Are there gaps in your knowledge about anti-aging filler treatments? Maybe it’s time to fill them.
We’ve all been there. Looking in the mirror, we notice a crevice where there was once a youthful arc, or a deep furrow where once the skin was flawlessly smooth. Thankfully, since collagen and the first fillers made of hyaluronic acid hit the market in the early 2000s, women and men have had an alternative to looking perpetually creased.
With the approval in December 2016 of Restylane Refyne (for the treatment of moderate to severe, facial wrinkles and folds) and Restylane Defyne (for moderate to severe, deep facial wrinkles and folds), cosmetic dermatologists and plastic surgeons now have that many more filler options to choose from – and it’s not like they were lacking prior to these products hitting the market either.
To assist us in bridging the information gap regarding these newest additions to the world of dermal fillers and how they work, we enlisted the services of three industry professionals: cosmetic dermatologists, David E. Bank and Debra Jaliman, and plastic surgeon, Jacob D. Steiger.
Jacob D. Steiger, MD of Boca Raton, Florida is a double-board certified facial plastic surgeon who also specializes in fillers.
David E. Bank, MD of Mount Kisco, New York is a cosmetic dermatologist and director of the Center for Dermatology, Cosmetic & Laser Surgery.
Debra Jaliman, MD is a New York City-based cosmetic dermatologist and the author of Skin Rules: Trade Secrets From A Top New York Dermatologist (St. Martin’s Press).
How do the newest fillers work?
“Restylane Refyne and Restylane Defyne offer a smoother consistency, which means that the product might be less visible during facial expressions,” says Dr. Steiger. “Refyne is more flexible and can be used in shallower folds and wrinkles, while Defyne has less flexibility, and because of that can provide better structural support for deeper folds and wrinkles. Both are indicated to last up to 12 months.”
“The newest fillers from Restylane tend to stretch and contract, almost like a mesh net. Because these move with you like your own collagen, they work well in areas where you have lines from muscle movement, such as around the mouth and the eyes,” says Dr. Bank, who emphasizes that he likes the versatility of using all the fillers – old and new – “as part of our tool kit.”
“Hyaluronic acid fillers have advanced so much in the past 10 years, even though we first got them in the US in 2003,” says Dr. Jaliman. “They used to all be very similar. Now there are fillers with differing amounts of hyaluronic acid and particle size. For example, if the filler is made up of very small particles, it is better for fine lines – like Juvederm Volbella XC, approved for use in the lips in June 2016. If it has large particles, it is good for deep nasolabial folds (smile lines). And there are fillers like Juvederm Voluma (approved in January 2015) with Vycross Technology, which cross-links the hyaluronic acid gel to make it firmer so that it lifts the face.”
What new fillers are expected to hit the market in 2017?
“Vollure – by the makers of Juvederm – is supposed to launch in the next few months,” says Dr. Steiger, “and will be used for the treatment of nasolabial folds.” The hyaluronic acid in Vollure is less concentrated and more effectively cross-linked so that it lasts from 12 to 15 months, causes less swelling and provides smoother results.
What is the last frontier for fillers?
“The neck remains the last unconquered area of cosmetic dermatology,” says Dr. Bank. “The issue is that the neck presents a round, large surface area that moves, twists and turns. At the moment, nothing we have cosmetically available for a sagging and a lax, loose neck – even noninvasive tightening technologies like Thermage and Ulthera – can come close to a mini-lift or full facelift. So if some kind of technology can lift, tone and tighten that area on par with a surgical procedure, people will opt in for that.”
Can fillers replace facelifts?
“Twenty years ago, surgery was all we really had to effectively rejuvenate a face,” says Dr. Steiger. “However, as our knowledge and technology have advanced, we can now better customize treatments to address different signs of aging. Surgery helps treat sagging skin, muscles and deeper ligaments of the face. Fillers specifically help treat a loss of volume and the related structural support of the face.”
“I don’t think that fillers replace facelifts,” says Dr. Jaliman. “I think they just make a face more aesthetically pleasing by adding volume. As we age we lose the fat that sits on top of our cheekbones, for example. With a syringe or two of Voluma I can restore someone’s cheekbones and make them look much prettier. Also, as we age, we lose the volume in our upper lip. So you can take fine-line filler, add a little volume and fill the fine lines to make someone look much younger.”
Dr. Bank is frank with his patients about their options. “If the skin is thin, sun-damaged and has lost elasticity, that is when you need to think about having a surgeon help you out. Trying to get lax skin to lift by pumping more and more filler into it is futile. A physician can’t be afraid of saying ‘no’ to a patient.”
Dr. Steiger says he chooses filler based on its properties. “Thicker fillers tend to give more lift; thinner fillers provide more refinement. The different fillers are like colors. One color alone can make a nice painting, but not a masterpiece. Having the entire palate to work with will yield the best possible results.”
How can patients reduce bruising from filler injections?
“Bruising is the biggest inconvenience of fillers,” says Dr. Bank. “We recommend using cold ice packs before and after the injections to constrict the blood vessels.” Dr. Bank also says that on the day of the injections you should try to “keep the head higher than the heart so the blood doesn’t pool. And hold off going to the gym, because an increased pulse rate draws blood to the head and neck which can lead to more bruising.
Before patients begin their treatments, Dr. Bank’s office provides each with an information sheet listing which medicines or supplements should be avoided and those that should be ingested 5-7 days prior to the injections.
What to avoid:
- Aspirin, Advil, Aleve, Motrin, for 2-3 days after treatment
- Omega fish oil tablets
- Vitamin E
- Alcohol (on night prior to procedure)
What to take:
- Bromelain supplements
- Arnica tablets (use as directed)
- Tylenol, if needed
