A guide to fillers and injectables for your anti-aging concerns.

07 13 injectables fillers guide 2More than ever women are beautifying themselves at a younger age. In our thirties the skin begins to lose elasticity and produces less collagen so we lose volume, causing us alarm and the need to fix it. Plus, some of us wouldn’t mind a little bit of enhancement, even though aging hasn’t left its definitive mark. For example, according to Dr. Jack Kolenda, MD, FRCSC, an otolaryngologist-head and neck surgeon practising facial plastic surgery in Oakville, Ont., “women in their twenties are most interested in improving their lips. Those in their thirties notice nasolabial folds, that are caused by volume loss in their interior cheeks and eyes, so we inject to replenish those areas. As aging advances we recontour marionette lines, jowl lines and temple hollows.

Everyone has different concerns they want to address. Yet with the plethora of non-invasive dermal fillers and injectables available, sometimes it hard to decide what to pursue for your particular needs. “Dermal fillers fill things to create shape and contour. Many brands have a variety of different products for unique purposes.  Hyaluronic acid fillers are the most common type of injectable fillers,” explains Dr. Vince Bertucci, MD, FRCPC, and the co-director of Cosmetic Dermatology & Laser Fellowship at the University of Toronto.

No matter what concerns you have, Elevate’s got you covered. We spoke with several experts and compiled a list of fillers and injectables of some available options so you can go into a consultation with some knowledge.

BOTOX

Botox is used for facial rejuvenation to create a soft and refreshed look in the aging face. “Botox launched in Canada in 2001 for cosmetic purpose and was originally discovered in 1981 by the Carruthers, two Canadian doctors,” explains Dr. Bertucci.

Site of Injection: “It is used to give a refreshed look to the upper facial wrinkles, so the glabellar lines, also know as “the 11,” forehead wrinkles and the crow’s feet. There are many off-label uses as well,which are advanced techniques, including facial slimming of the lower face wrinkles around the mouth, the nasal bunny lines (they appear when you wrinkle the nose) and to also alleviate gummy smiles,” says Dr. Bertucci.

Treatment Protocol: The treatment is done once and is injected with fine needles in a series of little needle pokes to relax the muscles that contribute to wrinkle production.

Downtime: “Don’t exercise, rubber massage the area or lie down for four hours after the injection, but patients can return to other daily activities,” says Dr. Bertucci.

Results: Results show at two weeks, but may see them as early as two days. Lasts usually three to four months.

Side-Effects: “There is possibility of redness and small bruising from the needle. Botox is one of the safest cosmetic procedures that can be done. There were more than 6.1 million procedures done in the U.S. last year (2012).”

Cost: $350 and up, varies with amount and number of areas injected.

XEOMIN

“Xeomin is a botulinum toxin with a different preparation process than Botox. In Europe there are many different modulators, but in Canada we only had Botox, so Xeomin is the new kid on the block. Xeomin is a purer molecule and the container that it comes in doesn’t have to be refrigerated. The purer molecule is where the advantage lies as patients have less of an immuno reaction to it and therefore cannot develop an immunity to it [after years of prolonged use],” says Dr. Kolenda. 

Site of Injection: Muscles in the forehead, periorbital area, glabellar area, to improve lines in the upper lip and to target marionette lines.

Treatment Protocol: Small needles are used to administer injections of Xeomin, depending on the areas of concern into facial muscles, “which cause motion and overtime cause wrinkles. By reducing the motion of the muscles you are smoothing the surface of the skin,” explains Dr. Kolenda.

Downtime: None. “There is also no preparation, we simply clean the area of makeup and residue, and inject into the targeted muscle group.”

Results: Lasts from three to six months. Some patients have longer results, while others have shorter lasting results. “As you maintain the areas with reapplications you start to get prolonged results because you are not moving the muscles and so you forget how to use them. As well the muscles become atrophied (smaller), so women find that their injections last longer than expected when they have been using it for years,” says Dr. Kolenda.

Side-Effects: Mild bruising which can be covered with makeup.

Cost: $9 to $12 per unit.

DYSPORT

Dysport temporarily reduces the movement of some upper facial muscles that cause wrinkles.  “It is the latest neuro modulator, which is what we are calling them now, the third one that has been approved in Canada. The second one was Xeomin. Dysport has been in Europe for 20 years, four to five years in the U.S. and was recently approved by Health Canada.  It comes on faster than Botox,” says Dr. Cory Torgerson, MD, PhD, FRCSC, an otolaryngologist-head and neck surgeon practising in facial plastic surgery in Toronto.

Site of Injection: “The results with Dysport are softer in comparison to Botox, so it’s good for use in the forehead and around the eyes for the crows feet, as it has a softer effect,” says Dr. Torgerson.

Treatment Protocol:  Similar to Botox.

Downtime: None. 

Results: Some see results within 24 hours, while for others it results show within three days after treatment.

Side-Effects: Sore throat, headache, pain at the site of injection, respiratory or sinus infection. In some cases eyelid ptosis (drooping) may occur.

Cost: “The cost is determined by the area in my office,” says Dr. Torgerson. “So the glabellas are $300 or about $12 per unit.”

JUVÉDERM VOLBELLA

Juvéderm in general is in the hyaluronic acid filler category. “The Juvéderm family of products has been around in Canada for many years, but Juvéderm Volbella with licodaine is the newest one that is used specifically to enhance the lips and pout. Volbella gives a soft, natural look with reduced swelling in comparison to other lip fillers. It is very soft and moldable. I have been lucky to use it and I haven’t seen lumps or bumps in lips when patients move their lips as with other fillers,” explains Dr. Bertucci.     

Site of Injection: Lips and periorbital area.

Treatment Protocol: Injected with a small needle once.

Downtime: “Typically I would tell the patient that it’s important not to schedule any events for four to five days because they may be self-conscious of the swelling in the lips. With Vobella, however, the swelling lasts from one to two days,” says Dr. Bertucci  

Results: “Lasts for up to 12 months, which is typically not seen with filers used in the lips.  Usually they last for three to six months, so longevity is the major benefit of this product.”

Side-Effects: Swelling of the lips; the needle can cause bruising and there is always the rare possibility of more severe side effects. 

Cost: “Depends on office to office, but it is more costly than the standard lip filler because it lasts longer.  It is well worth the price because of the nine - to 12-month duration,” says Dr. Bertucci.  

RADIESSE

“Radiesse is a non-permanent filler that comes with two components, a gel matrix component and calcium bead component. It works differently than other hyaluronic acid fillers, in that the bead component made of calcium stimulates the patient’s body to produce collagen,” explains Dr. Kolenda. The skin absorbs the product and what remains is your natural collagen that gives facial volume.

Site of Injection: The cheeks, the nasolabial folds, marionette lines, re-contouring the jaw line and also the temple area. “I wouldn’t use it in the lip area, however, as the molecule is too firm to give a natural feel to the lip,” says Dr. Kolenda.

Treatment Protocol: “I use a canula as it reduces the side-effects of bruising. In terms of the amount of injection, we look at the patient and decide what areas to address. They may require one syringe or multiple syringes, depending on what they want to achieve. If more volume is required (usually less is more) I will do the injection to a level that I think is good and then we ask them to come back in two weeks and see if they need more volume then.”

Downtime: None, most patients return back to their daily activities immediately.

Results: Results are immediate, but volume enhancement lasts for up to one year or more and the collagen production strengthens the skin. “Since the product breaks down over time some patients come back after eight months to get a top-up before full volume deflation has occurred and this extends the duration of results,” explains Dr. Kolenda. 

Side-Effects: Minor swelling and bruises occur, which can be covered by makeup. “Before, however, I advise patients to stay away from non-sterile anti-inflammatory, herbal medications and multivitamins because this can lead to more bruising,” says Dr. Kolenda.

Cost: “$750 per syringe, but the cost will vary in different offices,” says Kolenda. In each syringe there is 1.5 cc of volume, which is more than other fillers.

TEOSYAL REDENSITY II

Teosyal Redensity II is a nutrient-rich dermal filler specifically formulated for under the tear troughs. Physicians have shied away from this area because they have not had a product to treat it naturally because it is such thin skin. It is a semi cross-linked hyaluronic acid mixed with a dermal restructuring complex, which contains amino acids, anti-oxidants, vitamins and minerals.  These nutirents helps to get rid of the dark circles. So over time you are not only filing the hollows underneath the eyes, but you are also lightening to make your eyes brighter.

Site of Injection: Tear troughs and under eye dark circles.

Treatment Protocol: Injected using a needle, and patients may need to do a followup after six months, when they may need a touch-up.  “There is no pain as we don’t have a lot of nerves in the eye area, and also Redensity is formulated with with something that numbs the areas to decrease discomfort,” explains Dr. Torgerson.

Downtime: None.

Results: Immediately visible and improve with time. Lasts up to six to nine months. Patients are asked to come in for a six-month followup and some may need a touch-up. 

Side-Effects: Swelling or bruising, but not a high instance of this.

Cost: Approximately $400 to $600 a syringe.

RESTYLANE-L

When it comes to fillers, “Restylane is the gold standard,” says Dr. Torgerson, “It’s definitely under-rated as it has been marketed more to physicians than patients, but it has been around the longest.” Restylane-L is combined with lidocaine to reduce discomfort during the injection process.

Site of Injection: “I wouldn’t put it in the tear troughs or the lips, as it’s a by-phasic product (so it’s thicker and you want to use thinner fillers in these areas as the skin is thinner around the eyes and lips), but you can use it almost anywhere else as it is very tolerable and safe. I love it in the nasolabial folds,” says Dr. Torgerson.  

Treatment Protocol: After your initial injection it is recommended to go in for a touch-up at anywhere between four to six months.

Downtime: None.

Results: “Instant, but it also depends on where you put it.  Lasts between nine months and up to one year,” says Dr. Torgerson.  

Side-Effects: Slight swelling and bruising.

Cost: $550 per vial.   

SCULPTRA

Biocompatible and biodegradable sculptra corrects shallow or deep wrinkles in the face and is derived from fruit acids known as poly-L-lactic acid. When injected it stimulates the production of collagen. The face appears fuller as lines and creases become less pronounced.

Site of Injection: “Sculptra is good to inject over a larger area and to create volume and lift,” says Dr. Torgerson. It is used for wrinkles, folds, scars and skin aging in the temples and cheeks.

Treatment Protocol: Average of three treatments over two to three months, spaced at four to six weeks apart. “It takes time to build it up in the face in comparison to other injectables,” says Dr. Torgerson.

Downtime: Two to three days, depending on amount of areas injected.

Results: Restores lost collagen in the skin that can last for up to three years. Results gradually appear in the skin to assimilate a natural appearance. Touch-up treatments may be required to maintain desired results. 

Side-Effects:  “Swelling may occur on the day off as there are a whole bunch of needles used,” says Dr. Torgerson. Hematoma, blood spots under the skin, may occur and can take up to two weeks to resolve.

COST: $800 per vial.

SELPHYL

“Selphyl is PRP, plasma-rich platelets that are injected into the face to stimulate the production of collagen,” says Dr. Torgerson. “It is a natural process that works to improve skin texture, tone and overall quality. Selphyl results in the thickening of the collagen, so I like to use it post facelift, but it is not a filler per se. It is not good for achieving volume, rather it is better for thickening.”

Site of Injection: Tear troughs, neck rings and wrinkles, crow’s feet, skin depressions and décolleté.

Treatment Protocol: One to three injections spaced from four to six weeks apart.

Downtime: None.

Results: “It takes about three weeks for you to begin to see results. It will last for four to five months, and you will need a couple of top-ups. It is not for those who want immediate results,” comments Dr. Torgerson. 

Side-Effects: “There is quite a bit of swelling,” comments Dr. Torgerson. Some patients may experience mild swelling, bruising, discolouration, itching or tenderness for up to 48 hours after injection. Due to the natural makeup of Selphyl there is little chance of rejection or allergic reaction in the patient.

COST: $800

PERLANE
“Perlane is a hyaluronic acid gel. It’s thicker than Restylane, so you get a good lift from it,” explains Dr. Torgerson.  The molecule is larger than Restylane, which is from the same family, so it works better on deeper lines and contours.

Site of Injection: “In the chin or on the jaw line, also great for the temple areas, so generally areas with more tissue,” says Dr. Torgerson.

Treatment Protocol: Begin with one injection for full correction and then follow up with a touch-up at six months.

Downtime: None.

Results: Will last for up to one year.

Side-Effects: “Apart from the usual side effects of some mild swelling and bruising, there is nothing to worry about,” says Dr. Torgerson.

Cost: $600 per vial.

DID YOU KNOW?

As of January 2013, Health Canada requested manufacturers to revise the product labels of botulinum toxin products, so that each indicates the unique potency of the active ingredients. This change was required so consumers are not mislead in thinking the products are interchangeable. The active ingredients clostridium botulinum toxin type A and type B are produced in different ways and derived from different clostridium strains, which can result in unique and unexpected side-effects in different people. Appropriate labeling helps prevent unwanted side-effects in advance. Discuss concerns you may have regarding benefits and risks about botulinum with your doctor.