A combination of earlier magazine work and new blog posts

Filling a Gap in the Treatment of Facial Wrinkles

Injectables are dermatologists’ newest weapons in the war against aging.

It used to be that the only way to shave off years- other than airbrushing-was to go under the knife for face-lifts, eye jobs and brow-lifts. Now, don’t get me wrong: Cosmetic surgeons are called that because they still do plenty of surgery, from curing weak chins and cutting away loose skin to administering pec, butt and calf implants to make people look like they’ve been working out at a gym for years. And don’t forget liposuction, a little procedure that can make saddlebags disappear or an inch melt away from a runway model who ate a fudge sundae the week before her show.

But surgery is no longer a must. The latest route for the savvy youth junkie is using fillers, injectable products that rejuvenate the face, which are now a $250 million annual business. You may have seen the results of these procedures around South Beach: puffy lips that look like they’ve been stung by a swarm of bees. But those superplumped lips are just one thing fillers tackle. They can, among other things, fill in wrinkles, reshape the face, add volume to shrunken cheeks and straighten out bumps along the bridge of a nose. In talented hands, fillers can postpone, or in some cases help you avoid, surgery. And a whole new range of products is coming out in the nick of time.

Botox, a watered-down version of poisonous botulism, paralyzes the muscles into which it is injected for four to six months. That means smooth foreheads, no frowns when you get angry and no crow’s-feet. But the downside is that a bad doctor can give you droopy eyes or leave you with no expression at all-think a bowling ball with two eyes and a mouth. Bad. And the Botox monopoly will soon be challenged by a slew of brands that aren’t yet household names, such as Reloxin, Xeomen and PurTox, based on the botulism strain. All promise the same effects but with longer staying power and lower prices. And Myobloc, yet another version, will be marketed as a much cheaper, almost generic Botox. That’s good for consumers: You’ll be able to get your face rejuvenated and still have money to shop at Bal Harbour.

Hyaluronic acid is a staple for cutting-edge dermatologists. It’s a natural substance present in every body tissue, with the highest concentrations in skin. Injections fill in lines and wrinkles around the eyes and those annoying ones that run from the edge of the nose to the corner of the mouth (nasolabial folds), as well as enhance lips. They are often used in conjunction with Botox and last about six months.

Restylane has been around a few years and virtually had the market to itself. But Juvèderm, which just received FDA approval, is launching a major marketing push. About 20 more products are on its heels, so expect lots of competition. Products most talked about are Restylane Touch, which injects easily and is supposedly excellent for lip enhancement and fine lines. Perlane is injected deeper and designed to fill deeper wrinkles, restore volume to sunken cheeks and make deep nasolabial folds disappear. SubQ is designed to treat severe wrinkles. Puragen promises longer-lasting results and will be one of the first with a built-in anesthetic to minimize pain (all injectables cause pain, even though the area is usually prepped with a numbing cream such as lidocaine).

You’ve probably heard of collagen, such as Zyderm, the 20-year-old mainstay for filling in face wrinkles. It is made from cows, and not only are some people allergic to it, but it also lasts only a couple of months. Now there is CosmoDerm and CosmoPlast. They’re derived-get ready to be grossed out-from the skin of babies. But don’t worry: It’s grown in labs from skin cells. The great news is that since they’re based on human skin, they can’t cause allergic reactions. That means you can walk into an office during your lunch hour and leave looking better. There is no downtime (unless you’re one of the unlucky ones to bruise), and it lasts twice as long as original collagen. Coming soon is Dermalogen, touted to last longer than existing products, Dermalogen XL for deep wrinkles, and Evolence and Evolence Breeze, collagens derived from pigs (there goes the kosher market). These are widely used in Europe, are great for enhancing lips and can last a year.

There are also fat injections, though they’re a bit nasty, too. Fat taken from your thighs, butt or abs with a syringe is injected into facial lines. There is no chance of rejection and it’s a great natural filler, but there is a bit more downtime and it lasts only a few months.

If you’re looking for something semipermanent, try Radiesse. Originally designed for dental, bone and vocal-cord reconstruction, dermatologists found that this synthetic bone-like substance, when injected, stimulates human collagen to grow around it. It is great at filling in lines (be certain to get a seasoned doctor, as an amateur can leave small bumps) and lasts between 12 and 18 months. And there is Sculptra, whose particles also stimulate collagen growth. Originally used to fill in the sunken cheeks typical of HIV/AIDS patients, it is now regularly used to rejuvenate the backs of hands and erase nasolabial folds. Usually you’ll need two to three treatments.

If you want a filler that will last until you die, there’s silicon-not the type used to caulk your bathtub, but microdroplets. In skilled hands it fills in small lines near the mouth, erases scars from chicken pox and can even straighten a bump on the bridge of the nose by building up sunken spots on each side. Hello, filler, good-bye, nose jobs. ArteFill is also FDA-approved, and like silicon, is a permanent filler.

But remember, the efficacy of these products relies on skilled derms and doctors, so don’t price shop. Someone chosen from a flyer given to you at a nightclub might offer diluted Botox or be a doctor whose degree was earned through a correspondence school. You also have to prepare yourself. For about a week before your procedure, stop smoking, drinking and taking vitamins such as E, aspirin, and Advil. They all increase the risk you’ll bruise, swell or be tender for a few days. 0

Fillers can postpone, or in some cases help you avoid, surgery. And a whole new range of products is coming out.