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05-14-12 | Posted by

When going under the knife is not an option, but anti-aging creams are not getting the job done anymore, injectable fillers and wrinkle relaxers can be a lifesaver. A few syringes of this and that to lift, smooth and plump can give you an instant “what did she do?” kind of feeling (in a good way that is). The “wow” factor is unsurpassed.

In the U.S., we now have 12 products* that have the FDA nod to use that suit different situations – and more are always on the way, although the process is a slow one. The term “Liquid Facelift” generally refers to combining several types of soft-tissue fillers. There are some products that get injected deeply, for cheek fullness as an example, and others that get injected more superficially just under the skin, for fine lines around the mouth. Since there is such a wide range of FDA cleared brands available today, it is truly a customized procedure. In the past, fillers and wrinkle relaxers focused on garden variety correction of lines and softening folds, period. Haute injectors have perfected their techniques and the emphasis has shifted toward using several different injectable products in deeper and more superficial levels.

According to New York Plastic Surgeon Z. Paul Lorenc, M.D., “Dermal fillers are injected to target the specific areas of your face in need of enhancement or rejuvenation. Several areas may be treated in a single session with both dermal fillers and neurotoxins for what I call “Facelift by Syringe.” For example, lines around the eyes, mouth and nose, tear troughs or hollows under the eyes, upper cheeks,  forehead, and lips. The whole procedure takes half an hour and depending on what products are used, results can last well. The key is choosing an injector who has a good eye.”

*Injectable products cleared by the FDA as of May 2012:

  1. ARTEFILL – Bovine collagen with PMMA particles
  2. BELOTERO – Hyaluronic acid
  3. BOTOX COSMETIC – Botulinum toxin type A
  4. DYSPORT – Botulinum toxin type A
  5. JUVEDERM XC – Hyaluronic acid with lidocaine
  6. LAVIV – Autologous fibroblasts
  7. PERLANE-L – Hyaluronic acid with lidocaine
  8. PREVELLE SILK – Hyaluronic acid with lidocaine
  9. RADIESSE – Calcium hydroxyapatite
  10. RESTYLANE-L – Hyaluronic acid with lidocaine
  11. SCULPTRA AESTHETIC – Poly-L lactic acid
  12. XEOMIN – Botulinum toxin type A

Treatment: Hyaluronic Acid Gel Fillers

“Lifts lift and fillers fill. Dermal fillers can enhance the results of a surgical facelift nicely, especially in terms of volumization. But these treatments are also viewed as an alternative in many cases, such as younger women who do not have significant sagging and women who are not good candidates for surgery,” said New York Plastic Surgeon Alan Matarasso, M.D.

FDA Approved Brand Names in the USA: Juvederm, Restylane, Perlane, Belotero, Prevelle Silk

How It Is Administered: By syringe, usually more than 1 syringe is needed for full correction of an area, and often 3 or 4. Various size needles may be used, usually ranging from 27g – 32g. Some physicians may also use a blunt cannula to inject deeply or soft needles that are bendable for specific areas of the face.

Where It Is Administered: Facial folds, wrinkles, cheeks, chins, nose, lips, under the eyes, tear trough, scars

How Long Do Results Last: Each product has a slightly different formulation, but they can last from 6-12 months and longer

Best For: Facial contouring, creases, folds, wrinkles, around the eyes, and ideal for lip enhancement

Possible Side Effects: Swelling, Bruising, Tenderness, Redness, Asymmetries

Pros: The FDA approved products are safe, well tested fillers. If you are not happy for whatever reason, an enzyme called Hyaluronidase or Wydase, can be injected to break the product down quickly.

Cons: These fillers are temporary and additional treatments will be needed to maintain the results

What Are The Risks? There is always a slight chance of infection and lumps and bumps, but these are rare when administered by an experienced injector

What Should You Ask At Your Consultation? Am I a good candidate, how long will it last, how many syringes are needed, what are the risks and alternatives?

What Should You Be Looking For From Your Practitioner? Treatments should be done ONLY by healthcare practitioners, plastic surgeons, dermatologists, cosmetic doctors, nurse practitioners. These are medical devices.

Treatment: Wrinkle Relaxing Injections (Neurotoxins, Neuromodulators)

“The most ‘bang for the buck’ in injectable treatments is Botox. Results are consistent, people love the subtle improvements we can achieve without looking too different and it is a good complement to other treatments including Fraxel, Ultherapy, Sculptra Aesthetic and other lasers and fillers,” said New York Plastic Surgeon Bryan G. Forley, M.D. 

FDA Approved Brand Names: Botox Cosmetic, Xeomin, Dysport

How It Is Administered: By using a fine needle and injecting directly into facial muscles.

Where It Is Administered: Most common areas to be treated are creases between the eyebrows, forehead, crows feet, but these drugs can also be used around the mouth, chin, to lift eyebrows, tip of the nose, lower lid muscle roll.

How Long Do Results Last? Lasts 3-6 months depending on how active your facial muscles are and how much was injected. For some people, the longer they have treatments, the longer the results can last.

Best For: Dynamic wrinkles caused by muscle contractions – such as crow’s feet, forehead lines, creases between the brows, neck bands, droopy corners of the mouth, upper lip lines, lowered brows.

Possible Side Effects: Possible droopy eye, but this is quite rare; asymmetries that are easily corrected; bruising that resolves quickly; needle sticks can sting.

Pros: Treatments are highly effective in most people. This is truly a bespoke treatment; results can be tailored to your specifications so you do not have to look frozen or distorted. Procedure takes 15-30 minutes and is more affordable than many other aesthetics treatments.

Cons: Treatments have to be repeated about every 4-6 months to maintain the effects

What Are The Risks? Uneven effects, too much used to create an unwanted result– but these effects are all very temporary and usually resolve quickly.

What Should You Ask At Your Consultation? Am I a good candidate, what areas should I have treated to get the best results, when will the effects be visible?

What Should You Be Looking For From Your Practitioner? These products are prescription drugs – and therefore should only be administered by licensed healthcare practitioners.

Treatment: Tissue Simulators

“Longer lasting products have found their place in facial rejuvenation. There is a group of people who are seeking treatments that last well so they do not have to keep coming back for touch ups every few months,” said La Jolla Plastic Surgeon Steven Cohen, M.D.

FDA Approved Brand Names: Sculptra Aesthetic, Radiesse, Artefill

How It Is Administered: Sculptra Aesthetic is a powder in a vial that gets reconstituted with saline before it is injected; Artefill and Radiesse are administered by syringe, usually more than 1 syringe is needed for full correction.

Where It Is Administered: Facial folds, wrinkles, cheeks, chins

How Long Do Results Last: Each product is different; Sculptra Aesthetic can last 2-3 years after multiple sessions; ArteFill is a long lasting product and can be permanent; Radiesse can last up to 1 year.

Best For: Best for facial contouring, wrinkles, volumization, creases, folds, acne scarring.

Possible Side Effects: Swelling, bruising, tenderness, areas of firmness, redness, under and over correction

Pros: Sculptra Aesthetic offers a very natural result that occurs over time as new collagen is stimulated; Radiesse offers good value for money and can add substantial volume; ArteFill is the longest lasting FDA approved filler and is considered to be permanent

Cons: Sculptra Aesthetic requires more than one treatment session – often 2, 3 or more – to get the desired effect. Artefill requires a skin test because it is an animal product (bovine or cows). None of these products is recommended for the lips.

What Are The Risks? There is always a slight chance of lumps and bumps, under and over correction.

What Should You Ask At Your Consultation? Which filler is right for me? How many treatments will I need? How long with the treatment results last?

What Should You Be Looking For From Your Practitioner? Treatments should be done ONLY by qualified healthcare practitioners, plastic surgeons, dermatologists, cosmetic doctors, nurse practitioners.

According to Dr. Forley, “Products that are biostimulatory enhance new collagen production to produce longer-lasting volumetric correction. When combined with skin tightening devices, we can achieve dramatic effects that approximate what a facelift can do in some instances.”


If you are in the San Diego area, you can undergo liquid facelifts by visiting Ronald J. Edelson, M.D.

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