THE NEWER FACIAL INJECTABLES
DECEMBER, 2007 & JANUARY, 2008

There are at least 10 new injectables to correct folds and wrinkles and to restore volume for sunken cheeks. Each of these injectable fillers has different properties and indications, so you need to rely on the experience, judgment, and good eye of your doctor to pick the best product for you.

The technique of injection is even more crucial, because I am sculpturing the face with the injectable fillers. Correct injection of the product is actually much more important than which product is used. To quote Dr. Val Lambros, an excellent plastic surgeon in Newport Beach, California: "Injecting is not easy to do - you have to be thinking in three dimensions. The nature of the product is not as important as the delivery of it".

These newer injectables can be painful if used without anesthesia, so we use dental nerve blocks (what your dentist uses) and local anesthesia. Then the injectables are pain-free.

If you are relaxed and free of pain, I can take my time with sculpturing the face with injectables.
You want an injectable that is long-lasting but not permanent. The reason I don't use permanent fillers in our Plastic Surgery practice on the Upper East Side of Manhattan is that the tissues of your face move as you age - so that a permanent injectable that looks great today may create a deformity in five years. If your tissues become thinner with time, a permanent implant can become visible.

Radiesse®, for example, is a good injectable to replace lost volume. It lasts one to two years. This is a good time frame. I discussed Radiesse in the "What's New This Month?" article for March and April, 2007.
Some of the other newer injectables are:

• Sculptra® . Sculptra consists of Poly-L-Lactic Acid and is useful for the gradual and progressive restoration of facial volume. It requires several treatments.
• Juvederm Ultra® and Juvederm Ultra Plus®. Juvederm Ultra and Juvederm Ultra Plus are hyaluronic acid products that are injected into the deep layers of the skin to correct moderate to severe facial wrinkles and folds.
• Perlane®. Perlane is a hyaluronic acid produced by the same manufacturer as Restylane®. Perlane is used for restoring volume and recontouring facial folds.

We still use a lot of Restylane and Cosmoplast® (human collagen) in our practice because patients are very comfortable with these products and they are quite free of problems. Restylane and Cosmoplast are great for creating fuller lips and correcting superficial and moderate wrinkles.