Needle Points

Clients are hunting for the fountain of youth. And as more injectables enter the market, it is becoming increasingly accessible and affordable for them to find it with just the prick of a needle. “More patients are opting for fillers to achieve a non-surgical facelift, rather than going under the knife,” says Whitney Bowe, M.D., assistant medical director for cosmetic and laser services at Advanced Dermatology PC (Westchester, NY). “By combining deeper, long-lasting fillers with more superficial fillers, we are able to achieve a result most patients find more natural and youthful than a facelift.” And, with so many new injectable options, it is a matter of knowing which fillers work best to meet each patient’s individual needs to achieve optimum results.

Since gaining FDA approval for smoothing wrinkles in 2002, Botox has been the shining star in the anti-aging arsenal of injectables. More than 10 years later, it is still patients’ most requested procedure. “Botox is the most popular because it boasts the highest efficacy and safety profile,” says board-certified plastic surgeon Edward P. Miranda, M.D. “The brand name is the most recognizable in the mainstream. Also, the results are quick and noticeable right away.” And, as Miranda points out, Botox is increasingly being used for more than reducing the appearance of facial wrinkles, as are other well-known injectables. “Botox treatments in the jaw are growing in popularity but not for anti-aging purposes,” says Miranda. “This treatment is for those looking to narrow the jawline, resulting in a more feminine look. Botox relaxes the jawline, and the procedure is perfect for females who have a wide or square jaw and don’t want to go through jaw reduction.”

According to Bowe, the benefits of injectable treatments extend beyond face value. “If your face looks great, but your neck and hands give away your true age, it’s time to invest in Botox or other fillers for areas other than the face,” says Bowe. He uses injectables on his clients to smooth out the bands that run both across and down the neck, to fill the top of the hands so they appear less boney and show fewer veins, and to smooth out the creases and fine lines that appear between the breasts, often caused by clients sleeping on their sides.   
Lesser known injectables are beginning to share the spotlight with Botox. “Many physicians are beginning to realize that cosmetic issues, from marionette lines to sagging jowls to creased tear troughs, stem from a single source—loss of facial volume,” says Mitchell Chasin, M.D. “The best way to reverse this is through treatment that will stimulate the production of collagen and elastin, rather than just fill it in.”

Chasin is a fan of one of the newest fillers on the market, Juvederm Volumna, which is a formulation of hyaluronic acid, a natural building block of the skin designed to restore volume to areas of the face. “Because it is a form of hyalur-onic acid, it can be dissolved with a substance called hyaluronidase, which adds to the changing approach to treating symptoms of aging at the source by addressing overall facial loss,” he says.

Beverly Hills plastic surgeon Brent Moelleken, M.D., agrees that hyaluronic acid fillers are extremely effective for clients who are looking for the best anti-aging results. “I think the trend of injectables is toward the use of heavy hyaluronic acids,” says Moelleken. “They have the best combination of ease of use; low complication rates; and long, but not permanent, effects.”
Moelleken also points out the importance of combining and layering different fillers for optimal results. “Different areas of the face have different sensitivities, so not every filler works well on every area of the face,” says Moelleken. “We are quite happy with LiveFill, a process that uses the patient’s own tissue. After harvesting, LiveFill is inserted as precise grafts into areas of the face that require filling.”

For his patients, Bowe has recently begun offering Belotero Balance, a new soft dermal filler. “This filler has a low viscosity and integrates very easily into the skin, so the results are natural and smooth,” says Bowe. “When I inject it superficially, it doesn’t create that bluish hue we sometimes see with other fillers. This makes it my first choice for filling in fine, superficial lines on the forehead and around the eyes and lips.”

Education for both you and your clients is key to choosing the right injectables for their needs. “There really are no ‘unpopular’ injectables,” says Chasin. “There are only ones that are used less frequently because there is less consumer demand, or they are designed to treat very specific conditions. It’s like asking which golf club is least popular. You might not use them all on every outing, but you use them all eventually.”

According to Bowe, injectable treatments not only help clients look better but they also impact  how clients feel about themselves. “Many of my patients say they had more success with their weight-loss programs, at work, and in social situations such as dating after I performed a cosmetic procedure on them,” says Bowe. “Although I’m sure looking more youthful and well-rested as a result of the procedure itself might play a role in these successes, I also think that the confidence and attitude change that comes with feeling and looking better is responsible, as well.”