Should You Try Injectable Fillers?


Should you try injectable fillers? : Injectable fillers can “refresh” your face. Before you take the plunge, learn the pros and cons

By Camilla Cornell

Should you try injectable fillers?
A more youthful and rested look with no anesthesia and no need to go under the knife? Small wonder that in 2011, non-surgical procedures like injections of Botox and dermal fillers accounted for 82 percent of all cosmetic procedures performed and 37 percent of all spending on plastic surgery, according to the American Society for Aesthetic Plastic Surgery, which includes Canadian doctors. It’s a trend that will likely continue as more of us consider anti-aging alternatives that fall between a facelift and a wrinkle cream. A recent survey of more than 800 Canadian women by Leger Marketing found that one in four was open to getting an injectable treatment, and 34 percent considered injectables to be an everyday procedure akin to teeth whitening and hair colouring.

How fillers work
Second in popularity to Botox in non-invasive anti-aging procedures, fillers add volume to the face, usually by filling in wrinkles and lines, and sometimes by plumping up areas of the face that have lost fat pads (such as the cheeks, under-eye area and temples), causing the skin to sink and sag, explains Calgary dermatologist Dr. John Arlette.

Most patients who see Vancouver dermatologist Dr. Frances Jang for dermal fillers start treatments in their 30s, 40s or 50s, but patients range in age from their 20s (usually for lip plumping or, occasionally, filling smile lines) even up to their mid-80s.

The subtle improvement that dermal fillers can provide is a selling point for many. “Patients say they don’t want to look dramatically different,” says Jang. Treatment takes as little as 20 minutes, and in some cases you get immediate results. Jang cautions about expectations, though. “Patients in their 50s or older sometimes opt for dermal fillers because they’re opposed to a facelift or don’t want to spend the time or the money,” she says. But by that age, “no matter how much you get, [fillers can’t] give you the same end result as a facelift if there’s too much skin laxity and volume loss. You really have to re-drape and tighten the skin,” which is what a surgical facelift does.

First-generation dermal fillers, introduced in the early to mid-1980s, were made of animal collagen. They had to be topped up every three months and required a patch test first because they caused allergic reactions in about three percent of patients.

Since 2000, those fillers have given way to a range of new formulations. Some contain lidocaine to make treatment more comfortable. And some doctors now inject with cannulas (tubes with a blunt tip) rather than needles, an innovation that, along with lidocaine, has “reduced pain and discomfort by 90 percent or more,” according to Toronto dermatologist Dr. Benjamin Barankin.

Here’s a cheat sheet on various options:

Hyaluronic acid (HA) fillers (brand names include Juvéderm and Restylane)
By far the most commonly used fillers, these can plump thin lips and hollowed under-eyes; fill facial wrinkles, acne and post-surgery scars; and fill creases such as smile lines (nasolabial folds) and “marionette” lines (which run from the mouth to chin). “They can also be used on their own or in conjunction with Botox to soften the lines between the eyebrows,” says Arlette. HA naturally occurs in the middle layer of your skin, keeping it plump and elastic. Although HA fillers are synthetically produced, the substance is nearly identical to the HA we produce naturally. The fillers come in various formulations so doctors can target specific areas. More viscous (thicker) versions, such as Juvéderm Voluma, recontour the face, and lift and sculpt cheekbones, chin, temples and even the nose.

The pros: Results are immediate (and if you don’t like what you see, there’s an injectable “eraser” called hyaluronidase). It lasts from 12 to 16 months.

The cons: It doesn’t last as long for lips (five to six months). Also, “there’s a reasonable ’ chance you could have a bit of bruising,” says Jang, especially if you have had injections around the mouth.

The cost: About $500 to $800 per syringe (with one to five syringes needed, so the total cost per treatment might range from $500 to $4,000).

Wrinkle fillers: Are they right for you?
4 popular wrinkle fillers
What you need to know about Botox
Made of tiny calcium-based crystals suspended in a water-based gel, it is used in the mid-face area, often for deep smile lines and marionette lines. The beads initially plump up the target areas, but also stimulate your body to produce its own collagen for a longer-term effect.

The pros: Radiesse typically lasts 12 to 18 months.

The cons: It can’t be used in thin skin around eyes and lips (where its crystals can sometimes be visible). It’s not reversible, so if you’re not happy with the results, you have to wait until it dissipates.

The cost: About $650 to $800 per syringe, with two syringes needed on average, for a total treatment cost of $1,300 to $1,600.

Sculptra aesthetic
Originally used to treat gaunt-faced HIV patients, Sculptra is best for patients whose faces are thin and saggy, but who don’t want, or aren’t ready for, a facelift. Sculptra is a “stimulatory filler,” meaning it encourages skin to produce its own collagen over time. It is made of poly-L-lactic acid—the same material used in dissolvable stitches.

The pros: Results can last two years or more.

The cons: You need a minimum of three treatments over several months and you won’t see a change for three to five months. It’s not reversible.

The cost: $2,000 to $2,500 per treatment.

Platelet-rich plasma therapy (for example, The Selphyl System)
Platelet-rich plasma therapy is less commonly used than the ones mentioned above. Introduced in 2009, it treats wrinkles, crow’s feet, scars, and neck and under-eye crepiness. Doctors draw your own blood into a test tube and put it through a centrifuge to separate the platelets and fibrin from the blood cells. They then inject the platelets into your skin to trigger the growth of collagen and cells.

The pros: Since it is your own blood, it’s bio-compatible. Results can last a year.

The cons: It takes two to six weeks to see an improvement, and it takes a few treatments. It’s not reversible, says Arlette.

The cost: About $1,200 per treatment.

Autologous fat transfer
Also less commonly used, autologous fat transfer is a technique that has been around since the 1980s. Doctors extract fat from your thighs, buttocks or flanks, process it and then inject it as a filler.

The pros: Using your own fat eliminates the risk of allergic reaction or rejection by the body. It lasts six months minimum.

The cons: It’s more time-consuming and expensive because you have to undergo liposuction (to extract the fat). Not all the live fat cells will survive the transplant. There’s potential for swelling, discomfort and lumpiness. And it’s not reversible, says Arlette.

The cost: $3,000 to $5,000 per treatment.

What can go wrong
Dermal filler injections should be administered by a physician, or a nurse under a physician’s direction. When considering your options, ask who will administer the filler, what kind of training or credentials they have, and how many procedures they have done in the past—more is better. Don’t choose based on the lowest price, says Jang. “I’m not saying the most expensive is the best, but you want someone who will listen to you, has been doing it for a long time and has a good reputation.”

Among the more common complaints? That results either aren’t visible, or that too much filler was used, resulting in a pillowy or lopsided-looking face; lumps or bumps in the skin; and bruising. Lips can be tricky, too, says Barankin. A doctor who uses too much filler or uses the wrong type can leave you with “duck lips” (think Goldie Hawn in The First Wives Club). Opt for a doctor who takes it slow, he says. “You can always add more filler later if it wasn’t enough.”

Although the new generation of dermal fillers is far less likely to prompt an allergic reaction, there is still a risk of that and other side effects. Ask your doctor beforehand about possible side effects and risks of the procedure, and what you should do if they occur. Health Canada reports incidents of pain, bruising, redness, swelling, nodules (raised bumps), abscesses, infection, skin discoloration and hyper-pigmentation. There can be lumpiness from improper placement of the material.

When to steer clear
Health Canada advises postponing a dermal filler treatment if you have inflamed or infected skin, or pimples, cysts, rashes or hives. Avoid the procedure altogether if you have a bleeding disorder, a tendency to excessive scarring or a history of severe allergies, particularly those marked by anaphylactic shock.

This article was originally titled "Fillers: Are they for you?" in the December 2012 issue of Best Health.

Article by
Toronto Dermatologic Surgeon