making it even harder to evaluate the growing list of brands.
Hyaluronic acid-based fillers act as humectants to increase volume and are best used for lips and wrinkles. "It's like putting a sponge under your face and filling it up with water," says Dr. Stuart Kaplan, a dermatologist based in Beverly Hills.
New hyaluronic acid-based fillers on the market include Juvéderm XC and Hydrelle by Anika Therapeutics, both containing the anesthetic lidocaine to help reduce pain during the injection procedure. Sculptra, a poly-L-lactic acid, is best used for loss of volume in large areas of the face, such as in cheeks and at the temples. Calcium-based Radiesse works to combat deeper creases around the nose and mouth. Most of these products last up to 12 months.
The new wave of fillers, however, aims to improve the longevity of the treatments. The most controversial may be permanent options such as silicone (not FDA-approved) or Artefill, formulated from bovine collagen and synthetic PMMA microspheres, which stimulate collagen growth and are not reabsorbed in the body. Although these fillers sound appealing, experts question whether permanence is truly a benefit. "As we age our skin drapes differently," says board-certified dermatologist Dr. Debra Luftman. "What previously was a fill might become a ridge."
Also, since these materials are often foreign to the body, they can lead to allergic reactions. Side effects from silicone can be manifested, in worst cases, as infected boils and scarring cysts, Schultz says. "I only inject fillers that are native to the body such as collagens, hyaluronic and lactic acid," he adds.
Stem cell injections could become one of the most promising developments in the area of dermal fillers, doctors say, since stem cells integrate completely into the face and can truly claim to give a natural appearance. "Stem cell technology is revolutionizing medicine as lasers did in the past," says Newman, who offers a patented procedure called Stem Cell Lift at his clinic.
"Fatty tissue has the highest percentage of adult stem cells of any tissue in the body, with about 5,000 adipose stem cells per gram of fat," says Luftman. "Adipose stem cells have the capacity [of] cell memory, especially in the use of re-volumizing the face."
In the procedure, fat is removed from unwanted areas, stems cells are extracted, processed and re-injected into the face to fill wrinkles, sculpt and lift. "These living cells are genetically programmed [to be] incorporated into the surrounding tissues and take on the characteristics of their new surroundings," Newman says. It takes about three months for the cells to fully integrate and for the changes to become "permanent," meaning that they are not reabsorbed into the body but remain in place indefinitely, although they are subject to the natural aging process.
Although stem cell treatments are promising, many experts believe further development and safety studies are still needed before stem cell fillers can be adopted more universally. "There is not enough known about the reproducibility of results and side effects," Schultz says.
With so many options available, those interested in dermal fillers should visit a doctor to discuss expectations, evaluate options and devise a plan specific to their needs. "One can of paint won't paint every house," says Kaplan, underscoring the importance of choosing a doctor who is well versed in using different types of fillers and who doesn't have alliances with just one company. A doctor who is comfortable with different dermal fillers will choose the best ones for your needs, often using several kinds to achieve best results.
"The difference between looking naturally beautiful and looking like a chipmunk is all in the technique," says Beverly Hills dermatologist, Dr. Jessica Wu. For example, layering fillers over time offers gradual improvements instead of an instant and often unnatural appearance. "When fillers are injected inappropriately there can be hardening under the skin, lumps, swelling and even skin necrosis," or death of skin cells, Luftman says.
To find an experienced doctor, consult the American Academy of Dermatology's website (www.aad.org), which includes a physician-finder feature. Referrals from friends and colleagues can also be helpful, or prospective patients can check out local review sites such as Yelp (www.yelp.com) or Real Self (www.realself.com) to see what patients think of various practitioners.