Fashion & Beauty

Going Only Skin Deep

March 4, 2014


We wrote this story before watching the Academy Awards on Sunday. Seeing the full, frozen faces of Kim Novak and John Travolta and the over-plumped cheeks of usually perky-looking Goldie Hawn was certainly a wake-up call. The message? Whatever you do, don’t overdo it!

photo by Jeng Niamwhan, iStock

photo by Jeng Niamwhan, iStock

First came Botox, the uber-popular toxin injected to relax the muscles that form moderate-to-severe forehead lines that make you look angry all the time. Plus it has off-label (meaning not FDA-approved) uses to smooth crow’s feet and vertical lip lines.

Business is also booming for dermal fillers, so called because they are injected to fill in wrinkles and restore the skin’s volume. Dr. Christine DeWitt, a dermatologist with Medstar Georgetown in Chevy Chase, Md., says the demand didn’t suffer even during the downturn.

Got an important meeting, a job interview? While it may take up to a week to see the results of Botox or its less-well-known cousins Dysport and Xeomin, “fillers provide instant gratification,” says Hiba Bittar, COO of Luxxery, a plastic surgery practice in Waldorf, Md., which has a satellite office in downtown D.C. that offers injectables exclusively. That said, some bruising is possible around the affected site, so maybe not-so-instant, depending on the person.

Among fillers, the most popular are ones made from hyaluronic acid (HA).  A natural substance in the body, hyaluronic acid gives the skin a plump and hydrated appearance, but it diminishes with age, causing the skin to lose volume and form wrinkles and folds. One of the benefits is that allergic reactions to HA fillers are rare; also, the filler can last nine to 12  months and is eventually absorbed by the body. Furthermore, if the desired effect is not so good — too much fullness, for instance — it can be reversed by injecting hyaluronidase, a dissolving agent.

Distinguishing the differences among this class of fillers — which includes Juvederm, Restylane, Perlane and the newer Belotero — is a bit like trying to tell the difference between Coke and Pepsi, says Bittar.

“What does differentiate them is thickness,” says DeWitt.  “The more cross-linked the molecules are in a filler, the firmer it is.”

Thicker fillers such as Perlane (in the Restylane family) and Juvederm Ultra Plus are for plumping areas such as the cheeks and giving definition to the jawline; Belotero is very malleable and suitable for the eyes and around the mouth.

Among non-HA fillers, Radiesse and Sculptra are also for adding volume to hollow areas (rather than filling in lines and wrinkles) and are longer-lasting.

The former consists of calcium particles suspended in a sugar-based gel. It treats deep nasolabial folds or smile lines and can also be used to add roundness in the cheeks and chin area. Improvement lasts for a year or longer. The downside is that hard nodules can form under the treated area treated and there is no reversal agent.

Sculptra, says DeWitt, is made of the same stuff as dissolvable stitches. It’s a polyglycolic acid, which stimulates collagen production. It is used to reshape the cheekbones and jaw line and to fill in hollow areas under the eyes and throughout the face.  Unlike with HA fillers, you don’t immediately see the results. It can take from three to six months to see effects, which can last up to two years.

The newest kid on the HA block is Voluma. “It’s popular because it has most of the same properties of Juvederm but lasts twice as long [two years] as opposed to one,” says plastic surgeon Dr. Craig Dufresne.

DeWitt acknowledges that sometimes the filler your doctor might recommend, or you might choose, is dependent on whether your physician got a good deal on the products, on which pharmaceutical reps are in the area at the time, and on customer loyalty programs from manufacturers such as Allergan and Merz, which offer customers points they can accrue for rewards. But whichever filler you get, says DeWitt, the outcome depends on the practitioner’s experience.

 The subtle, minimal changes that fillers provide are ideal for Washingtonians frequently in the public eye, says DeWitt. “You look so relaxed and well rested” is the ultimate compliment.

What You’ll Pay
It may not be plastic surgery, but fillers are not inexpensive, and most people will need more than one syringe-full per visit and more than one visit to keep up the results. The cost per syringe for Juvederm, Restylane, Belotero and Radiesse ranges between $600 and $800. Sculptra comes in vials and once opened must be used quickly, says Dr. Elizabeth Tanzi of Washington Institute of Dermatologic Laser Surgery. “Most people will use an entire vial [about eight syringes, which costs $1,500] per session. If we only need to use half, then we need to plan for another patient who needs a half vial of Sculptra within a day or two or the product goes to waste.”

“The price for 1cc of Voluma is $1,300. Most people average about 1 cc, although it really depends on the injected area and the amount of volume [desired],” says Dufresne.

– Janet Kelly


2 thoughts on “Going Only Skin Deep

  1. George says:

    I agree with this article. Really need to be careful with injections.

  2. linda kastan says:

    I thought briefly about asking my dermatologist whether I’d be a candidate for fillers, but when I saw Goldie Hawn at the Oscars looking like a chipmunk, I’m re-thinking that question.

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