While doctors are just getting acquainted with the new fillers, several other options are already on the horizon. Two implants—VeraFil and Perma—are being presented as alternatives to pout-plumping lip injections. VeraFil, which the FDA recently cleared for use on under-eye hollows and is already being used off-label for lips, is a deflated tube that is inserted via a three-millimeter incision and then filled with saline. “We inflate it all the way up and then we go up and down to find the right volume for the patient,” says James Newman, a facial plastic surgeon in San Mateo, California, who helped develop the implant with Evera Medical. The procedure, done under a local anesthetic, takes 15 to 30 minutes and is reversible only with further surgery. Perma, a soft, solid silicone implant that comes in nine different shapes and sizes, was also greenlighted by the FDA for use in the chin, nose and cheeks, but doctors are experimenting with it in the lips as well.
Both sound promising, but for some, memories of the SoftForm lip implant, which was approved by the FDA in 2000 and then phased out of the market in 2005, are all too recent. Because lips are always moving, the implant had a tendency to migrate, says New York dermatologist David Orentreich, adding that “the ease of using fillers in the lip is hard to beat.”
While there’s plenty of competition on the filler front, up until now, Botox has had a stronghold on the muscle-freezing market. But a brand-new, much longer-lasting procedure is threatening to rival its dominance. GFX, a device that uses radio-frequency energy to target motor nerves (it’s been used for decades by cardiologists), is now being tested on the nerves that control the “elevens,” the vertical lines that can form between the eyebrows. A thin probe is inserted into the face via two to four needle punctures, and the nerves are injured so that “they can’t conduct the signal to the muscle as strongly,” says Newman, who is also involved in GFX’s clinical trials and is an investor in the technology. “We can injure the nerve for a much longer period of time than Botox can,” he says, adding that GFX is not meant to stop muscle activity 100 percent, as Botox initially does. “If patients want to really scowl at somebody, they can still have some activity.”
No matter how enthusiastic doctors are, many of them say that semipermanent options are not for first-time patients. Rather, they’re for an experienced group who have had, well, their fill of fillers and temporary fixes.
But while it’s safe to assume that furrowed brows will never be in style, other trends are less predictable. The full lips that are in vogue today may very well be passé tomorrow. Westreich thinks the more permanent procedures are akin to getting a lifelong hairstyle: “A very small subset of people would want that; they’ve had the same bob since 1978,” he says. “But most people would say, ‘The Jennifer Aniston cut I had 10 years ago—I’m really happy I don’t have it now.’”