Seeing the doctor every four to six months for facial “maintenance” has become almost as common as getting a haircut every 6 weeks. Men and women of all ages are receiving injections to minimize the changes associated with aging and to maintain a natural and rested appearance.

There are two broad categories of products used for facial injections: fillers and relaxers. Filling agents restore volume to the face. With most fillers, the results are immediate. Wrinkles which are caused by facial movements are usually treated with relaxing agents. The results of relaxing agents are usually seen several days after treatment. In general, the lower face is treated with “fillers” and the upper face treated with “relaxers.”

Injected filling agents have been used for about 100 years. Historically, silicone and paraffin were used to augment the cheeks and nasal bridge. Unfortunately, these substances were not well tolerated by the body and many complications developed. In 1981, bovine collagen was approved for filling facial creases and lines and rapidly became the “gold standard” injectable used for improving the signs of aging. Over the following 20 years, new injectables have been developed providing many options for filling and relaxing facial lines and wrinkles.

“Filling” agents can consist of hyaluronic acid (a natural skin polysaccharide), laboratory derived human collagen, or tiny calcium particles. These filler agents are injected under the wrinkle or fold and provide scaffolding under the skin to elevate the wrinkle. Hyaluronic and collagen are also used in the lips for augmentation. These procedures can be uncomfortable; a topical or injected anesthetic may be required.   The main risk of these procedures is bruising. Patients who are considering any facial injection should avoid aspirin and ibuprofen for 10 days before treatment.

While collagen typically lasts about 4 months, hyaluronic acid results can be seen up to about 6 months. Hyaluronic acid pulls in water as is breaks down, so there is less loss of correction over time. For deeper cheek folds, an injectable with tiny particles of synthetic bone can be used and correction may last up to a year. In October of this year a new semi-permanent injectable was FDA approved to treat cheek folds. This filling agent consists of small synthetic spheres in bovine collagen. Treatment with this filler may last up to 4 years.

A unique filling agent utilizes the injection of crystallized particles under the skin. The skin builds collagen around the particles, and over time the tissue “grows” in volume. This agent was FDA approved for the treatment of facial fat atrophy. It is a relatively painless procedure, and approximately three treatments sessions are required for optimal correction.

“Relaxing” agents were discovered to improve wrinkles almost by accident. Botulinum toxin (BT), which had been used for many years to treat muscle spasms, was noted to smooth the wrinkle lines in patients treated for facial spasms.   Since its FDA approval in 2001, (BT) has become one of the most popular facial cosmetic treatments in the United States.

BT is typically used in the upper face to treat the crow’s feet, the forehead lines, and the lines between the brows. The injection takes only a few minutes, and is only slightly uncomfortable. Patients may return to work immediately after treatment. The onset of facial muscle weakening is about 5-7 days after treatment, and the results last approximately 3 months. BT is one of the safest cosmetic procedures performed. The most common risk is bruising. Rare complications of BT injection include headache, and a temporary drooping of the eyelid.

Many new injectables are in development. Companies are striving to produce the injectable with the best biocompatibility and with long lasting results.

Ira D. Papel, MD, is a Past President of the AAFPRS and Theda Kontis, MD, is a Member of AAFPRS.

The AAFPRS advises a ll patients to make informed decisions when it comes to undergoing any facial plastic surgery procedure, by ensuring your surgeon meets the above criteria. The organization also provides consumers with free information and brochures and a list of qualified facial plastic surgeons in their area by calling 1-800-332-FACE.

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