By now just about everybody knows something about facial fillers. They’ve been around for 30+ years, but the newest types have proven to be safer and more effective at creating natural improvement in the appearance of facial lines. There are several types of fillers available, and it pays to educate yourself on what filler is best for each part of the face and what the possible side effects and complications are. First, you need to know what filler materials are. The most popular products currently are Juvederm® and Restylane®, which are both made of hyaluronic acid (HA). HA is a substance produced naturally by your body as part of the matrix of your skin. It is injected to fill in fixed wrinkle lines and add volume to the lips, cheeks and other areas. Other materials have been used in the past. These include silicone, which has been abandoned because it is very difficult to remove and can cause scarring and skin changes. Human fat has also been used, but tends to reabsorb quickly and unevenly. Human or animal-derived collagen has uneven absorption and is not long-lasting.

When considering if you need HA filler and what type, keep the following 5 things in mind:

1. What am I trying to correct with this treatment? Fillers are recommended for fixed facial lines, such as the nasolabial folds (the folds at the edges of your mouth that extend to the sides of your nose), but also are used in the nasojugal groove (the tear trough), the cheeks and the lips. They work wherever a crease is present, which doesn’t disappear when the face is totally relaxed. A dynamic wrinkle, or one that comes and goes with facial expression, may need a neurotoxin like Botox® or Dysport®.

2. Is the treatment safe in the area I want it? The FDA has very narrow indications for all of the available facial fillers. This means the companies likely only did extensive (i.e. expensive) clinical trials to show the filler was effective and safe to be injected in one particular area, usually the nasolabial fold. Thus, they are only truly approved for these areas. Some, including Radiesse®, are only approved for facial atrophy in HIV patients. However, as with a majority of drugs, physicians have found ways to safely use these drugs “off label”. The key is to find an experienced physician who understands the affects and limitations of the medication. If he/she tells you there are no side-effects or all their patients have had good outcomes, look for another doctor. They should be mentioning that fillers will cause swelling and possible bruising that can last 1-2 weeks after the injection. The filler material may feel hard or lumpy in the beginning, although this almost always improves in a few weeks. Rarely, people can have allergic reactions to the medicine, sometimes causing breathing problems. Injection into the tear trough has, in rare instances, led to filler getting into a vein which caused a blood clot. This is a potentially life threatening complication and injection here must be performed by someone very familiar with facial anatomy. And those with a history of cold sores can develop severe outbreaks after injection.

Also consider the timeless maxim, “less is more”. No one wants to look like they’ve had an injection, yet many patients feel like they haven’t gotten their money’s worth if they don’t walk out with larger than life lips. Remember, the physician can always add more filler later on if you aren’t satisfied with the volume changes, but removing filler is not as easy, involves injecting a different enzyme that breaks down the material, and can be unpredictable. Adding filler gradually will give the most natural results.

3. What is the cost? Filler is sold to the physician by the vial and cannot be shared between patients. The vials are quite small and most patients on their first visit will need at least 2 if they plan to have their nasolabial folds and lips done (you can get away with less for a smaller area). Most physicians charge around $550 to $800 dollars per vial depending on the material and the injection locations.

4. Can I afford to keep up with this? As filler isn’t permanent, it will need to be repeated, generally in a year to 18 months, depending on the material and location. Budgeting for it will be a must and should be considered before getting started. That being said, most physicians agree that fillers seem to delay the need for more invasive procedures, like a face lift, which are much more costly. If you are dropping a hundred dollars here or there on facial creams that have little evidence of doing anything significant for your skin, filler may be more economical and effective in the long run. If you are the type that prefers to buy shampoo at the dollar store and thinks spending money on smelling nice is an unnecessary luxury, chances are you stopped reading this article a while ago.

5. Is there a cheaper/safer alternative that will bring me similar results? The best medicine is preventive. If you don’t want lines to appear, treat your skin with respect. Refer to our previous article on the subject by clicking here. The main point we stress is avoiding unnecessary sun exposure and keeping up with regular exercise.

As with all cosmetic procedures, don’t rush in until you have all the facts and have weighed all your options. When performed by a skilled physician in the proper setting, facial fillers can be a nice way to rejuvenate the face, but as always, use caution and keep realistic expectations. Call us at 801.264.4420 for a consultation, or visit us at utahoc.com.

We’ve all seen the boom in medical spas over the past few years. Maybe you’ve been to one and received great care. There are, however, some troubling trends here in Utah and in other states where physicians without any experience or facial cosmetic training are performing and overseeing delicate procedures. Most of these procedures, if not performed properly, can have dire permanent consequences. A recent story that appeared on KSL and KSL.com, mainly dealing with laser skin procedures, highlights these dangers.

[Click here to read the story and see the video]

With regard to facial fillers and neurotoxins, like Botox and Dysport, there are plenty of places offering these services, but are the people performing these services qualified and do they have proper oversight? In order for a spa to use the “medical” moniker, they have to have a medical director in charge or a physician who directly performs the procedures. Most states, including Utah, don’t yet have strict laws regarding the qualifications of a medical director. In most cases, they just need a medical degree. There is no requirement that they have facial plastic surgery training. This means physicians with no training in facial injections, and their possible complications, could be overseeing or performing your injection. What are the risks? Well, skin infections from Botox and fillers, while rare, can cause serious scarring of the skin. Allergies to these medications also can result in serious local and systemic reactions. Is your provider prepared to deal with these occurrences? Improperly placed fillers can cause facial disfigurement may not always be reversible. Even when they are reversible, an equally skilled injector must perform this procedure.

So what should you do to keep yourself safe? Don’t be afraid to ask questions and be observant. Here are 4 questions to ask before you make your appointment, and a few more things to consider while talking with the doctor and once you are in the chair receiving the procedure:

1. Who is the medical director or doctor performing the service and what are their qualifications? (Look for a physician specifically trained in performing the procedure you seek. Ask if he/she was trained in residency, received training at a weekend conference, or hasn’t received any formal training. Obviously the more training the better. You can also search out the doctor’s name for any good/bad reviews or look at their state licensing board to make sure they haven’t had any actions against them in the past. This is good advice for anyone seeking out any medical care).
2. If an auxiliary staff person (Nurse Practitioner, Nurse, Physician Assistant or aesthetician) is performing the injection, what is their experience and qualification? (There is a reason these medications are not available over the counter and must be dispensed by a physician. Ensure the practitioners injecting have been trained and licensed).
3. Will the doctor be present if they aren’t performing the injection? (Many “medical directors” are not present when procedures are performed and cannot easily respond to patients having problems. They may also not be present because the nurse or PA knows more about the procedure than the doctor).
4. If I have a complication, early or late, who can I contact? What about in the middle of the night? (Any physician in active care of patients is available 24/7 through an answering service, or has a call group in which other physicians cover for him when he’s not available. If this isn’t the case with your medical director, look elsewhere).

Once you are satisfied that a trained physician is performing your procedure or directly supervising, consider the following:

1. Is the doctor offering reasonable results and not watering down the potential risks? (It is always easy to glaze over the risks of a procedure while promising excellent results. Any physician experienced in cosmetic procedures knows that complications can and do occur. Not mentioning them shows a lack of experience or interest in the patient’s welfare).
2. Is sterile technique being practiced? (While you may not be totally familiar with what constitutes sterile technique, making sure the doctor washes his/her hands and wears gloves, uses new needles and properly cleans your skin with alcohol or other sterilizing solution. These simple precautions make infections very unlikely).

Medical spas, when run with the patient’s best interest in mind, can be very calming and relaxing places to receive elective medical care. Asking the right questions and being observant of the techniques used will ensure your spa is also a safe place for treatment.