Fillers or Facelift?

December 1, 2008

Wish you looked younger? You're not alone, even Ponce de Leon was looking for the Fountain of Youth 600 years ago. Today, however, we have better options than those that were available to the Spanish explorer. In fact, some people might argue that the elusive fountain can be found in their cosmetic surgeon's office.

WISH YOU LOOKED YOUNGER?

You're not alone, even Ponce de Leon was looking for the Fountain of Youth 600 years ago. Today, however, we have better options than those that were available to the Spanish explorer. In fact, some people might argue that the elusive fountain can be found in their cosmetic surgeon's office.

EXPERT ADVICE

Making the choice

TEMPORARY FILLERS

THE ADVANTAGE OF TEMPORARY FILLERS IS THAT IF YOU DON'T LIKE THE RESULTS, THEY EVENTUALLY GO AWAY. THE PRIMARY DISADVANTAGE? YOU HAVE TO UNDERGO INJECTIONS EVERY THREE TO 12 MONTHS TO MAINTAIN YOUR RESULTS.

Restylane, Juvéderm, Captique, Hylaform are hyaluronic acid (HA) fillers. Prevelle Silk and Elevess are HA fillers with a local anesthetic. The HA gel fillers cost about $500 to $1,200 per treatment, and usually last six to eight months, sometimes a year.

Perlane & Juvéderm Ultra Plus, also HA fillers, are more robust, thicker fillers and are generally used for deeper areas such as smile lines between the nose and corners of the mouth.

Evolence is a new collagen filler made from porcine (pig) tendon collagen and may last up to a year. The advantages? No allergy testing required, and you're replacing lost collagen with collagen! Cost: $450 to $900 per treatment.

Radiesse is a synthetic bone-type material that works for deeper smile lines, lasts up to 18 months and costs $1,200 to $1,600 per treatment.

Human (autologous) fat use may decrease with the improvement of fillers, but it's advantage is that it can be harvested from the patient's body and stored. It costs about $1,000 per treatment and lasts about three to six months or can be permanent after several injections.

PERMANENT FILLERS

PERMANENT FILLERS CAN WORK WELL FOR PATIENTS WHO HAVE HAD LITTLE SUCCESS WITH TEMPORARY FILLERS. THE DRAWBACK IS THAT PERMANENT FILLERS CAN CAUSE PERMANENT PROBLEMS IF PATIENT IS DISSATISFIED WITH RESULTS. ALSO, AS THE SKIN CONTINUES TO AGE AND SAG, SO DOES THE PERMANENT FILLER. WHICH IS THE BEST ROUTE FOR INDIVIDUAL PATIENTS? MUCH OF THAT DEPENDS ON PATIENT PREFERENCE AND PHYSICIAN COMFORT LEVEL.

Silicone is still a popular filler that works well in the hands of an experienced surgeon, but it's very technique sensitive.

ArteFill is made of synthetic acrylate beads suspended in bovine (cow)-based collagen and used to improve nasolabial folds. It costs about $500 or more per syringe.

Sculptra is a synthetic poly-L-lactic acid that is FDA approved to restore or correct the signs of facial fat loss (lipoatrophy) in people with HIV. It is also sometimes used off-label for cosmetic treatment. Cost is about $1,000 to $1,200 per vial.

FACELIFTS

FACELIFTS COME IN SMALL, MEDIUM AND LARGE AND CORRELATE LOOSELY WITH AGE. A PERSON IN THEIR 40S WOULD PROBABLY BENEFIT FROM A SMALLER PROCEDURE WHEREAS A TYPICAL 60 YEAR OLD WOULD NEED TO SIZE UP.

SMALL These are the smallest lifts with minimal incisions and may lift the skin only. The results don't last nearly as long as a full-fledged facelift and usually have less effect on the sagging neck. The cost varies from $3,000 to $4,500.

MEDIUM Next size up is the mini-lift, which tackles moderate signs of aging. Because the mini-lift includes the deeper layers (SMAS), you can expect significant results and longevity. The cost varies from $4,500 to $6,000.

LARGE These are the traditional, more comprehensive facelifts with larger incisions and more aggressive SMAS procedures. These lifts will provide tighter, longer lasting results. The muscles and surrounding tissues in the face are tightened and the skin is re-draped over the new foundation and trimmed to fit. Prices range generally from $6,000 to $20,000, depending on the extensiveness of the procedure, location and physician. General anesthetic or IV sedation is used and it can take a couple of weeks to recover.