What do the procedures have in common? Replacing volume. "Nothing makes people look more youthful than filling in volume," says Fredric Brandt, a New York City and Coral Gables, Florida, dermatologist and founder of Dr. Brandt Skincare. "And as we get more and more experience with the newer injectables, it seems like we are able to achieve better results without surgery." Adds Patricia Wexler, a New York City dermatologist, "What I see most in my practice is a large amount of volume loss in the face, which tends to happen in your early 40s, and that is when you replace a surgical procedure with a nonsurgical one."
"For the past few years, the trend has been more natural looking lips," says Fardad Forouzanpour, founder of the Beverly Hills Cosmetic Surgical Group, adding "injectables can give lips more volume and correct lines and wrinkles that form around the mouth." Brandt finds that Restylane and Perlane hyaluronic acid-based fillers tend to look more natural. But, Forouzanpour notes, more important than the kind of fillers is the physician's injection technique and the amount that is injected. Adds Wexler, "If you have cracks at the corner of your mouth or above the lip line, collagen works well to replace structure in the skin. People don’t think about collagen anymore because they are so into hyaluronic acid. Although I use Restylane to add volume, I need collagen to create a border around the lip [cupid's bow]." Results vary but Forouzanpour states they can last from four to six months and cost around $450.
So which fillers work best? It's hard to say. "Doctors pick certain ones and get proficient at using them," says Wexler. "In 2003, we had collagen — period. To do the right kind of filling now, one syringe of anything won't be complete," she explains. (According to the AAFPRS, there are currently close to 20 FDA-approved cosmetic injectable drugs on the market.) "Besides filling in volume, we need to think about surface irregularities. Even the most plump face won't be pretty if the skin isn't in good condition." And she warns, "If a 68-year-old woman who has never taken care of her skin and spent a lot of time in the sun comes to me, injectables won't give her enough of an improvement if she has loose skin and sun damage. There's a point when you have to start from a new baseline, and if the person is healthy, she would need a face-lift."
Before getting any procedure, even nonsurgical, do your homework. Check out your doctor's background and reputation before you get injected. "A lot of my work is fixing other people's work," notes Wexler.
Here's a primping primer on today's most popular injection makeover techniques.
The Liquid Face-Lift
It's no secret aging brings on a world of change: Cheeks and chins thin, fat pads droop, eyes hollow. "Restoring contours to the face, not eliminating every tiny line, is what makes you look young," says Brandt. Previously, the only option was multiple facial surgeries and weeks, if not months, of recovery, but now it can be done with just one visit to the doctor. "I resuspend the face with Botox, lifting up the brows, neck, jawline, and tip of the nose and then fill in and replace volume around the eyes and cheeks," explains Brandt.Oscar Hevia, a dermatologist in Coral Gables and an associate of Brandt's, uses Radiesse, a calcium-based filler, injecting it under the eyes and into the cheeks and nasolabial folds. The effects last about eight months and it costs about $850. Here, the most commonly used injectables, which are often used in combination for best results.
Hyaluronic acid Also known as Restylane, Perlane, and Juvéderm. "I love Restylane and Perlane for the tear troughs, cheeks, and jawline because of the volume and lift they give to the face," says Wexler. And according to Brandt, who also uses Restylane and Perlane, they can have a cumulative effect. Backing up his claim is a recent study that showed Restylane can last up to 18 months with a single maintenance shot. Average cost is $750 per syringe.
Botox "There's no filler to take care of lines caused by movement," says Wexler, who uses Botox to freeze the mechanical lines between brows and deep crow's-feet, as well as to lift sagging jawlines and necks. "If you paralyze the muscles that pull the neck down, then the muscles that pull it up have nothing to oppose them." Even surgeons agree. Sam Rizk, a facial plastic surgeon in New York, says, "Botox is great for the brow. I don't like how unnatural brow lifts can look." Botox effects last about four months, and it costs around $400 per area injected.
Fat replacement "I've been doing this for 23 years," says Wexler of the procedure, which uses your own body fat (from, say, your hips or butt) and injects it into your face. It is generally done on cheeks and lips and along the jawline. "It also supplies stem cells, which change the texture of skin and make it luminous and firm." Unfortunately, this requires several monthly treatments so the fat can graft to its surrounding blood vessels. Cost: around $5,000 for liposuction and $500 per injection.
Sculptra If you're lipo leery or one of the lucky few with too little body fat for a fat replacement, there's Sculptra, a poly-L-lactic-acid filler. Wexler uses it on cheeks, jawline, temples, and forehead. "It's a fine particle that stimulates your own skin to grow," she explains. "It lasts several years and can be done in two to four treatments. But if it isn't massaged evenly, granules can form under the skin." Average cost: around $2,000 per treatment.
So what does an extensive procedure like a full liquid face-lift cost? It depends on what and how much your doctor injects, but expect to spend $3,000 to $5,000.
Eye Rejuvenation
"There's almost no reason for lower-eyelid cosmetic surgery when you can cover dark circles and treat sunken-in eyes or bags with Restylane," says Kenneth Steinsapir, a Los Angeles facial and eye plastic surgeon. "You get almost immediate results that are as good as, and in many cases better than, what can be accomplished with surgery." Another advantage? "Fillers allow a level of control that doesn't exist with other lower-eyelid procedures because it can be adjusted with an enzyme that erases the filler's effect."Steinsapir does admit that fillers are expensive and need to be repeated about once a year, but he is very pleased by the results. "When you combine Botox with hyaluronic-acid fillers, you can walk out of the office looking 10 to 15 years younger."
Nose Reshaping
"Using fillers to reshape the contours of the nose is not a new idea, but what's different now is that they're safe and last a long time," says Alexander Rivkin. "I have used fillers to raise and define an underdeveloped bridge, camouflage a bump, lift a droopy tip, and correct postrhinoplasty defects." If you have an asymmetrical nose or a hook shape and you don't want surgery, fillers can instantly fix any hollows. "Even though this makes your nose slightly larger, it straightens it and creates the illusion of a smaller one," says Wexler. But she warns that the nose has a compromised blood supply, and if you block a blood vessel that feeds the area, the skin will die. The caveat: If your nose is too wide or bulbous, Brandt notes that surgery works best. If you do go the filler route, Rivkin suggests hyaluronic acids, which can last up to eight months in this facial area, or Radiesse, which can last a little more than a year and costs around $1,000.Skin-Care Options
Still wary of injectables? Try one of these wrinkle-fighting products.Dr. Brandt Time Arrest Crème ($100): This peptide-packed moisturizer gives skin a lifted look by promoting skin's production of collagen and elasticity.
NuFace Microcurrent Device ($325): Tighten your complexion at home. Microcurrents instantly lift skin, and studies show a reduction of fine lines and wrinkles when used over time.
Good Skin Tri-Aktiline Total Face Instant Line Reducing Moisturizer ($44.50): This hydrating cream contains proven smoothing, wrinkle-filling ingredients like Argireline.
Estée Lauder Time Zone Anti-Line/Wrinkle Eye Creme ($43.50): Immediately brightens eyes as hyaluronic acid helps plump lines.
