What’s the deal with facial fillers?

Collagen is the scaffolding that supports your skin. As you age and those collagen fibers break down and are no longer replenished to the same extent, wrinkles start to form. If you want to treat wrinkles by getting some of that collagen back you have three choices.

1. Topical collagen creams

This is an easy and inexpensive option. The only problem is that they DON’T WORK! Rubbing collagen on your skin doesn’t do a damn thing for wrinkles.

2. Creams that stimulate collagen synthesis

This approach is a little more expensive (or a lot more expensive depending on which brand you buy) and scientifically speaking there’s a little better chance that this will do more for your skin than just rubbing on collagen. Unfortunately,  most of that scientific data on collagen is based on in vitro testing on human skin cells in the lab. There’s little if any data showing that it actually works on people.

3. Collagen injections

This is a little more painful and a lot more expensive but injecting collagen (or other fillers) really works. Just in case you’re  flustered over facial fillers we asked friend of the Brains Dr. Michele Koo to break down the details.

Filler Injections – The Newest, The Latest, is Collagen Passé

How do you choose what filler to use for what? How do you know what’s the “right filler to use” for your particular complaint? Are all fillers the same? Collagen injections are rather passé, as there are many products that far outlast the previous generations of collagen.

With so many different types of fillers that are currently available, Radiesse, Sculptra, Voluma, Juvederm, JuvedermUltra Plus, Restylane, ….etc etc, it is really tough to choose. Often times, your plastic surgeon or dermatologist will suggest only one type of filler for everything. Others will suggest one type for your eyes and another type for your lips and cheeks.

Hyaluronic acid and hydroxyapetite

There are currently two basic types of fillers on the market that are FDA approved. One is hyaluronic acid and the other is hydroxyapetite. The former is a type of thick viscous gel and the latter is more of a hard calcium substance. Both are injected with a needle.

The hydroxyapetite type of filler, Radiesse, is recommended for those who have true loss of volume from the face in cases of HIV facial muscle atrophy. Many plastic surgeons of dermatologists will use this product for large volume deficits of the face for cosmetic purposes other than the above.

The remainder of the products consists of hyaluronic acids,the differences are in their molecular make up. Some are more “cross linked” and more complex making the product more stable or more hydrophilic (attracting water from surrounding tissues) and will determine how “big” of a fill can be achieved. All products will last about 12-18 months. The Voluma is claiming longevity of 2 years.

The bottom line

Make sure your plastic surgeon or dermatologist is well versed in the use of the product they choose and ask why they are choosing that particular product. My personal favorite is Juvederm Ultra Plus for overall use in lips, lines of the face and even in the hollows under the eyes. I also use Restylane, Silicone (off label FDA use) and Juvederm and Juvederm Voluma. I tend not to use Radiesse or Sculptra as I feel they are too rigid and very unforgiving for facial creases and lips. I find that Restylane does not last as well as Juvederm therefore that is not my first choice for fillers, but in cases of a first time nervous patients or a very thin-skinned patient I might choose to use it.

You can reach Dr. Koo at www.drmichelekoo.com and follow her on Twitter at @drmichelekoo.