Guide to Filling Wrinkles

Learn about all the different kinds of wrinkle fillers.

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Radiesse is increasingly popular for correcting minor deformities of the nose after fractures or rhinoplasty. Almost magically, when Radiesse contacts bone, new bone is formed. When not touching bone, it creates bulk and scar. Part of the improvement may be permanent, although the manufacturer states that this filler lasts between one and two years. Some surgeons claim it lasts longer.

The placement of Radiesse is truly an art, and results will vary with the skills of the surgeon. Its injection is really surgery: surgeons use the injecting needle to break attachments of skin to underlying tissue before the injection, and they use the material like steel rebar in concrete—crossing folds to reinforce them and hopefully stall recurrence.

No allergic reactions have been reported to date, and no skin test is needed. Radiesse cannot be used to make lips larger, however. In a third of patients it clumps and forms lumps in the lips. If these lumps occur, the lip must be punctured and the material squeezed out. This usually solves the problem.

Radiesse costs the surgeon $295 for a 1.3 cc syringe. The average cost for a Radiesse injection is $900.

Sculptra
Sculptra was approved as a filler in 2004. It has been marketed outside the United States, as NewFill, since 1999. Chemically similar to suture material, Sculptra (poly-L-lactic acid) currently is approved only for filling facial fat loss (lipoatrophy) in HIV-positive patients. Injected into the deep dermis, it may last as long as two years, although one study showed it had disappeared in four months. It may last longer, because it stimulates the body to make a collagen scar around the material. As with Radiesse, lumps may appear when it is injected into the lips. But there have been troubling cases of stubborn lumps in other parts of the face, prompting a warning about the long-term effects. I expect that this material will soon be approved for cosmetic purposes. It will then be used to fill nasolabial folds, marionette lines, and other facial hollows.

Unlike Restylane, Sculptra can be mixed with lidocaine to lessen the pain of the injections. New, creative uses for Sculptra and other fillers are described almost daily. Sculptra has even been used, off-label, by podiatrists to plump up unattractive feet! The average cost for a Sculptra injection is $1,000.

Autologen
This novel product is collagen made from a patient’s own skin. A piece of skin is processed in a laboratory and returned to the patient’s doctor for injection as collagen. Despite the hope that the collagen would be permanent, since it is the patient’s own tissue, it only lasts as long as cow collagen.