Filler agents like Sculptra, Botox and Juvaderm can be used to fill in wrinkles, scars, depressed areas, and to fill out thinning areas, such as the aging lip or cheeks.
It is our opinion that at the current time the ideal filler is one that would have the following characteristics: Be absorbable, Non-animal or human derived. Last approximately two years. Feel natural. Be very non-reactive. Therefore, two of the major filler agents that we use are Juvederm and Sculptra.
Currently, the agent that is used most frequently in my practice is the hyaluronic gel Juvederm, which is manufactured by the Allergan Corporation. Juvederm is cross-linked hyaluronic acid, lasts up to 10 – 12 months, is lab derived, and feels very natural.
Juvederm injections are performed under a topical anesthetic. The entire procedure, including application of the anesthetic and injection, is performed in a 45-minute office visit. The results are almost immediate, although there is occasionally some swelling that can last overnight. Patients are advised to avoid aspirin or NSAIDs such as Motrin, Advil, and Naprosyn for a week prior to the treatment to avoid bruising.
Sculptra Aesthetic is a facial injectable that works gradually in a series of treatments — on average, three injection sessions over a few months — for a subtle, more youthful looking appearance.
Sculptra Aesthetic targets the underlying causes of the signs of facial aging. It can give you noticeable results that emerge subtly and can last for up to 2 years. It begins to work within the deep dermis, where your skin’s structure is reinforced as Sculptra Aesthetic helps to replace lost collagen. This reinforced collagen structure provides a foundation that gradually restores the look of fullness of your shallow to deep facial wrinkles and folds that have depleted over time. The result? Sculptra Aesthetic is different because it gradually and subtly corrects these facial wrinkles and folds. This can provide a refined, more youthful looking appearance that can last up to two years.
Sculptra Aesthetic is made from a synthetic material called poly-L-lactic acid, which is gradually and naturally absorbed by the body as it works to replace lost collagen. Poly-L-lactic acid has been used safely for decades in dissolvable stitches and as a facial injectable since 1999 in over 30 countries.
Frown lines between the eyebrows, wrinkles along the forehead, and crow’s feet next to the eyes can be significantly lessened with BOTOX®. The treatment takes minutes and lasts months. It is an effective, low risk procedure that remarkably rejuvenates the aging face. Unlike the popular misconception, when performed properly, a frozen or unnatural look should not be the result of BOTOX® injections.
BOTOX® is best used to treat dynamic wrinkles (those as a result of the action of the underlying muscles), examples of which are noted above. BOTOX® treatments do not require an anesthetic to be performed and the results are seen 4-7 days after the injections.
It is our experience, that the duration of the effects of the injections is directly related to the number of units of BOTOX®. As there is a permitted variation by the manufacturer in the amount of sterile saline used to prepare BOTOX®, the number of units in a single syringe will vary by practice. In addition, the duration of the BOTOX® effects may vary depending on the site into which it is injected. For example, BOTOX® injections into the crow’s feet may last longer than those into the glabellar region. Following this protocol of my practice, we find that the results last up to 6 months after the first treatment with BOTOX®. After repeated injections, however, the results last longer and can extend up to 8 – 10 months or more.
Patients should avoid aspirin and the NSAIDs, such as Motrin, Advil, and Naprosyn for the week before the injection. It is alright, however, to use acetaminophen products such as Tylenol.
Other Fillers and Injectibables
These agents can be divided into those agents that are permanent and non-absorbable (like Silicone, Gortex) or temporary and absorbable (like hyaluronic gels, collagen.)
Filler agents can also be classified by their origin:
- Autologous (come from the patient themselves-fat)
- Cadaver or Animal – collagen, alloderm
- Laboratory – hyaluronic gels