A third collagen-stimulating filler, Radiesse, is also approved for use with HIV patients, as well as for deep folds around the mouth. It contains microspheres suspended in a water-based gel and lasts for at least a year. Miami and New York dermatologist Fredric Brandt, who is a big fan of fillers like Restylane, Perlane and Juvéderm—all of which use hyaluronic acid, a substance that occurs naturally in our connective tissue, to plump—questions the value added with synthetic fillers. If lumps or bumps appear after an injection of hyaluronic acid filler, Brandt says, the body will eventually eradicate them, thanks to hyaluronidase, an enzyme already present in humans. If such complications occur with Radiesse or other synthetic fillers, he contends, they’re more difficult to reverse. Goostree counters that with proper technique, those problems shouldn’t occur in the first place. “And if you have extra swelling or something that feels like a lump,” she says, “you can inject a steroid in it and that usually smooths it out.” Bumps, she adds, can also be massaged away after injection or removed surgically, if necessary.
Either way, Brandt points out, improvements seen with hyaluronic acid fillers might actually last longer than the six months previously thought, especially in patients who use them regularly. A recent University of Michigan study suggested that Restylane not only temporarily fills wrinkles but also induces collagen growth.
ArteFill, Sculptra and Radiesse generally cost more per visit than hyaluronics. One syringe of Restylane starts at about $500, whereas Radiesse starts at $700. But that won’t necessarily up the revenue stream for doctors. Shorter-acting products keep patients coming back to the office, and while they’re there, they just might throw in a microdermabrasion session or some laser hair removal. “I have to develop a relationship with patients,” says New York facial plastic surgeon Richard Westreich. “A single treatment and I never see them again? That’s not so enticing for me.”
Jonah Shacknai, founder and CEO of Medicis Pharmaceutical Corporation, which makes Restylane and Perlane, is steadfast in his commitment to fillers with a more limited life span. While he admits that the company is looking into longer-lasting forms of hyaluronic acid, he’s thinking in terms of adding “months, not years.” Using permanent plumpers in a human face, he says, is “putting a static product in a dynamic place.”
That is indeed a concern of medical professionals who caution that while these fillers stay in place, your face is constantly changing. “The concept of something that goes in permanently and then things age around it is something that none of us knows how we’re going to deal with in the future,” says Vito Quatela, a facial plastic surgeon in Rochester, New York, who is also president of the American Academy of Facial Plastic and Reconstructive Surgery. “My preference is a filler that lasts somewhere in the one- to two-year range.”