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Fill 'er Up!: Facial Rejuvenation and Contouring Using Cosmetic Fillers

By Danya B. Hoenig, PA-C

The recent but much anticipated trend in facial plastic surgery away from the so-called "done" look towards a more natural appearance has led to an explosion in the field of cosmetic fillers. While a filler will not replace the need for a facelift, there are numerous applications of cosmetic fillers that create a subtle, beautiful and natural appearance. Fillers can be used for anything from smoothing out a little wrinkle to evening out a deep furrow. Cosmetic fillers can correct hollowness around the eyes, add fullness to thin lips, or balance a disproportionate face. They can be used to restore fullness that is naturally lost as fat diminishes from the face with aging, or can be used to create stronger features such as prominent cheekbones or a more angled jawline. These cosmetic fillers range from temporary (lasting a few weeks or months) to semi-permanent (6-12 months) to permanent. They are derived from animal sources, donated human sources (yours or someone else's), or are completely synthetic. Some are injected, some are surgically implanted, and the range in cost for one treatment can vary between a few hundred to a few thousand dollars. All of these details can easily become overwhelming, so, in your quest for a beautiful, natural-appearing and youthful visage, here are the facts to help you round out your knowledge of cosmetic fillers.

The simplest and least expensive method of facial contouring is by the use of a temporary, injectable filler. The injection of temporary fillers is performed in the office, with or without a topical anesthetic or nerve block, and the procedure takes about 5 to 15 minutes. Collagen is the old favorite, with Zyderm and Zyplast being the most commonly used brand of collagen. This product typically lasts from 2 to 4 months, and the cost ranges between $200 and $400. A skin test is required prior to injection of collagen since about 4% of the population will have an allergic rection to the bovine (cow) collagen.

The newest and most exciting additions to the line-up of temporary, injectable fillers are Restylane and it’s thicker counterpart, Perlane. Both are made from hyaluronic acid, a substance that naturally creates volume in the skin. Since this product does not involve the use of foreign substances, allergies are extremely rare and a skin test is not required. Additionally, the results last about twice as long as collagen, and in some instances, Restylane and Perlane can last for up to 12 months. While they are not yet available in the US, FDA approval is expected in the summer of 2003. The cost is expected to be between $500 and $1000 per treatment.

As an alternative to injecting a substance that your body will eventually absorb, another class of fillers involves injection of a permanent substance. Once this foreign substance is injected, your body will naturally form scar tissue around it to protect it from entering other areas of the body. This scar is made of collagen, which as we know is a filler all by itself. However, since the foreign substance is not biodegradable, it will stay in your body presumably forever. Although this may seem like an ideal permanent solution to facial contouring, your body's reaction to the foreign material is unpredictable and some of these products can be toxic. While many people will do fine with injection of a foreign, non-biodegradable filler, some people will form excessive scars, creating firmness, lumpiness, inflammation, and migration of the substance. And since it is permanent, it is very difficult to remove if problems do arise. There are nearly 20 types of permanent injectable fillers, but the most commonly used are Silicone and Artecoll (made from the same chemical as plexiglas), neither one of which is legal in the United States.

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