INJECTABLE FILLERS

Injectable Fillers are used to plump up (i.e., fill) folds and furrows on various locations of the face. They work by "puffing up" the area in question to bring it more into line with the surrounding contours. The most common sites enhanced in this manner are the nasolabial lines (which go from the nose to the corners of the mouth) and the marionette lines (which go from the corners of the mouth to the chin) but many other parts of the face and body can be treated. They can also be used to create fuller lips, including the lower and/or the upper lip, and to minimize the appearnce of lines on the hands. While facelifts and other surgical procedures may be necessary to achieve ideal correction, injectable fillers instead of or, often, in addition to these procedures can extend the results further. For example, nasolabial lines are not generally treated with maximum efficiency by a facelift. They may be improved but due to their distance from the points of tension with a facelift (above and behind the ears) and their genesis (which is partly a consequence of smiling and other facial movements), these lines may not receive adequate improvement from a facelift alone. The addition of a filler extends and enhances the process. Fillers are similarly useful in younger patients who have not yet developed enough excess facial tissue and jowling to warrant a facelift and in patients who do not want a facelift or who, for medical reasons, cannot have one but who nevertheless desire cosmetic improvement in those regions.

While injectable collagen was the primary material used for the past twenty years, many new substances have been developed and they are now widely available. The most popular of these is hyaluronic acid, which is available in the United States as, among others, Restylane® and Juvederm®. Each is, or is soon
expected to be, available in different formulations that, due to their precise chemical makeups, are designed for use at varying depths of the skin, and on different parts of the face and body. These are long-lasting but nonpermanent substances that provide correction for 6-12 months or more, depending on exactly how much and which product is being used along with individual variations in the rate of absorption. Another popular
semi-permanent filler is Radiesse, which consists of calcium hydroxylapatite microspheres suspended in a water-based gel.

Treatment takes about 20-30 minutes depending on how much is being done, and whether or not a topical anesthetic is used (in which case, an additional 30-60 minutes is required for maximum effectiveness). Several sessions may be required for the best results. These substances are packaged in
pre-filled syringes with specific amounts of the material in each syringe. The cost of the treatment depends, among other factors, on the number (and size) of syringes used.

These are truly lunch-time procedures, as the patient can resume his or her normal activity right after treatment. Makeup can be applied directly on the treated areas. As with any injection, they are associated with the risk of bruising and other potential problems but they are generally safe and effective,
and have very few side effects.

There are many other substances available, each with its own set of advantages and disadvantages, and new ones become available on a regular basis. There are, for example, permanent injectable substances and permanent implantable materials (the difference being, among others, the size and thickness of the product). Even within the category of non-permanent injectable fillers, there is a wide range of duration of correction available, depending on exactly which product is selected. Notable among these is Sculptra, a longer-lasting injectable that has received FDA approval for use in patients who have lipodystrophy
(fat loss) as a side-effect of anti-retroviral medications used to treat HIV.

The field of injectable fillers is rapidly changing and growing, and new developments can be anticipated continually.