A Beginner's Guide to Fillers

Fillers and injectables are often the prescription fix recommended by dermatologists and plastic surgeons to stave off the effects of aging. But if they’re not used properly, fillers and injectables can do more harm than good making you look swollen or distorted. On the flipside, when they’re used right, and in the right patient, fillers and injectables can not only erase the signs of aging, but also hinder them, too. “Fillers target signs of aging deep beneath the skin by adding volume to it. Restoring volume in the skin prevents wrinkles caused by the action of the muscles of facial expression,” says New York dermatologist Adebola Dele-Michael, MD.

Fillers and injectables can improve the look of aging skin because they plump up volume-deficient areas to give fullness, fill in lines and wrinkles and stimulate collagen to some degree. While certain products, like Sculptra Aesthetic and Radiesse, are used primarily for their ability to create new collagen in the skin, generally any time any type of filler is injected into the skin, new fibroblast activity is stimulated that prompts new collagen to be created.

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New to fillers and don’t know where to start? First off, sit down for a consultation with your dermatologist, plastic surgeon or facial plastic surgeon so you can map out the best anti-aging plan for you (keep in mind that it may include other in-office treatments like peels and lasers, as well as a good skin care routine). Next, you’ll want to identify the areas that need to be treated, how to best do it and which fillers will be used. Hylauronic acid fillers like Restylane, Juvéderm and Perlane, which typically require just one session and give instant results, can be used to add volume to the lips and cheeks and smooth out lines around the mouth (although there are plenty of off-label uses, too). Radiesse and Sculptra Aesthetic, which show improvement over a series of treatments, are usually reserved for those with more extreme facial fat loss as well as deeper smile and marionette lines, the corners of the mouth, chin wrinkles, and the jowl area. If there is an area of concern that shows zero signs of aging, you may not need to treat it just yet. For the most part, you only want to treat parts of your face where there are some age-related changes, even if they are minimal.

If you only have a few small lines or wrinkles, you may only need a little bit of filler. It’s better to start off small than go overboard in the beginning. “Preventing signs of aging takes less fillers and injectables than someone who has lost a lot of volume through age and has wrinkles that has been there for awhile. When the someone wants to prevent aging, just small amounts of product are often enough,” says Concord, CA, plastic surgeon Eric Mariotti, MD.  

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Because you’re treating the first signs of aging, you can probably stretch out your appointments. “Many of my patients schedule their Botox for every three to four months and add filler at every other visit. I say doing a bit of filler more often is better than doing a lot every once in a while,” says Dr. Mariotti. Also, you may not need nearly as much product as if you were treating a full-fledged aging face. The results will last for the same amount of time regardless of how much product is being injected. Expect anywhere from six months to 16 months or longer depending on what is injected and where.

So the big question at hand still remains: At what age is it appropriate to start taking measures into your hands to ward off future aging? “I don’t believe there is a certain age for proactive measures, as everyone ages at different rates depending on genetics, skin care and sun exposure. In your 30s, it may be a good time to start using Botox sparingly and perhaps a little bit of cheek filler to replace what has started to go,” says Dr. Mariotti. Adds Dr. Dele-Michael, “The age to start receiving preventive cosmetic treatments should be determined after a consultation with a board-certified dermatologist. Hyaluronic acid fillers are great to start off with because they are reversible and their effects are temporary.”