Injectable Fillers, the Downside

Restylane, Alloderm, collagen, fat, Sculptra... the choices in injectable facial fillers seem endless. What's more, new products become available all the time, each one promising to do more, last longer, and produce fewer side effects. And with average treatment costs in the several-hundred-dollar range, injectable fillers are increasingly popular with women from all walks of life, from soccer moms to fashion models. But, just how effective are fillers? Are the results worth it? And what potential problems do you need to watch out for?

Understanding the Beast
Fillers are substances injected under the skin to fill in lines, plump up skin, and remove wrinkles. Some fillers contain natural ingredients - including your own fat harvested from somewhere else on your body. Some fillers are made of synthetic ingredients. And others are a combination of natural substances derived from animals combined with synthetic ingredients.

Typically, fillers are injected in the doctor's office, as out-patient procedures that allow you to return to work and regular activities immediately after the appointment. The results are generally immediate, and the appointment usually takes less than an hour. There is often some slight discomfort or itching after the procedure, but that should clear up within a day or two. While some bruising may occur, side effects are rare and generally mild. So what's the catch?

Thanks Ma'am, We'll See You in Six Weeks
As with Botox (an injectable, but not a filler), one of the biggest downsides is that fillers are temporary. Sad to say, but the easier and safer the injectable, the more temporary it seems to be. You can even use your own fat as a filler, but the results will probably fade within weeks. There is no risk of allergic reaction with this procedure, because the filler is harvested from your own body, but chances are you'll be back at your doctor's in practically no time at all - although a small number of patients have reported terrific results that have lasted for up to a year.

Collagen is an older filler (which, for this hypochondriac, means that it may be "safer" and "better tested") that has a relatively short life span. In fact, some women arrange to have new injections every six weeks - and many report that it's their favorite. Restylane is perhaps the most popular filler around - and also reported to be the most painful.

Fillers containing hyaluronic acid usually last much longer; Juvederm is one such brand, and is touted to last up to one year, although there is talk that it doesn't live up to its claims. ArteFill is another "permanent" filler, while the makers of Radiesse and Sculptra claim semi-permanence. Of course, the longer-lasting the filler is, the more possibility there is for side effects or botched treatments that cannot be remedied. This may be an especially difficult problem in the case of Artefill, because it contains bovine collagen, an ingredient with a fairly high rate of allergic reactions.

Watch Out for This One!
Liquid silicone (Silikon 1000) has also been known to be used as an injectable filler despite the fact that it is not sold for this purpose. Because it is permanent, it has advantages. However, known complications with liquid silicone include migration and lumpiness that can develop years after treatment. There have even been reports of silicone finding its way into blood vessels and forming a clot! It's so risky, in fact, it's been likened to injecting a time bomb - or, the Russian roulette of cosmetic dermatology and plastic surgery.

So since Silikon 1000 is approved for use in one part of the body, certain loopholes in FDA regulations allow docs to use it off-label as an injectable filler. But because of the dangers associated with silicone injections into the face and lips, the FDA has banned doctors from advertising it. What's more, there have been so many lawsuits related to this use of silicone that many plastic surgery medical malpractice insurance contracts now carry a clause that prohibits doctors from using it and refuse liability coverage for complications resulting from silicone injections.

Risks Include...
One widely recognized problem is that the longer-lasting fillers can also cause lumps to form under your skin at the site of the injection. Sometimes the lumps are visible. And, even when they're not, they can be felt. Who wants to be kissed by lumpy lips? Artecol and Dermalive are two brand names that have been frequently associated with this problem. And yet, to be fair, it can happen with any of them.

The official statement from the American Society of Plastic Surgeons is that the risks involved with injectable fillers include: allergies, infection, abscesses, open sores, skin peeling, scarring and lumpiness. They neglect to mention the horrible side effect mentioned by one medical study -- necrosis. That's dead tissue. Call me squeamish, but the thought of my lips turning into dead flesh is pretty scary. I realize that every medical procedure contains inherent risks. But I wonder: is the potential gain worth the risks that come along with injectable fillers?

Woman Overboard-Your Greatest Enemy May be You
Take it from a woman who over-plucked her eyebrows when she was fifteen-and they never grew back: making changes to your appearance can be intoxicating. I was so entranced by how large my eyes looked that I kept on going. The same thing can happen with facial fillers. Too much of a good thing is - too much. No one wants plastic fish lips - but it's easy to see how a little filler can turn into more next time, and then a longer-lasting one, and one more time, and suddenly you've gone too far.

One way to ease into the world of fillers is to ask your doctor to try a temporary injectable like collagen the first few times. This will give you an idea of what a longer-lasting product like Juvederm will do for you. And that way, you can live with a filler for awhile before you commit to the new look.
This brings me to a final issue related to injectable fillers. Is it just me, or are we in the midst of a trend toward unnaturally shaped, very large lips? I've reviewed about six dozen plastic surgeons' before and after photos of "lip enhancements" on the Internet, and I have to say: at least half of them looked quite unnatural and unattractive to me. So bad, in fact, that the "before" photos often looked better.

What's up with this? I haven't notice plastic surgeons posting photos of nose jobs that look worse than what the patient had to begin with. Or breast implants gone wrong. Why all these oddly shaped lips and over-plumped creases? While the information highway appears to be in full bloom, the web, in many ways, has made it all the more difficult to find a qualified practioner. My advice: stay away from strip malls and nail salons that offer injectable treatments, and read our Beginner's Guide to Choosing a Surgeon.

Striving for Perfection
Perfection is the name of the game in plastic surgery. Doctors are trying to provide us with the perfect facial fillers, and the rest of us are crossing our fingers and hoping for that perfect, smooth, wrinkle-free skin. It looks to me like injectable fillers do not yet live up to the hype. But with new products coming out every day, the perfect filler might be just around the corner.


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About the Author

Kathleen Bowers wrote Scarless Surgery, What's in store in the Future, Injectable fillers, the downside and Facelift Alternatives, A Complete Guide. You can find her articles in www.body-philosophy.net. Her work is usually in the field of medical alternatives. She enjoys an afternoon at the park and that inspires her to work.