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8 years ago, only collagen and fat were used to fill wrinkles. Now, we have a multitude of chemicals that are used for this purpose.

Belotero, Restylane and Juvederm are my favorites for filling superficial and deep wrinkles. They are made of hyaluronic acid, a substance that is already present in your skin. Restylane is injected into wrinkles with or without local anesthesia. After a day or so of swelling, the wrinkles look much better. Restylane will last between 6 and 12 months. Juvederm has been shown to persist for a year in most patients. Dr. Perry uses this filler for superficial, fine lines.

Radiesse is useful for deeper folds, such as the nasolabial folds, the marionette lines, or to smooth out the borders of the jowls. Radiesse is made of a material similar to the building blocks of bone. In fact, when placed in contact with bone, new bone is made. In the deep wrinkles, the material lasts between one and two years. Radiesse is a very exciting new filler for the nasolabial folds. Recently, I have begun using Radiesse to fill in depressions in the nose. I have found this to be an exciting alternative to revision rhinoplasty.

Fat is the only material that has a chance of permanence. Most people are only too happy to give up a little fat, which is usually taken from the belly or hip area under local anesthesia. A space is then made for the fat, and the fat is placed under the skin. Fat is used to fill areas such as the nasolabial folds, the marionette lines, the lips, and other areas that are depressed. Since fat is harvested in a true surgical procedure, there are more risks to its use than with Restylane or Radiesse.

New, permanent, wrinkle fillers. How good this sounds, doesn’t it? But what if there is a problem? Or what if an infection occurs. The only solution might be to cut out the area of skin! Permanent fillers violate one of the principles of plastic surgery: If an implant does not dissolve, it must be removable. Silicone and Artefill (PMMA) are not. In fact, the public voted and the Artefill company went bankrupt earlier this year. I commented in the New York Times about the demise of Artefill and said this was a good thing for consumers. I took alot of heat over those comments from users of the product. What did I say about “straight talk”?

Filler risks: like any procedure, there are risks with fillers. Infections have been reported and are on the rise. Nodules may occur, some even many months after the procedure. And people with clotting disorders are not good candidates for fillers, since strokes and blindness have been reported with all fillers...