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November 1, 2011

Saving Face: Your Guide to What Really Works

hand with needle

Photo Credit: Bill Diodato

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Whether or not you fear needles, temporary facial implants "can re-establish the youthful shape of the face," Marmur explains. "Fillers can strengthen the cheekbones and temples, elongate the chin, and redefine the jaw." There are synthetic fillers, such as Radiesse (a durable substance often used for the jawline) and Sculptra (a watery solution for volumizing large areas like chins). Hyaluronic acid fillers (like Restylane and Juvederm) are made of the same water-binding substance found in our bodies and are used for smoothing lines around the thin-skinned eye and lip areas.

The Pros: Fillers like Sculptra and Restylane gradually stimulate collagen formation in the dermis, so it's likely you will need less and less filler for touch-ups.

The Cons: Results can last six months or more, but if you're not happy with the effects, hyaluronic acid fillers are reversible with a hyaluronidase injection, which dissolves the substance. And be warned: Too much filling and you could start looking like a puffed-up blowfish.

When to Start: 40+ Downtime: None. Cost: $562 per treatment. Maintenance: Twice a year.

EXTRA CREDIT DEEP DIVE: "By injecting filler deeper, underneath the muscle and right above the bone, you can lift certain areas and give shape to the face," says Wexler of the scaffolding-like effect. For example, instead of inflating nasolabial folds superficially, the idea is to make laugh lines disappear by using filler to lift the peripheral muscle of the cheek with volume.


Sure, the traditional peel may sound old school, but don't discount it, especially if budget is an issue. The application of various acids — salicylic, glycolic, lactic, kojic, retinoic, alpha hydroxy (AHA), or trichloroacetic (TCA) — onto the face resurfaces the skin by aggressively sloughing off dead skin cells from the top layer. Each acid interacts differently on the skin, so a derm usually combines a few to achieve the desired result. Peels can be used to get rid of brown spots, dull texture, and fine lines resulting from sun exposure.

The Pros: Did we mention peels are more reasonably priced? They are also an extremely effective option for darker skin tones, since using light and laser treatments can potentially discolor and scar skin with more melanin.

The Cons: Superficial peels don't go as deep into the skin (to affect collagen-building change) as a laser can, and the results of stronger peels can be unpredictable. "You can't control a chemical peel the way you can control the parameters and pulse duration of a laser," says Marmur, who explains that peels can lead to burns or post-inflammatory hyperpigmentation. "Lasers are a much more sophisticated way of treating the skin on a deeper level."

When to Start: 20s+ Downtime: For light peels, two or three days of redness and peeling. Medium peels (such as a 30 percent trichloroacetic acid) require up to a week of social lockdown. Cost: $150 to $719 per treatment. Maintenance: Light peels, once per month for a series of three. Deeper peels, once every three months for a year.


The future of fillers focuses on their potential to trigger your body to make more of its own collagen, elastin, and new skin cells.

FAT STEM CELLS: Harvesting fat from one area through liposuction, then purifying it and transferring it into your face acts as a natural and permanent filler. Fat contains lots of stem cells, and Baumann says that "stem cells have the potential to become fibroblasts [the cells that produce collagen] or other skin cells, so the idea is that they will cause the skin to regenerate itself faster." But she adds this caveat: "Stem cells can turn into any kind of cell, so what if they turn into skin cancer cells?"

ETA: Fat injections have been around for years, but they're not FDA-approved, and there's no hard data to suggest that the stem cells in fat will turn into collagen-making fibroblasts or healthy new skin cells when transplanted into the face.

BLOOD GROWTH FACTORS: Provocative in a True Blood kind of way, but not yet FDA-approved for facial rejuvenation, is PRP, or platelet-rich plasma, known as "vampire filler." The procedure involves drawing your blood, separating the platelets in a centrifuge, and then injecting that plasma — rich with growth factors — into your face where it will theoretically help to generate collagen and fresh skin cells. As creepy and out there as it sounds, PRP has solid roots in orthopedic medicine, where it's used to facilitate the repair of injured tissue. "While the scientific evidence on PRP is limited," says Shamban, "the concept edges closer to what will be coming in the near future: extracting our own cells, culturing them, and reinjecting them into the skin to tell it to make more collagen."

ETA: While some dermatologists offer PRP treatments off-label (i.e., for another purpose than what was approved by the FDA), the treatment is neither undergoing clinical trials nor seeking FDA clearance for cosmetic use.

SKIN FIBROBLASTS: The fibroblast filler LaViv just won FDA approval for smile lines, and it may be a game-changer. "The science is very convincing, and fibroblasts are better than stem cells because we know they make col-

lagen," says Baumann. Sample skin tissue is removed from behind the ear and sent to a lab where the fibroblast cells are multiplied into millions of new collagen-producing cells, then frozen until the defrosted formulation is injected into the patient's face in a series of three treatments over three months. Shamban, who was involved in clinical trials for LaViv, says: "It's the first biological cell therapy that's been approved to treat lines and wrinkles. Recent studies also show that old fibroblast cells can be revived in the lab to act like younger cells. This may mean that when you're 70, we could potentially make your fibroblasts act like they're 25." Talk about turning back time.

ETA: Expect to see it roll out to derm offices over the next year.

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