Most people could do without their wrinkles. The ones between the eyebrows look cross.  The ones running across the forehead look worried. The rest just look old.

What causes wrinkles?  The pleating of the skin by the muscles of facial animation.  Botox® injections paralyze these muscles causing the pleats to relax.  Unfortunately, the effect only lasts 3 to 4 months and the deeper wrinkles remain. Some people object to the expressionless, mask-like face Botox® can create.

Lift procedures can’t eliminate wrinkles without being abnormally tight – and even those relax with time. To understand this, think of this analogy.  Think of your skin like clothes your body wears. If your clothes were severely wrinkled, you wouldn’t take them to the tailor to remove material and sew them tight (like a nip and tuck).  You take them to the dry cleaners for steam pressing (like filler materials). The converse is also true: If your clothes are saggy and baggy, head straight to the tailor (nips and tucks).

Filler materials actually add volume to build up the depressions in the skin causing wrinkles. When I opened my practice 23 years ago, collagen was king.  Because collagen is derived from cowhide, it requires a skin allergy test similar to a TB test. If this test was negative, I could fill in virtually every wrinkle, creating a very youthful face – for 3 or 4 months!  Because of its short lived effects, I rarely use injectable collagen today.

Then came Restylane®, stretching the results to 6 months.  Restylane® is composed of hyaluronic acid which is a non-animal based product so no skin test is required.  Restylane® is definitely the filler material of choice for fuller lips but it can even be used to fill the finer lines around the lips and in the crows’ feet.

Radiesse® is an excellent wrinkle filler for people who are reluctant to do something irreversible.  Made of calcium microspheres, Radiesse® requires no allergy skin test. You can walk in wrinkled and walk out corrected.  Radiesse® looks best in wrinkles located in the thicker skin of the forehead, nasolabial and chin areas. The results are very impressive and last up to one year.

Bellafill® is FDA approved  for PERMANENT wrinkle correction. Bellafill® is composed of microscopic beads of a plastic that has been used safely in the body for over 50 years. These beads are mixed in collagen for ease of injection.  Because of this, a collagen skin test is given 30 days before Bellafill® treatments begin. Bellafill® is injected into the deep dermis of the skin where the beads are embedded.  Over time, the body coats each bead with a capsule of collagen, adding to the filling effect. Recent studies show excellent persistence of Bellafill® corrections for over five years.  Some doctors and patients are afraid of Bellafill® because it is PERMANENT.  It is true that over-correction of a wrinkle should be avoided with Bellafill® – it could create a ridge where the wrinkle used to be.  If this did happen, the ridge could be feathered into the untreated skin using a light injection on either side of the ridge. Because it is permanent, Bellafill® is more expensive than most filler materials up front.  Long-term, however, it is “the bargain of the century”.

The most common adverse events of filler materials include lumpiness, persistent swelling, redness and increased sensitivity at the injection site.

“Are the injections painful?”  I use a topical anesthetic cream that uses three medications to relieve pain.  I can also anesthetize the areas completely with nerve block injections but they do “sting”.

Who is not a candidate for filler materials?  People with flawless skin! All kidding aside, anyone with an allergic reaction to the skin test or taking blood thinners, aspirin or immunosuppressive drugs should avoid filler materials.  Filler materials are also not recommended for pregnant or breastfeeding women or people with active skin “breakouts”. Lastly, a history of severe allergic reactions or severe scarring should preclude injection of fillers.

Why did I have a colleague inject only one of my nasolabial folds with Bellafill®?  First, I wanted to be a living, breathing example of the amazing difference Artefill makes in the appearance of the skin. Secondly, I wanted to show my patients that I “walk the talk”.  In other words, I would never ask my patients to undergo a treatment I wouldn’t use on myself. I can’t wait to have my other nasolabial fold erased with Bellafill®!

From my H-ART,

Yale M. Kadesky, M.D.