What You Should Know About Wrinkle Fillers

Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional facelift costs. Most will fill hollows, lines, and wrinkles in less than 30 minutes with results that can last from 4 months to more than a year.

Injectable cosmetic fillers have been around for decades. In recent years, medical advances have brought new versions of this wrinkle treatment. Newer cosmetic fillers are longer-lasting, even semipermanent. But be sure to do your homework before heading to the cosmetic surgeon or other health care professional.

Where Do Wrinkles Come From?

Skin is held tight and smooth by three critical components: collagen, hyaluronic acid, and elastin. These chemicals combine to create a firm, spongy meshwork under the skin surface. This elastic structure keeps the skin surface smooth and firm.

With age, this meshwork slowly loses its strength. With weakness in the underlying support structure, the skin's surface no longer has its baby-skin smoothness.

Injecting cosmetic fillers helps fill the thinned-out meshwork. The fillers plump up the tissue underneath the skin, shrinking wrinkles. The skin becomes firmer, smoother, and younger-looking.

What Do Wrinkle Fillers Do?

Injectable wrinkle fillers, unlike Botox injections that relax the muscle under a wrinkle, fill the line, crease, or area with one of several different substances. As a result, trouble spots nearly disappear.

Wrinkle fillers can also be used as "volumizers," plumping and lifting cheeks, chins, jawlines, and temples; filling out thin lips, and plumping sagging hands.

The treatment is fast and easy. But all wrinkle fillers have a downside, including the risk of allergic reaction and the formation of tiny bumps under the skin. In some cases, those bumps may be permanent. And sometimes, a bluish skin discoloration known as the Tyndall effect happens. The color change can last for several months, but there are treatments available. In very rare cases, skin cells may die if the wrinkle fillers are not used properly. There have also been a few reported cases of blindness, scarring from skin loss, and nerve paralysis. Typically, the wrinkle fillers that last longer are the ones more likely to cause side effects.

Hyaluronic Acid Wrinkle Fillers

The most popular category of wrinkle fillers is hyaluronic acid. Each type works in a slightly different way with varying results.

Side effects are rare but can include redness, swelling, and bruising at the injection site. The filler may also show up under the skin as tiny bumps. This is a problem that often improves over time.

How long the results last varies from several months to over a year or two. Some research shows that repeated injections may help stimulate the body's own natural production of collagen. That will help reduce the number of lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.

Hyaluronic acid wrinkle fillers include:

• Belotero Balance
• Juvederm Voluma XC
• Juvederm Ultra
XC
• Juvederm Volbella XC
Juvederm Ultra
• Juvederm Ultra Plus XC
• Juvederm Vollure XC
• Prevelle Silk
• Restylane
• Restylane Contour
• Restylane Defyne
• Restylane Kysse
• Restylane-L
• Restylane-Lyft with Lidocaine
• Restylane Silk
• Restylane Refyne
• Revance

Synthetic Wrinkle Fillers

This smaller category of wrinkle fillers includes lab-made substances that are not related to anything found naturally in the skin.

All the fillers in this group have similar side effects, such as redness, swelling, or bruising at the site of the injection. Other side effects, though rare, include nodules or bumps under the skin that can be seen and felt and that, in rare instances, may require surgery to remove.

The benefits include a longer-lasting effect. And at least one filler offers semipermanent filling of lines and creases. Remember, products with longer- lasting effects are more likely to cause side effects. And when not used correctly, synthetic wrinkle fillers may cause disfigurement.

Synthetic wrinkle fillers include:

• Bellafill
• Radiesse
• Sculptra
• Silicone

Collagen Wrinkle Fillers

Scientists made the first wrinkle fillers from a purified form of collagen extracted mostly from cows. Although it worked well and offered a natural- looking fill, the results didn't last long. Most collagen injections began to break down as early as 1 month after treatment. Because these wrinkle fillers were made from an animal source, they also had a higher rate of allergic reaction and required allergy testing beforehand.

New ways of processing the collagen have helped lower the risks. Plus, new forms of synthetic collagens are making these injections safer and more useful to a wider range of people. Although the results don't last as long as other wrinkle fillers, many believe the results are more natural looking. The body naturally breaks down injected collagen, so you need to get collagen injections two to four times a year to maintain results.

Side effects of collagen injections include some risk of allergic reaction (mostly for those still using cow sources), as well as bruising and redness at the site of the injection.

Collagen injections include:

• Cosmoderm
• Evolence
• Fibrel
• Zyderm
• Zyplast

Autologous Wrinkle Fillers

Fat is the most commonly used substance in this category. Your own fat is surgically removed from your thighs, buttocks, or stomach, treated, then injected. You will need to have two procedures (one to remove the fat and one to inject it). Both procedures can be done in one visit. The fat expands the skin, shrinking wrinkles. Because it’s from your own body, there’s no allergic reaction. Additional fat purification steps done in the lab can be costly and time-consuming. Results can be semipermanent, although you may need a series of injections done over time.

Platelet-rich plasma injections (“vampire lift”) are another type of autologous wrinkle filler/volumizer. Blood is drawn from the arm, treated, then injected into the face. The effects can last 12-18 months.

Risks are similar to other wrinkle fillers, including bruising, redness, and swelling at the site of the injection. Because the fillers come from your body, these injections do not require FDA approval.

Minimizing Risks and Increasing Good Outcomes for All Wrinkle Fillers

Wrinkle fillers are among the safest cosmetic procedures in use today. But there are things you can do to help ensure your treatment is safe:

• Don't let price be your guide. If you are offered a wrinkle filler treatment that costs far less than the standard treatment, it's likely some compromises are being made, either in the skill of the provider or the quality of the product. Never risk making a bargain with your face.
• All wrinkle fillers should be done in a medical setting with sterile instruments. Treatments done in homes, hotels, spas, or resorts are not being done in medical environments, no matter who is doing them.
• Do not get injectable wrinkle fillers from sources outside a doctor's office. Know what you are being injected with, and ask your doctor if an FDA-approved wrinkle filler is being used and if it was purchased directly from the maker. There have been reports of everything from industrial-grade silicone to baby oil being used. If a provider won't give you this information, don't let them do the procedure.
• Use sunscreen daily to help preserve the filler and help protect against post-inflammatory pigment changes due to the needle sticks from injections.

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