Last week on the Total Body Surgical Cosmetic Surgery blog we talked about wrinkles and how good skin care and Botox can make a big difference. This week we will take a look at the common fillers that can be used.
Below is one of the commonly used scales to measure and quantify the severity of wrinkles and skin damage.
| Group | Classification | Typical Age | Description | Skin Characteristics |
| I | Mild | 28-35 | No wrinkles | Early Photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup |
| II | Moderate | 35-50 | Wrinkles in motion | Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation |
| III | Advanced | 50-65 | Wrinkles at rest | Advanced Photoaging: Obvious discolorations, visible capillaries (telangiectasias), visible keratosis, wears heavier foundation always |
| IV | Severe | 60-75 | Only wrinkles | Severe Photoaging: Yellow-gray skin color, prior skin malignancies, wrinkles throughout - no normal skin, cannot wear makeup because it cakes and cracks |
Class II we would usually use Botox or Dysport because slowing the underlying muscles will usually eliminate the wrinkle as long as it is maintained.
Class III wrinkles will usually require "filling" as they are present at rest and are more or less permanent fixtures. Filling them will not remove the wrinkle 100% but will go a long way toward making them tolerable.
There are many fillers on the market and thank goodness most of them now last a year or more. This is in contrast to only 5 or 6 years ago when a filler would work for 2-4 months. Many techniques can be nearly peramanant.
Hyaluronic acid fillers such as Juvederm and Perlane are great all around fillers that can be used nearly anywhere in the body. This is because it is a naturally occurring substance in the body and is colorless. They cause very little collagen production and the newer ones contain lidocaine which is a nice plus for the patient and injector. These are the most widely used products.
Radiesse is another filler that is made of small calcium hydroxyapetite beads in a sugar based carrier. This filler is limited in its use and should not be used in the lip or superficially anywhere. It is great for larger volume fills in the cheek and nasolabial fold. It works by causing your body to form collagen in the treated areas. It should last 12 to 18 months but will need some supplementation in that time.
Other common fillers are Sculptra which is poly L lactic acid can be used to create volume in the cheeks but this is a much slower process than the other two.
More permanent fillers are fat and silicone. Fat harvesting and grafting has become common all over the body, but is very popular in the face. Fat is harvested, treated and placed in areas where fat has disappeared over time. There is some variability in the percentage of the fat that lives and therefore the procedure may need repeating. Lastly, silicone. Silicone has received a bad name. There are countless examples of low grade silicone used in too large a quantity to create a terrible result. At Total Body Surgical, I have a great deal of experience with silicone. We use only the best quality silikon 1000 that is manufactured by Alcon and made for use in the eye. It works great for augmenting lips, filling areas of imperfection on the nose, and some acne scarring.
Next week....we'll address pigment issues!! Come see us at Total Body Surgical. Mention this blog and get $10.00per unit botox....That's a good price now!!