Fillers are proving an attractive option to those who want to avoid facelifts. The use of facial fillers is soaring- hyaluronic acid procedures (notably Hylaform and Restylane) alone grew more than 650% in 2004 from 2003, according to the American Society for Aesthetic Plastic Surgery.

Procedure involving many other fillers are also on the rise. And, as long as new products such as Captique, a hyalurinic acid approved in Fall 2004 by the FDA, continue to become available, dermatologists don't expect a slowdown in the race to save your face from the ravages of time.  Why such high demand? Because facial fillers offer visible results without any downtime, a significant factor for many people, dermatologists say. And, not everyone wants or needs to undergo facelift surgery. If you're 50, you can often look 40 or even 35 if you just keep up with the fillers.

Those facial fillers approved by the FDA for this use include Restylane, Hylaform and Captique, which are hyaluronic acids; and bovine- and human-based collagen products, which are marketed under the brand names Zyderm, Zyplast, CosmoDerm and CosmoPlast.

Before considering a treatment with a soft tissue filler, the American Academy of Dermatology recommends that  potential patients ask the following questions:

* Are the results permanent or temporary?

* What are the potential side effects?

* Is the filler approved by the FDA or is it being used off label?

* How long has the physician used the filler? Ask how many patients the doctor has treated and if before and after photos are available.

Restylane has really changed the whole filler scene, mostly because it lasts about twice as long as collagen. Many people who wouldn't previously consider collagen are now considering Restylane because they may only have to have to get treatments twice a year as opposed to 3 or 4 times a year.

Other facial fillers that are used, such as Radiance (also marketed as Radiesse) are considered "off label" since they are approved by the FDA for other uses. Fat injections, which involve the transfer of fat from one area of the body to another, also fill in lines nicely.

The most popular non-surgical procedure, Botox, is an injectable but does not act as a facial filler. Instead, it is a botulinum toxin that paralyzes targeted muscles. Mostly used to correct unattractive furrows on the brow, Botox is effective, low risk (only 3% of patients experience significant complications) and the procedure takes only 15 to 30 minutes. However, treatments do need to be repeated every 4-6 months.  

Finding The Right Filler

Choosing the right filler depends on the patient's age, expectations and time and financial commitment. Consequently, a complete consultation with a trained doctor is crucial, according to dermatologists. Experts advise finding a board-certified plastic surgeon who is familiar with ALL the procedures, or as many as possible. That way, the physician has a much better method of evaluating the patient's face to determine the best treatment for them.

Dermatologic surgeons say that combining a botulinum toxin and a filler can produce dramatic results.

Whichever procedure you choose, it is important, say dermatologists, for a doctor to administer the injections, since facial filling is a very specialized technique. Its effectiveness is directly related to how it's injected.

PHyaluronic Acid (brand names: Restylane, Hylaform, Captique)...  This is a substance found in all living organisms. Injection areas include: nasolabial folds, forehead wrinkles, smile lines and lips. Results last 4 months to 1 year, depending on the formulation. Average cost: $600/syringe.

Botulinum Toxin (brand names: Botox, Myobloc)...  This is Botulinum Toxin type A, produced byClostridia Botulinum bacteria. Injection areas: forehead, frown lines, crow's feet and vertical neck bands. Results last up to 6 months. Avg. cost: $399 per procedure.

Fat injections (name: fat injection)... This is fat transfer from one part of the body to another. Injection areas: nasolabial folds, crow's feet, lips, frown lines and facial recontouring. Results are very variable--from months to years. Avg. cost: $1,282 per procedure.

Bovine-based collagen (brand names: Zyderm, Zyplast)... This is derived from purified bovine (cow) collagen. Injection areas: nasolabial folds, crow's feet, lips, frown lines. Results last up to 6 months. Avg. cost: $400 per procedure.

Human-based Collagen (brand names: CosmoDerm, CosmoPlast)... This is derived from human collagen. Injection areas: nasolabial folds, crow's feet, lips, frown lines. Results last up to 6 months. Avg. cost: $600/syringe.

Calcium Hydroxy-lapatitie (brand names: Radiance (also Radiesse)... This is a synthetic form of a material found in bones and teeth. Injection areas: nasolabial folds, crow's feet, lips, frown lines. Results last 2 years, possibly longer. Avg. cost: $1,500-2,000/syringe.

Vitamin or detergent Injections (brand name: mesotherapy)... Substances used may vary from doctor to doctor. Injection areas: skin's middle layer where there are small, localized pockets of fat or cellulite. Results are apparent after several treatments, but no reliable data on how long the effects last. Avg. cost: $1,000 - $2,000 per treatment.

Note: "The Aesthetic Book" is an excellent quarterly magazine for detailed information about cosmetic procedures of all kinds, covering dentistry, dermatology, health and well-being, and plastic surgery. See www.theaestheticbook.com/subscribe or call: 310-265-4461 for details.