Beyond Botox: Dermal Fillers

Dermal fillers can address multiple cosmetic issues, from softening wrinkles to creating a patient's desired facial contours to creating fuller-looking cheeks and lips. They can also be used to mask wasting syndrome for patients with HIV or cancer, and people with recessed scars use fillers to even out their appearance. 

Many patients view fillers as a low-commitment option due to their lower cost—relative to more invasive plastic surgeries—and temporary nature. However, it's crucial to keep in mind that fillers are still a risky procedure, especially when administered by unqualified practitioners. Misplaced fillers can enter the bloodstream, leading to dangerous infections. 

Your cosmetic surgeon should ask about your medical history, including current medications and allergies, before injecting fillers. For a better chance at your desired results, you may pay a little more, but it's always best to pick an experienced professional.

Types of dermal fillers

A cosmetic surgeon may choose more rigid dermal fillers for areas like the cheekbones and softer fillers for the lips. Lidocaine may be added to the filler injection to suppress pain. Common filler materials include:

• Calcium hydroxylapatite. Originally used by dentists, calcium hydroxylapatite is naturally found in human bones. It's considered one of the safer fillers because it's less likely to move or cause side effects.
• Hyaluronic acid. This is another natural substance that also may be injected into arthritic joints to alleviate pain.
• Polyalkylimide. This "biocompatible" filler is highly unlikely to cause an allergy. Once injected, it takes about one month for the filler material to become naturally covered in a thin layer of collagen that improves its stability.
• Polylactic acid. This biodegradable material has been used to make sutures for 40 years. Results take time to develop and typically require three monthly treatments to reach the desired look.
• Polymethyl-methacrylate microspheres (PMMA). Specialized techniques help keep PMMA looking natural since it can be visible under the skin. You'll want to find an experienced surgeon to inject this permanent filler.

Fillers vs. other anti-aging injections

Fillers are different from neurotoxin injections, such as botulinum toxin, which paralyze facial muscles to smooth out wrinkles. Instead, fillers add volume without impacting the muscles. Cosmetic surgeons typically prefer neurotoxin injections for the upper face (forehead and eye wrinkles) and fillers for the lower two-thirds of the face.

Fillers vary in thickness and how deeply they're intended to be placed. Some fillers last one to two years, but others can last longer. You can even choose to use your own body fat as a filler for a more extensive procedure with permanent results. Multiple types of facial injections can be combined to produce an overall desired effect, known as a "liquid face-lift."

Look for an experienced board-certified cosmetic surgeon who will have the expertise to balance the art and science of updating your look with injectables.