Job hunting? The edge may be in a needle, top doctor explains best filler options

By April MacIntyre Dec 15, 2011, 23:21 GMT

The current hot trend in dermatology and plastic surgery are dermal fillers, injected directly into the lines and depressions with a needle to plump up the skin and firm the areas.

As we age, the collagen and elastin in our faces - which is what gives us a youthful appearance and cushion to the skin - break down, resulting in gradual development of wrinkles, hollows and fine lines.

The current hot trend in dermatology and plastic surgery are dermal fillers, injected directly into the lines and depressions with a needle to plump up the skin and firm the areas.

The most common chemical used in these fillers is the hyaluronic acid gel which is a natural component of the skin. The way it works on the skin is by filling up a space in the skin with the look of restored volume.

Since it’s a natural structural compound of the skin and even found in many topical cosmetic serums, it assimilates into the skin structure and gives immediate results. The acid gel becomes part of the skin and will last anywhere between four and 12 months.

According to the American Academy of Cosmetic Surgery, fillers like Restylane and Perlane have seen a 110% increase in procedures performed in the past three years. Botox, which doesn't fill wrinkles, but reduces the muscular contractions that cause them, has seen a 115% increase. Face-lifts, on the other hand, have only seen a 20% increase in the same time period.

The average price for fillers is $800 per session, according to the AACS. Compare that to a face-lift, which can run into the tens of thousands.

In this economy, many people are eschewing facelifts (upwards of $50,000) for more reasonable liquid facelifts, as people are concerned about their appearance when going to job interviews.

Today, a range of dermal fillers can be injected into the face, neck, lips, hands and décolleté, taking years off the a patient all while during a lunch hour, with no invasive surgery and little recovery time.

"Fillers have dramatically changed the game," says Dr. Ilya Reyter, a Beverly Hills' dermatologist. The use of fillers can hold off a face-lift for at least a decade.

Dr. Ilya Reyter is a leader in his field of dermatology and dermatologic surgery. A pioneer in facial volume restoration using fat transfer and fillers, Dr. Reyter has received acclaim for his work at the University of Southern California (USC) Keck School of Medicine.

In his private practice, Dr. Reyter specializes in all aspects of dermatology and cosmetic surgery, including the treatment of sun damage and photo aging using resurfacing lasers, fat transfer, Botox, and soft tissue fillers.

Dr. Reyter is an Assistant Clinical Professor in the Department of Dermatology at USC. As part of his faculty work, Dr. Reyter developed a pioneering lipodystrophy program to help patients fight the disfiguring side-effects of facial fat and volume loss.

In this program, Dr. Reyter trains physicians to effectively treat facial fat loss, which often occurs in aging, but can be accelerated by certain diseases, such as HIV.
Using advanced techniques to harvest and transfer a patient’s own fat, Dr. Reyter can reverse the sunken, atrophied facial features that are so difficult to treat by any other means.

Dr. Reyter tells Monsters and Critics that there is a bit of a backlash on the more permanent fillers which create scar tissue nodules, creating a permanent lump under the skin.

Fillers work under the skin to replace elasticity and plump up sagging skin. The look, when done right, is more youthful and natural than what was previously attainable; done wrong, though, faces look out of proportion and contour problems like lumps become noticeable.

Dr. Reyter is seeing an increase of professionals looking for a minimally invasive edge and market competitiveness "leg up" in a youth-oriented culture, many who are often confused as to which filler will work best for their needs.

Dermal fillers Restylane, Perlane, Juvederm and Prevelle Silk are made of hyaluronic acid, a naturally occurring substance essential to plump and youthful-looking skin. Non animal-based hyaluronic acid dermal fillers came on the world market with the introduction of Restylane in 1996.

Before Restylane, dermal fillers were made of animal products such as bovine collagen, silicone or body fat. hyaluronic acid dermal fillers are often a better option. Because the body already produces the chemical naturally, it rarely causes an allergic reaction, and it gives a smoother, more natural appearance.

Dr. Reyter's residency training in dermatology was at the University of Southern California, where he was elected Chief Resident. After residency training, Dr. Reyter joined the clinical faculty at USC, began private practice, and established a growing practice in Beverly Hills. Most recently, Dr. Reyter accepted a fellowship position in Mohs Surgery/Procedural Dermatology. The fellowship is the highest level of surgical training within the field, allowing Dr. Reyter to offer his patients the best possible care in dermatology and dermatologic surgery.

Dr. Reyter tells us that getting doctors to concur on what filler works best is not easy. All physicians have their opinions on the various fillers, and they often differ.

Dr. Reyter tells Monsters and Critics, "Patients shopping for bargains in facial fillers may be enticed by the claims of long lasting fillers. As always, buyers beware! The claims may sound too good to be true, and they often are."

Not all fillers are created equal. Dr, Reyter says, "My fillers of choice are hyaluronic acid gels, such as Restylane and Juvederm. They are the gold standard. These are wonderful, versatile products can create dramatic improvements in facial appearance. They are based on substances that we all naturally have in our skin, and are meant to break down and go away. This is a good thing. As the face ages, bone and fat get reabsorbed, and the skin then lies in a different position. The fillers you add today may not look right in 5-10 years if they were permanent. Many people who have had silicone injections have experienced this first hand."

Dr. Reyter shared his outlook on the more permanent fillers. "Major cosmetic companies are creating fillers that they claim to be longer lasting than hyaluronic acid gels. Some physicians are even touting these as 'permanent' fillers. These include products such as Artefill, Sculptra, and Radiesse, and are based on substances that are not readily broken down by the body, and therefore can induce scar tissue formation. As all scar tissue is made of collagen, they claim a 'positive' benefit of inducing collagen formation. I guess that's one way of looking at it!"

"These products are FDA approved for use, but they it’s important to remember that the FDA views fillers as devices, not drugs. The FDA approval process for devices is much less stringent than it is for drugs."

Dr. Reyter elaborated. ""I do not use these more 'permanent' fillers my practice. The risk/reward ratio is simply not favorable for my patients. It has been said that permanent fillers can cause permanent complications....I firmly agree with this. I continue to see patients in my office for complications arising from injections of these types of fillers by other physicians. Many are still suffering from disfiguring lumps, bumps, and irregular skin texture years after the original injections. Often times, the only treatment course is injection of steroids or chemotherapy agents into the lumps, which can have some success in alleviating the problems. For the worst cases, I have had to surgically remove the lumps and nodules."

The bottom line: Have only the most highly trained board-certified doctor inject anything into your face. Factors include a patients' individual skin textures, age, sun damage and genetic and metabolic factors, not to mention the doctor's skill and experience with injectables. The filler that works best for you is usually judged on a case-by-case basis by an experienced doctor.

http://www.reytermd.com/

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