End of the Lines?
The truth about instant wrinkle smoothers and fillers.
May 15, 2008 -- Hollywood stars preening for the red carpet aren't the only ones who turn to Botox and injectable collagen to take a few years off their faces. Last year, more than 3 million Americans had their wrinkle-making muscles relaxed with Botox; more than 1 million had their lines and lips plumped with fillers.
That's a 35 percent increase over the previous year, and the spiking curve is expected to climb still higher in 2008. As word of mouth spreads, more physicians become adept at using injectables, and new fillers get FDA approval.
In fact, demand among ordinary folk is so high that you can get your fill at the mall: About 1,500 so-called medical spas (or med-spas) have opened across the country, most selling wrinkle-smoothing injectables in a spa-like setting, though not always administered by an experienced doctor.
To get the look you want -- and lower the risk of a temporarily frozen forehead or overplumped "trout pout" -- remember, that getting injected is a medical procedure, not just a beauty treatment.
To a generation raised on collagen injections to fill acne scars and to plump lips, having a lunch hour "face-lift" seems as simple as having your hair highlighted.
That's the kind of misconception that led to disappointment and embarrassment for Myriam S., a 47-year-old physical therapist in La Cañada, Calif. She scheduled an appointment for Botox injections shortly before Christmas, but it didn't go as planned.
Over the holidays, Myriam greeted friends with her right eye and face so badly bruised that she couldn't minimize the discoloration with makeup.
"The doctor said the nurse who gave me the Botox hit a blood vessel," Myriam says. Would she do it again? "Absolutely," she says, "but next time, I'm only letting a doctor do the injecting."
Caution should be your watchword, says Wendy Lewis, a cosmetic surgery consultant in New York City and London, and the author of "America's Cosmetic Doctors and Dentists."
Even when the needle is in the most experienced hands, there can be temporary side effects, such as bruising, swelling and tiny bumps along the injection site. But your risk of serious problems, including deformities that last for months, is lower when you go to an expert, Lewis says.
It's safest to go to a doctor who is board certified in dermatology, plastic surgery or an above-the-neck specialty. A head and neck surgeon, an ear, nose, and throat doctor, or an ophthalmologist may have a cosmetic surgery subspecialty. Just as important is experience with a variety of injectables.
Above all, don't let price or convenience -- or the appeal of a Botox or filler party -- sway you.
"Don't have it done in a hotel room," Lewis says. "These parties are the antithesis of the way it should be done. When you receive Botox or a filler, you want proper lighting and to know exactly what you're getting. You don't want people sipping drinks and watching. Getting injected is not a festive occasion."
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All fillers work in the same general way:
They increase volume, either where no soft tissue existed or where it has diminished with age. Fillers can lift the depression of a crease, for example, or plump thin lips or flat cheeks. Fillers are often layered with one another and/or Botox, which relaxes the wrinkle-forming muscles.
"The art is in selecting the appropriate fillers to meet an individual's needs," explains Dr. Seth Matarasso, a professor of dermatology at the University of California, San Francisco. He offers an example of the fine-tuning that may be required for a natural-looking mouth: A dense filler can be injected to define the lip's borders, a less dense one to subtly plump them, and yet another to fill the fine superficial lines above the lip.
"What works where depends largely on a product's thickness," Matarasso says.
Here are the injectables you're most likely to be offered.
The extra padding on your hips might seem to be the ideal filler because it's your own tissue, but this method turns out to be unpredictable. In some people, the transplanted fat cells resorb quickly; in others, they last for years.
Fat is retrieved and transferred through a large needle, so bruising may occur. And because some of the fat will be reabsorbed within a few weeks, the doctor will slightly overfill to compensate for the expected loss. The resorption isn't always balanced.
"A lopsided lip, for example, can happen with any filler, but it's more likely with fat," says Dr. Theodore Kramer, medical director of the Riverview Cosmetic Surgery and Skincare Center in Norwalk, Conn.
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