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3/2/2011
Patient age, volumizing needs drive injectable filler choice
As patients' faces change with age, so, too, should their options for treating lines and wrinkles.
Patient age, volumizing needs drive injectable filler choice

As patients' faces change with age, so, too, should their options for treating lines and wrinkles. A variety of injectable fillers are on the market, but which ones to use on a given patient depends on the person's age, according to a cosmetic dermatologist.

Men and women for two decades have been reaping the benefits of smoother, younger-looking skin thanks to products such as Botox (onabotulinumtoxinA, Allergan) and other injectable fillers.

"Today, injectable treatments have become mainstream and people are no longer embarrassed to admit that they've had a little work done, whether they are in their 40s, 50s or beyond," says Nowell Solish, M.D., a cosmetic dermatologist in private practice in Toronto.


Which product, what age?

As the face ages throughout the decades, different injectables come into play.

Younger patients in their late 30s and early 40s typically have one of two concerns, Dr. Solish says.

"As people age, it is common that they are starting to get lines around their forehead or their eyes these are dynamic lines from years and years of repetitive movement. These patients are excellent candidates for Botox," he says. "This will serve two main functions: it will significantly improve the lines and also act as a preventive measure to slow down those muscles that are causing the lines.

"The other common problem that bothers patients as they begin to age is nasolabial folds. Here, fillers are great," he says. "For the younger patient, I will typically start out with hyaluronic acid like Restylane (hyaluronic acid, Medicis) or Juvderm (cross-linked hyaluronic, Allergan) or one of the other hyaluronic acids."

As patients move into their late 40s and 50s, facial volume diminishes, and instead of chasing a line or two, the focus becomes restoring volume and improving the overall shape of the face. Patients may start complaining about their deep nasolabial folds and their falling or sagging skin.

"That's when we get into more volume injectables or fillers," Dr. Solish says, "and that's when you can get the illusion that the face has had a minor lift when the patient hasn't had any surgery at all."

HA availability


A 54-year-old female patient before (left) and after injections of Restylane under the eyes, Perlane in the nasolabial folds and oral commissures, and Botox at the corners of the mouth. (Photo: Nowell Solish, M.D.)

All of the facial areas can be improved with hyaluronic acid products. Canadian physicians have the advantage of a product called Juvderm Voluma (hyaluronic acid, Allergan), which provides volume in the mid-face or cheek area. The product will likely be introduced in the United States in the next year. Other popular products that restore volume are Restylane, Perlane (hyaluronic acid, Medicis) and Sculptra Aesthetic (injectable poly-L-lactic acid, Sanofi-Aventis).

Injecting the cheeks will give them lift, which also lifts the nasolabial folds upward, according to Dr. Solish.

"Injecting the marionette lines that are sagging below the mouth and dragging that area down can be lifted, and injecting the lateral cheeks or the entire face-cheek area will give volume and help lift the face overall," he says. "These are all accomplished using different types of fillers."

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Facial maintenance

Once a patient begins a regimen of injectable treatments, the average time between clinic visits is around four months. Fillers that have been skillfully injected can last for up to a year, but patients typically will need to come back for Botox in six months.

While permanent injectables hold some appeal for patients, the ideal product would be one that is both permanent and reversible, Dr. Solish says. And that product has yet to be developed.


"If we could ultimately put in a product that would last a long time yet could be dissolved if you wanted it to, then that would be the best situation," he says. "I would hesitate to put anything permanent in my patients that I couldn't change."

Target audience

"Injectables have become so common and accepted that it's sort of like getting your hair highlighted," Dr. Solish says. "It's no wonder that younger and younger patients are requesting them."

The best candidates for injectables are those with good elasticity of their skin and a good quality skin, whereas patients who have had a lot of sun exposure or those with very thin skin tend to get less ideal results.

"Ten years ago, only 1 percent of my patients were men," he says. "Today, more than 10 percent of people getting injectables are men. They know that the procedures are safe and relatively simple, and that with regular maintenance a couple of times a year they can look good and also feel good.

"Young people and older people, too, are just not shy about it anymore," he says. "People who don't want surgery can look great with these excellent products. That's what really keeps me so busy."

Disclosures: Dr. Solish serves as a consultant for Allergan, Medicis and Revance Therapeutics.


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