A DISCUSSION OF INJECTABLES
The field of injectables has really blossomed in the past few years. We have progressed from bovine collagen which was stiff and only lasted 3 months to a wealth of choices. This discussion will try to help sort out these choices for you.
Hyaluronic acids (Juvaderm, Restylane, Perlane, Prevelle and Hydrelle) have brought easy-to-use, longer-lasting (up to 2 years), clear and reversible products to the market. They can actually be dissolved if the patient does not like the effect. I like to use these fillers throughout the face — in the cheeks, because these tend to flatten over time, in the hollows under the eye, in the nasolabial grooves, and the marionette or parenthesis area (the indentations on the side of the mouth either above or below). They can also be used to give a patient a chin instead of a chin implant. I also like to use filler more superficially around the chin to fill in the dents and irregularities that we tend to develop as we age. Filler can also be used under the brow to give an illusion of a brow lift and make the eye look both softer and more open.
Radiesse is a long-lasting filler, but it has the color and consistency of toothpaste, so I only use it deep in the face where it cannot be seen or occasionally to re-inflate a nipple reconstruction that has lost some volume.
Sculptra is a unique volumiser. It generally and diffusely fills the face. It is ideal for a patient, say a runner, who is slender but feels his/her face is looking gaunt with age. It can also be used to volumise and rejuvenate hands that are starting to look bony. The disadvantage of Sculptra is that although it lasts about 2 years, several sessions are sometimes necessary, and it can be a little pricey compared to other fillers.
Fat is in some ways the best filler because it is permanent where it takes. The problem is that even with the most current techniques, how much fat grafting will survive is unpredictable. For this reason, if I already have a patient under anesthesia for some other reason, fat grafting will be only a minimal charge and well worth the effort. As a “stand-alone” procedure, it is not worth the cost because of this element of unpredictability. It should also be used cautiously in the lips. In patients who tend to put on weight, the lip will expand with weight gain and cause a strange-looking deformity.
What fillers cannot do well is correct the thin, “etched” lines in the face. Here, a little product has a minimal effect and a little more often causes bumpiness. In general, etched lines are best treated by laser, and this is discussed elsewhere.
The risks of fillers are minor. They include bruising and swelling. Allergic reactions are EXTREMELY rare. The bruising is usually minor, but I have to admit about once a year I can give a patient a very noticeable bruise. This is because you can’t always see the veins to avoid injecting them, and certain areas are very vascular. If you are not on any hormone supplements (birth control or hormone replacement) and if you do not have a tendency to clot abnormally, I can help you find Vitamin K supplements to help prevent bruising.
There are medications and herbals that can increase bruising and bleeding you should avoid for two weeks before receiving fillers. These are: Advil, Aleve, Alka Seltzer, Anacin, Aspirin, Ascriptin, Bufferin, Dristan, Empirin, Excedrin, Fioranal, Feldene, Ibuprofen, Indocin, Midol, Motrin, Naprosyn, Nuprin, Sudafed and Vitamin E. Tylenol is fine! Many herbals can cause bleeding -- Echinacea, Ginko Biloba, Ginseng, Licorice Root, St. John’s Wort, garlic tablets -- and others have not been studied well enough to know what impact they will have, so it is prudent to stop ALL herbals two weeks before receiving fillers.
Fillers can be very transformative for a reasonable cost and little down-time. Some have called them a “liquid facelift,” but I think that is a little exaggerated and mainly a marketing ploy. Nonetheless, my filler patients are some of my happiest.
It will be a pleasure to discuss fillers with you. If you have any questions, please call my office (804-320-8545).
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