Fill Me In

Dermal fillers get under your skin, but in a good way.

Wrinkles are for pugs and prunes, and modern aesthetic science aims to keep it that way. Now, a few minutes in a chair and you can walk away sporting smoother, age-defying skin — with little or no side effects.

The key is a recent development in dermal or facial fillers, which plump up sagging, wrinkled areas around the nose and mouth without using animal protein.

"Facial fillers began about 30-plus years ago with collagen," explains plastic surgeon, Dr. Neumon Goshorn. "Collagen is an animal protein, so you had to have a skin test to see if you were allergic. They would take a tiny needle and put a little of the substance under the skin of your forearm and you had to wait 30 days to see if you were going to react to the collagen."

Today's dermal fillers are made of a naturally occurring part of the human dermis, so you can get a same-day consultation and procedure without an allergy test. "You could go in and get a filler put in and not worry about being allergic to it," says Goshorn. "It will plump out your wrinkle. You may be swollen for one to two days. You may see a little mark where the needle was stuck in your skin, but you can get it today."

Today's dermal fillers are made of a naturally occurring part of the human dermis, so you can get a same-day consultation and procedure without an allergy test.

How does it work? Simply put, it fills out the wrinkle from the inside. "You've got a depression and you're trying to get under that," says Goshorn, "put in the filler and plump that depression out, just like you'd pop out a dent in your car."

Dermal fillers like Juvederm and Restylane are made from hydraluronic acid, a component of the human dermis that is responsible for skin volume and hydration, and also tissue repair. They derive the hydraluronic acid from bioengineered bacteria and then, in a process known as "cross-linking," turn the liquid into an easily administered gel.

We sat in on a facial filler session at Eden Spa recently. The patient, Sarah, was interested in smoothing out her smile lines, but was also very nervous about the pain. Nurse Terri Healy started Sarah off with a small ice pack around her nose and then applied a topical anesthetic cream. By the time Healy made her first injection (she started at the bottom of the smile line and made a series of small injections up the crease), Sarah reported little to no pain.

"There's lidocaine in the gel," explained Healy. "And the topical anesthetic is for the needle stick."

When the injections were finished, Sarah reapplied the ice pack to minimize swelling and bruising. "Patients will see swelling that actually looks like the effects of the filler for two to four days," said Healy. "Once the swelling goes down it takes about a week for the filler to really take effect."

Because bruising is a possible side effect, patients are advised to avoid ingesting anything with blood thinning properties, like aspirin, red wine, and fish oil, for 48 hours before and after the injections. Sarah reported only minimal bruising, which she said was easy to cover up with makeup.

The results can last up to one year, but patients often schedule a checkup six months later. The most popular areas to get dermal fillers are in the nasiolabal crease (known as the "smile line"), other small wrinkles around the mouth, and on the outside of the lips (to create a fuller look). The typical procedure involves purchasing a one-milliliter syringe of the product to be used all at once, or over time. Although Allergan, the company that makes Juvederm, doesn't recommend using the same vial over multiple visits, some spas are more flexible. "You may not need a whole syringe to fill up your wrinkle, then your doctor or nurse puts your name on it, puts it in a Ziploc bag in the refrigerator and it's yours," says Goshorn. "You don't get charged the next time you come in until you've used up that syringe, then you buy yourself another syringe."

As for the popularity of facial fillers, Goshorn says the number of patients is steady, even in an uncertain economy. "It's extremely popular. You take the average 35- to 45-year-old lady who's just starting to think 'I'm aging. I see it in my mirror.' They're coming in to get the product," he says. "It was even much more popular prior to 2008 when the economy took a dip, but even still, it's very, very popular."

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