The Fountain of Youth
now comes in a vial. Of
the 15.9 million noninvasive
and minimally invasive
procedures performed
last year, botulinum toxin
type A and soft tissue fillers
have ranked one and two
on the American Society
of Plastic Surgeon’s yearly
statistics report, the same
top spots they’ve been in
for the last 12 years. There’s
no denying their popularity,
but it can still be difficult
to navigate the world of
needles, vials and units.
Firstly, it’s important to note
that there are three different
types of injectables:
neurotoxins, hyaluronic acid fillers and collagen-stimulating (aka longer-lasting) fillers. Secondly,
it’s best to go to a board-certified doctor practicing
in the scope of their
specialty training to help
identify which injectables
are best suited for each
specific concern. “I’m a
big believer in Malcolm
Gladwell’s rule of having
10,000 hours of practice
to achieve mastery in a
field,” says Chicago plastic
surgeon Julius W. Few, MD.
“You can look on Instagram,
where there are different
injectors of varying
experience, but sometimes
they’re injecting a product
under the eyes you
shouldn’t put there.
Ultimately, it’s not just about
hype; it’s about choosing
someone who has the
training and expertise—a plastic surgeon, a
facial plastic surgeon, an
oculoplastic surgeon, or
a dermatologist—that’s
who you want to go to.”
Neurotoxins
These line erasers work double-duty when it comes to reducing
signs of aging. By temporarily blocking
nerve receptors to facial muscles, they
soften the look of existing lines and wrinkles
while also preventing others from forming.
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Brand Names: Botox Cosmetic, Dysport,
Jeuveau and Xeomin
Treatment Areas: A saggy brow line, crow’s feet, forehead wrinkles and frown lines
What to Expect: Dysport kicks in within
a day or two; Botox Cosmetic, Jeuveau
and Xeomin can take three to five days.
Results typically last three to four months.
But, after repeated injections, results
may last up to six months.
Additional Uses: Treating neck bands,
excessive sweating, a gummy smile, cleavage
wrinkles, migraines and TMJ. In clinical
trials, many patients with depression who
were treated with Botox noted dramatic
improvement. “The effect may be at least
partly due to a similar mechanism of
action as for migraines,” says New York
dermatologist Doris Day, MD. “We know
that expression is tied to emotion as much
as emotion is tied to expression. Using Botox
to reduce sad or negative expressions
can help reduce the negative or sad
emotions that are connected to them.”
Average Treatment Cost: $300–$1,200 per area
Hyaluronic Acid Fillers
Lines and wrinkles, a natural
by-product of aging, are caused when
space is created between skin’s aging
collagen and elastin fibers. Hyaluronic acid fillers work to counteract this by attracting
water to the deficient areas to plump them
up and restore a more youthful look.
Brand Names: Belotero Balance, Juvéderm,
Juvéderm Volbella, Juvéderm Vollure,
Juvéderm Voluma, Juvéderm Ultra,
Restylane, Restylane Defyne, Restylane Lyft, Restylane Refyne, Restylane Silk,
and Revanesse Versa
Treatment Areas: Nasolabial folds and
wrinkles; volume loss in the cheeks, chin
or jawline; the backs of the hands; thin lips;
and under-eye hollows
What to Expect: Procedure time is around
15 to 30 minutes, depending on how
many areas are being injected. There’s no
downtime and recovery time can last
from a few hours to a few days. Results
can continue to be seen from three to 12
months depending on treatment areas.
Additional Uses: Correcting nose bumps;
lessening droopy brows; adding volume
to a bony chest; reducing acne scars;
lessening droopy earlobes; treating foot
pain; and filling in sunken temples
Average Treatment Cost: $550–$1,400 per syringe
Longer-Lasting Fillers
Also known as collagen-stimulating
fillers, these provide immediate
results that continue to improve over
time. Formulated in a gel or water base,
they stimulate the body’s own production
of collagen, which provides a longer-lasting
effect that adds volume and lifts the soft
tissues, ultimately diminishing lines.
Brand Names: Bellafill, Radiesse and
Sculptra Aesthetic
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Treatment Areas: Nasolabial folds and
wrinkles; the backs of the hands; volume
loss in the cheeks; thin lips; and under-eye hollows
What to Expect: Just like with hyaluronic
acid fillers, procedure time is around 15 to
30 minutes, depending on how many areas
are being injected. There’s no downtime
and recovery time can last from a few hours
to a few days. Results can last one to two
years for Radiesse and Sculptra Aesthetic;
and up to five years for Bellafill.
Additional Uses: Filling in nose depressions
and sunken temples; reducing acne scars;
and correcting nasal asymmetries
How They Differ: In addition to longevity,
results aren’t immediate and can be less
predictable than with hyaluronic acid fillers.
Average Treatment Cost: $550–$1,000 per syringe
Fat Transfer
Fat transfer is a filler technique
that removes fat using a small
amount of liposuction from a selected
area of the body and then re-injects it
into the face, hands or other treatment
sites. This is one of the safest ways to fill
skin depressions and re-contour facial
lines because the filler comes directly
from the patient’s body. Results are
immediate and can last indefinitely
because not all of the fat is reabsorbed.
According to La Jolla, CA plastic
surgeon Robert Singer, MD, “generally
about 30 to 50 percent of the injected
fat lasts permanently. Long-term,
fat injections are usually more cost
effective than other fillers and tend
to improve the quality of the skin.”
A Customized Approach
There is no one-size-fits-all
formula to aesthetic injectables.
Combining procedures is often the
best way to achieve the “filtered”
appearance most patients want. “If
someone has a moderate degree of
volume loss, as well as frown lines on
their forehead, then using a form of
botulinum toxin type A with filler can
create a more balanced result,” says Dr.
Few. “Injectors can use the appropriate
combination of all the tools in their
toolbox, whether it be a neurotoxin,
filler, or even a fat melter like Kybella
under the chin, to create the best
result that takes away distracting
issues in the neck, allowing the viewer
to focus on the face.” At New York
plastic surgeon Z. Paul Lorenc’s
practice, less-frequent visits for
injections is what’s trending with his
patients: “The combination of Bellafill
and fat transfer gives a really beautiful,
long-lasting result.” New York
oculoplastic surgeon Irene Gladstein, MD says, “Trust your doctor.
Appropriately spaced, creatively
combined and masterfully executed
procedures are all integral to creating
the most natural-looking results.”
On the Horizon
There are currently only a handful of
brands offering neurotoxins, but that
may be changing. “Newer neurotoxins
have claims that they are longer-lasting, and only time will tell,” says
Boca Raton, FL oculoplastic surgeon
Steven Fagien, MD. “Hopefully, the
competition with the newer products
will not only allow more choices, but
also stabilize and perhaps lower the
price, ultimately to the consumer.”
With the growing number of options,
choosing the right physician is
paramount. “New, improved fillers
are coming to our market and will
continue to expand the growing
portfolio of hyaluronic acid products,
while the choice of neurotoxins will
be more vast in the near future as
well,” says Dr. Gladstein. “Overall,
picking the provider that will filter
through new products and innovative options and guide you through the
protocols that work the best for you
will give you the best results.”
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Techniques used to administer
injectables are also evolving. “Using
microcannulas to creatively apply
volumizing agents is currently
revolutionizing the aesthetic industry,”
Dr. Gladstein says. In addition, some
injectables can be placed under the
muscle in the lower third of the face,
as opposed to just in the skin. This
deeper injection extends the life of
the filler because the body does not
metabolize it as quickly. Dr. Fagien
adds, “I’ve done research with
Allergan that has shown that some
hyaluronic acid gels with specific
injection technique showed dramatic
and sustainable improvement of skin
collagen, elastin, and generalized
moisture and elasticity.
Source: DailyBeauty – A beauty blog powered by NewBeauty Magazine –