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The Needle is the New Knife: Advances in Dermal Fillers

American Academy of Dermatology (

February 2, 2016

While the word "fillers" may bring to mind images of artificial faces, the reality of dermal fillers is much different. When administered properly, fillers can provide natural-looking results for patients seeking a rejuvenated appearance. Thanks to recent advances in filler techniques and materials, patients are seeing better results than ever.

Information provided by Whitney P. Bowe, MD, FAAD, clinical assistant professor of dermatology, Icahn School of Medicine at Mount Sinai, New York.

According to Dr. Bowe, people used to be afraid of dermal fillers - or at least afraid of discussing the cosmetic treatments they'd received. Over the years, however, these procedures have become more accepted, she says, and many people, including celebrities, now discuss them openly. "The perceived stigma of having a cosmetic procedure is starting to fade away," she says. "People are talking more and hiding less, especially because the treatments are more subtle now."

As acceptance levels have increased, patients also have become more proactive about addressing the signs of aging, Dr. Bowe says. When the only available option was cosmetic surgery, people would wait a long time before going under the knife, she says; now that less invasive options like dermal fillers are available, more individuals are considering these treatments as routine maintenance rather than a last resort. "People want to slow down the hands of the clock," she says. "They don't want to drastically turn them back."

This shift in public perception has been accompanied by developments in filler techniques and materials, Dr. Bowe says, and these advances allow dermatologists to create customized treatment plans to provide patients with the look they want. "It's not one-size-fits-all," she says. "It's become very easy to come up with a plan that helps patients look like the best version of themselves - not like someone else."

According to Dr. Bowe, people's faces lose bone, fat and muscle as they age, and the skin starts hanging downward and inward, which results in wrinkles. By injecting fillers into key areas on the outside of the face (i.e., the temples, cheekbones and jaws) dermatologists can replace this lost tissue, which helps restore volume and lift sagging skin for a rejuvenated appearance, she says. This new approach is more effective than the previous technique of injecting fillers directly into problem areas, she says, as it provides more natural-looking results.

Dermatologists also may achieve a more natural look for their patients by layering, or "sandwiching," different fillers in different areas of the face, Dr. Bowe says. In order to get the best possible result, the dermatologist may use one filler in the deeper layers of the skin and another in the middle layers, she says, and some treatments may utilize a third filler at the surface level. In addition to using different filler materials together, dermatologists also may use fillers in conjunction with botulinum toxin or lasers, Dr. Bowe says, and such combination treatments may be able to provide results that couldn't be achieved with fillers alone.

An emerging filler technique known as "skin boosting" also may provide patients with a new way to achieve a rejuvenated appearance, Dr. Bowe says. This technique involves very small injections of hyaluronic acid filler all over the face, arms, chest or hands; these injections are intended to hydrate the skin and trigger collagen production, which results in a healthier appearance.

The recent advances in filler techniques have been accompanied by developments in filler materials. Most notably, Dr. Bowe says, there are now a wide variety of fillers available, providing dermatologists with a range of treatment options for their patients. Each filler has its own unique consistency and properties, she says, and different materials are suited for different areas of the face. "There are so many different options available to us now," she says. "With such a wide array of fillers to choose from, we have the ability to customize each treatment to meet the patient's unique needs and provide optimal results."

As the U.S. Food & Drug Administration approves more fillers for use in specific areas of the face, dermatologists can provide their patients with even more specialized treatment, Dr. Bowe says. Recent developments include a hyaluronic acid filler designed to provide subtle enhancement of the lips, utilizing small particles to increase definition without increasing size. Additionally, calcium hydroxylapatite filler has been approved for use in the hands, where it can decrease the visible signs of aging, and two materials have been approved for use in the cheeks, where they can have a lifting effect that corrects smile lines and under-eye hollows.

Filler materials also have evolved over the years to provide a better experience for patients. Older formulas would break down after a few months, which meant patients had to get frequent treatments to maintain their appearance, Dr. Bowe says, but today's fillers last much longer - for years, in some cases. Additionally, she says, many formulas now contain the topical anesthetic lidocaine, which helps minimize discomfort at the time of injection.

Despite the advances in filler technology, some individuals may still believe a filler procedure will leave them looking artificial, with overfilled cheeks or "duck lips." When used effectively, however, fillers can help patients appear rejuvenated while maintaining a natural look, Dr. Bowe says. "You may see some artificial faces out there, but it's important to remember that you won't be able to recognize the good work," she says. "You don't want the people around you to be able to put their finger on what was done; you just want them to think you look refreshed."

In order to get the best results, Dr. Bowe says, it's important to seek out a doctor who has experience with fillers and understands the structure and function of the skin, like a board-certified dermatologist. She recommends that patients visit doctors' websites to review their before and after photos, and she also suggests asking satisfied patients for recommendations. "If a friend looks really good, ask them if they've had any filler procedures," she says. "Usually, if someone is happy with the work that's been done, she'll be willing to talk about it."

In order to achieve the results they want, Dr. Bowe says, patients should bring photos of themselves from a time when they were happy with their appearance. She says it's also important for patients to tell their dermatologist about any past procedures they've had, as well as any medications and supplements they're taking.

"Some people may still associate dermal fillers with an artificial look, but today's filler techniques and materials make it possible to appear rejuvenated in a natural way," Dr. Bowe says. "A board-certified dermatologist who has been trained in the proper use of fillers can help you achieve the results you want."

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