Many people are looking for non-surgical, no-downtime options to look their best for photos and gatherings. With the immense popularity and effectiveness of Botox, this is the leader in non-invasive perks sought by patients. Botox works well for eye area and forehead, but can make the face look unnatural if injected around the mouth. I much prefer fillers in this area.

As our face ages, it loses fat and volume. This is very noticeable around the mouth as we develop smile lines, puppet lines and flat lips. Fillers are substances injected with a tiny needle that restore volume (and youth) by placement of a substance underneath the skin. The substance injected will determine the longevity of results. Longer lasting injectables are frequently being introduced.

Collagen was one of the first injectables introduced. It is deposited directly under the skin for improvements of fine lines and wrinkles. The injections last 1 to 3 months on average. Some collagen preparations are made from bovine (cow) derivatives, and these require skin testing prior to injection. A need for a longer lasting injectable spurred the development of hyaluronic acid preparations.

Currently, there are several forms of hyaluronic acid on the market, and these comprise the most popular class of injectables. Most last for 6 to 8 months and gradually are removed by an enzyme that is naturally present in the skin. Hyaluonic preparations include Restylane, Captique, Hylaform and Hylaform Plus, and Juvederm. In general, Captique and Hylaform tend to last around 4 months and Restylane persists for 4-6 months. It is hoped that Juvederm lasts 8-12 months and Perlane lasts 9-12 months.

Radiesse and Sculptra are now widely available long-lasting injectables. Radiesse is made of bony mineral paste and lasts for 1-2 years. It can be used for volume improvements in the smile lines, pre-jowl area, cheekbones or under the cheekbones, or along the brow (to achieve a subtle “lift”). Results are apparent immediately, although a touch-up may help in achieving optimal results. The discomfort and swelling with injection is slightly more than that of the hyaluronic fillers. Sculptra is poly L-lactic acid and is used primarily in the deep tissues of the cheek to fill in large volume deficiencies. It is approved for HIV associated fat loss in the face. Injections may take 6-8 weeks before results are seen, and several treatments may be necessary.

Artefill is a new FDA approved filler that is currently the only permanent filler on the market. It is made of polymethylmethacrylate beads suspended in collagen and lidocaine. Skin testing is required one month prior to injection. The filler is used for the smile lines (melolabial folds) and patient satisfaction is excellent. It is not generally recommended for patients as an initial treatment, but for those looking for permanence after achieving satisfaction with another filler.

All injections can be performed in a doctor’s office under numbing cream or blocks (numbing shots, like dentists use). Ice and Tylenol are generally all that required after injections. Avoiding ibuprofen, aspirin, naproxen and similar blood-thinning anti-inflammatory medicines will minimize bruising (which is usually minimal). Massage after injections may be recommended.

A perfect “gift-wrapping” for the face, fillers will help you look your best for holiday photos, and keep people guessing!