Our practice has been offering various fillers for facial folds, wrinkles and contour irregularities for years and the history of modern fillers goes back about 30 years when collagen from bovine sources was the state of the art. As time has passed, this area has become increasingly important in the field of cosmetic surgery as new, innovative products have been approved by the FDA and have come into common usage. I have always felt that there are places where a filler is the best solution for certain cosmetic concerns, but have used them very conservatively. For several years, we have used Juvederm and occasionally Sculptra in addition to frequent use of Botox which is not a filler, but a medication that diminishes the movement of the muscles of facial expression.

My practice has recently hosted two trainers who brought new methods and concepts to our practice regarding the use of Sculptra, which is a filler that is used for adding volume to the face to replace the fat and bone that diminishes with aging, Perlane, a hyaluronic acid filler for creases like the nasolabial folds or marionette lines and Restylane, a hyaluronic acid filler that is used for smaller contour areas such as the tear trough and other areas where a more closely directed filling is necessary. We are excited by the opportunity to offer these fillers with a renewed sense of enthusiasm and more modern approaches to their use.

One of the key concepts that was passed on to us is that the fillers are best used in adequate volume to actually get reasonable correction of the target area. Both trainers (one a board certified cosmetic surgeon from Manhattan (NY) and the other a certified nurse injector from Dallas) said that many times they hear that a filler “did not work” because a trivial amount has been used where more volume was needed to provide reasonable correction. The fillers are not inexpensive, but their use does offer a less invasive way to achieve some significant rejuvenation effects in the face with little or no down time and less risk that a bigger procedure like a facelift. When all the costs of surgical procedures are considered, there are times when use of a filler, even a significant amount of it, is still a good value. I know that there are situations where surgery is the best answer, but I would be imprudent to ignore the availability and effectiveness of less invasive techniques. When the Plastic Surgery professional societies collect information about the number of specific procedures performed by members of the specialty each year, it becomes clear that the use of less invasive approaches like fillers and Botox are much more common and increasing in use faster than more traditional (albeit often more effective and long-lasting) procedures.

An effective middle ground technique between larger operations and the use of synthetic fillers is also available in the form of autologous fat grafting, where the patient’s own fat is harvested, then re-injected in the target area(s) to provide filling with live tissue, some of which will remain permanently with no risk of rejection or very low risk of significant tissue reaction.

It is important that patients who are seeking treatment with fillers seek a practice where the people doing the injection are well-trained and ethical in their practice. Many non-Plastic Surgery practices are offering these services after short training courses because the business offers cash flow in an environment where reimbursement is generally deteriorating. I am sympathetic to my physician peers about these issues, but I feel very strongly that it is important to stay within the boundaries of one’s training. The American Board of Plastic Surgery and the America Society of Plastic Surgeons have stringent requirements of training that include safety and ethical standards. Consumers of cosmetic services are well advised to be sure that the person or practice where they might receive their care is in good standing with those bodies.

We at Copeland Cosmetic Surgery are pleased to offer a significant variety of fillers to compliment our other services which include surgical approaches to rejuvenation, laser treatments, intense pulsed light treatments and counseling about good skin care and effective treatments for skin health.