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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.
dr. hoenig
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