What's the best wrinkle filler?

There are several options to take care of wrinkles. Botox will paralyze the underlying muscles and help to reduct wrinkles, especially those see with muscle motion. Fillers will help to plump out the skin. Ablative laser and chemical peels will help to tighten collagen and permanently remove wrinkles. Unfortunately one size doesn't fit all and not every filler is made the same. As with anything, treatments should be personalized so consultation with an experienced and qualified surgeon is the key to good results.

Often times, patients question which ancillary procedure is best for improving facial wrinkles/lines. The answer depends on the nature of the facial wrinkle that is in question.

Broadly speaking, facial lines either are static or dynamic. Static lines would include those that are present in complete rest, i.e. - without any animation. Examples of these would include, nasolabial folds, marionette lines, prior acne scars, as well as some deep frown furrows, forehead wrinkles, and crows feet lines that are present at rest (the last three can be exacerbated by animation, though).

Dynamic lines are those produced during facial animation - as true of crows feet, forehead lines, and glabellar (frown) lines. Dynamic lines are largely produced by the contraction of the underlying muscles, which in turn, "wrinkles" the overlying skin.

As discussed elsewhere, Botox cosmetic is an excellent option for dynamic lines, as it addresses the etiology - i.e. the underlying muscle. By paralyzing the muscle, one is not able to contract it, thereby overlying skin is spared of associated wrinkling.

Facial fillers, whether they be Juvederm, Restylane, Catique, Hylaform, Collagen, etc, etc, etc... - as there are literally countless many more - are used for, as the category indicates, "filling" in facial lines/wrinkles/folds. But realize that if the line is caused by the underlying muscle, then simply "filling" in the line is inadequate, as it is not addressing the etiology.

Also, it should be evident that the reason why there exists countless number of facial fillers is because no one filler is clearly the "best" for all situations. After all, if one was the "best" - why would there be a need for so many others? In general, most facial fillers are all temporary, and bring about an improvement in deeper lines, folds, or wrinkles. Most facial fillers come prefilled in a 1cc syringe, and depending on the line treated and degree of correction desired, may require more than one syringe.

Several other uses of facial fillers include:

• Lip augmentation - All of us have our own bias in regards to our "favorite" filler for this purpose. I personally like to use a different filler depending on the desired outcome - are we striving to DEFINE THE LIP OR TO VOLUMIZE THE LIP? For lip definition, I personally still like to use collagen, as I feel it is more precise in its delivery, but for lip volume, I utilize one of the hylauronic acids (Juvederm, Restylane, etc).

• Facial fillers can also be used to fill in the "lower eye bags" as well. For this area, I prefer the softer hylauronic acid gel fillers - they may last less, but for this area with thin skin, it looks and feels better. Once again, this is just my own preference, and not point of right or wrong.

The field of facial fillers are constantly coming up with new products, so ask your local health professional about it. Ideally, the day when one filler is more durable (i.e. more permanent), soft, and cost efficient will be the day when further fillers will not fill the 5 o'clock news as the "latest" and the "best."

A good injector (whether nurse or physician) is knowledgeable about all of the various wrinkle fillers currently available and is able to recommend a specific product for a specific area. In addition, more and more injectors are using multiple products and layering them to create a more comprehensive result.

Deep volumization can be addressed using products such as Sculptra or Radiesse, while more superficial contouring can be achieved using Juvederm (Ultra vs. Ultra Plus), Restylane, or Perlane.

Other factors to consider when determining which filler to use include desired amount of downtime, budget, and desired length of effect.

Smiling is the best non-invasive wrinkle filler.

Of the temporary fillers mentioned by others (Restylane, Juvederm, and Radiesse, etc.), I believe that a patient's own fat is the best "wrinkle filler."

Fat transfer returns volume to the face, and has the advantage of being a permanent filler. The stem cells in the fat also work over time to improve the tone and texture of the overlying skin.

I do not use Sculptra in my practice because of some extremely mutilating granuloma reactions and infections that I have seen experienced by other physicians. For those of us needing a quick fix, certainly Restylane, Juvederm, and Radiesse are all great wrinkle fillers.

Overall, the most versatile, long lasting, and effective filler currently is Juvederm. I like it because it comes in two concentrations, Ultra and Ultra Plus, that can be used for finer or deeper lines. After injection, this product has excellent longevity (upwards of 6 months), is soft and supple, and causes minimal skin reaction. It can be used anywhere, including the lips, and, worst case scenario, it can be dissolved with hyaluronidase.

Radiesse is an excellent choice for deep nasolabial folds, for 'non-surgical' rhinoplasty, and for deep injection augmentation of the cheeks and chin. It is unpredictable in the infraorbital region and definitely should not be injected in the lips.

Restylane is equally as versatile as Juvederm, with great short-term results, but perhaps only 10% of my patients still have results after 4 - 6 months. It generally lasts only 1 - 2 months in the lips.

For permanent results, Artefill is the one and only choice. Presently, I am using it only in the nasolabial folds and marionette lines, but with excellent results.

Sculptra stimulates collagen production, resulting in filling and overall volume restoration / augmentation over time (and requiring 3 - 5 injection sessions spaced 4 - 6 weeks apart). It is not a traditional, 'what you inject is what you get', filler. It works best for patients with criss-cross crepey wrinkles and diffuse lower face hollowing.

Juvederm or Restylane in combination with a very low dose of Botox works well for fine vertical lines extending from the lips, although CO2 laser resurfacing really works best.