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Could cosmetic fillers help your aging skin?

September 18, 2008 |

Pump up the volume!

That’s the latest rallying cry among those in the front lines of the war on aging. The sagging facial skin that was once made taut by going under the surgeon’s knife is now being restored to more youthful fullness using needles and cosmetic fillers instead.

And marionette lines aren’t the only things getting plumped.

Dallas cosmetic-medicine specialists are using Restylane and relatives such as Radiesse and Sculptra to youth-enize not just the face, but the earlobes, backs of the hands, even the bottoms of the feet. One specialist has used fillers to smooth out dog-bite scars and “straighten” a broken nose.”We’re just really at the tip of the iceberg on the variety of the uses of fillers,” says Dr. Lynley K. McAnalley of Highland Park Aesthetic Medicine, who made cosmetic injectables her specialty after starting her career as an emergency-room doctor.

And with each varied injection location comes a choice of filler agents, each with its own unique attributes, including composition, consistency, longevity and cost.

“Now we can do a lot with these filling agents that fill in gaps that you can’t do with a re-draping procedure like a facelift,” says Dr. Max Adler of Park Cities Dermatology.

“When you combine that with some of our other things like Portrait Plasma [skin regeneration] and fractionated CO2 lasers for resurfacing of the skin, all of a sudden you can get a pretty youthful appearance in most people.”

Adler’s twentysomething clients typically opt for lip enhancements. But fillers find a much wider range of uses among clients in their 40s, 50s and beyond.

“It’s a pleasure to see a 70-year-old walk out and say, ‘I like this so much better,’ ” says Adler. “Before, you didn’t have too much to offer them unless it was major surgery.”

When Todd Allen turned 40, he gave himself the best birthday present ever: fillers. He believes plumping his lips, cheeks and under-eye area took a good 10 to 15 years off.

“The noticeable places where we lose volume are under and around the eyes, and in the cheek-hollow area under the cheekbone,” explains McAnalley, “which causes the skin to fall down and toward the center of our face, causing a hollowed appearance. The nasolabial folds get accentuated and the marionette lines down from the corner of the mouth get more noticeable and tend to cause jowling.”

When injected just under the skin, fillers not only “fill in” crevices and depressions, but plump by attracting fluid and, in some cases, stimulating collagen growth. The results, Allen says, are better than workouts and yoga. Five years later, he’s still totally hooked by the effects and positive feedback from friends.

“No one has ever said anything to me like, ‘Oh my, you’ve got your lips done,’ ” says Allen, owner of Deep Ellum salon Orange. “Instead, it’s ‘You look so good and look so rested.’ ”

That’s the beauty, so to speak, of fillers versus a facelift. Ever-advancing cosmetic fillers give patients more subtle changes and shorter recovery times.

Going to extremes

The youthful appearance of a post-fill face can be belied by hands that are wrinkled, bony or prominently veined; that’s why injecting these thin-skin extremities has become increasingly popular. But the procedure requires a kid-glove touch.

“It takes a lot more experience and expertise because you have to inject it deep and you have to be careful to avoid the veins,” says Dr. Rod Rohrich, a board-certified plastic surgeon with the Dallas Plastic Surgery Institute and chairman of the department of plastic surgery at UT Southwestern Medical Center.

Even earlobes show the effects of time, becoming creased and stretched from the pull of earrings. Injections can take out creases, making earlobes “less flappy and flat,” says McAnalley. That makes for better earring positioning.

Feet might seem an unlikely place for a cosmetic procedure, but fillers have a use there, too. Foot tissue thins with age, which can make walking painful. Women in particular suffer from aching bones and bunions after years of wearing shoes that sacrifice comfort for fashion. Fillers injected into troublesome areas between the skin and bone “act almost like an inside-the-foot Dr. Scholl’s pad,” says McAnalley.

More gain, less pain

As one would expect, all of those needles can’t be comfortable. Topical ointments are commonly used to desensitize injection points. And clinical trials in Dallas’ own back yard at UT Southwestern have yielded pain-reducing advances such as fillers with the numbing agent Lidocaine already mixed in.

New formulas and techniques also have reduced bruising and swelling, says Rohrich, “almost so that you can go out that same night for dinner.”

McAnalley borrows a technique from the dentist: “I typically perform dental blocks when working on the mid-face area and lips because I find that it makes the patient more comfortable, and I can inject in as many places and as many times as I need to without worrying about the number of times they’re being stuck.”

Adler injects filler from inside the mouth, which he says allows him to get closer to the eyes with less bruising and pain.

“On a scale of one to 10,” he says, “one being no pain, 10 being gosh-awful, it’s a one. And I can vouch for that because … it was done on my face.”

In balance, any discomfort is easily outweighed by the “awesome” effects of cosmetic dermal fillers, says Allen. He’d rather save money for a treatment than take an expensive vacation.

“You only have one face,” he says. “It’s one of the smarter things I’ve done for myself.”

Price check

It’s hard to comparison shop for fillers. “Every physician is going to be a little bit different,” points out Dr. Max Adler with Park Cities Dermatology. “Everybody has specials on fillers at various times.”


Here’s what you can expect to pay, based on prices given by three area doctors.

ArteFill: $1,500 to $1,800/syringe

Juvéderm Ultra Plus: $650 to $800/syringe

Perlane: $650 to $900/syringe

Radiesse: $700 to $800/syringe

Restylane: $500 to $800/syringe

Sculptra: $1,000 to $1,250/vial


You wouldn’t let just anyone stick a needle in your face, right? Selecting the right specialist in a market full of practitioners doesn’t have to be overwhelming. Word-of-mouth recommendations from friends, hairdressers or other plugged-in pros are always a good starting point. Once you have a few names, here are some questions to ask:

•Who does the actual injections – plastic surgeon, dermatologist, certified specialist or medical assistant?

•What is his or her level of expertise and training?

•What method is used to reduce pain?

•Which filler or fillers are recommended for the treatment area you’re considering?

•What is the pricing structure?



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