Wrinkle fillers: Are they right for you?

Source: Best Health Magazine, October 2008

You see little crow’s feet tiptoeing up to your eyes. Your lips seem to shrink, becoming thinner, ill-defined. A pair of vertical lines begins to appear between your brows. Your jaw line starts to sag and soften. What do you do?

Maybe you do as most Canadian women do and think of these simply as signs of aging, to be accepted with grace. Perhaps you dig deeper into your jars of revitalizing creams and anti-aging serums. But there’s evidence an increasing number of Canadian women aren’t satisfied with either of these approaches; a significant cohort is opting for the syringe—or, in the vernacular of the beauty and cosmetic industry, “injectables.”

Common injectables

Typically administered in a cosmetic physician’s or dermatologist’s office, injectables encompass various needle treatments. Botox, arguably the best known, is derived from the botulinum bacterium, which is responsible for potentially lethal food poisonings and has been used for years in medicine as a treatment for spasticity. It diminishes expression lines, wrinkles and creases by weakening the underlying muscles.

Injectables also refer to a range of dermal fillers, which perform a different function than Botox—they increase volume in or below the skin. Among the more popular options are temporary hyaluronic acid fillers with such brand names as Restylane and Juvéderm. They’ve pretty much taken over from bovine collagen injections, which were popular in the ’80s and ’90s. Hyaluronic acid is a skin-plumping molecule found naturally in skin. It diminishes with age; dermal filler injectables use synthetic hyaluronic acid grown in the lab using bacterial cultures. Also on the injectables menu are volumizing treatments such as Sculptra, which is made of a larger-molecule polymer synthetic and is long-lasting and more expensive.

How common are wrinkle fillers?

How prevalent are injectables? Currently there are no official statistics. We do know that Canadians’ use of fillers such as Restylane grew 21 percent in 2005 over 2004, according to a survey by Medicard Finance Inc., a Toronto-based credit company that finances plastic surgery and cosmetic procedures. Since there are no numbers from government bodies such as Health Canada, some experts recommend calculating 10 percent of the American Society for Aesthetic Plastic Surgery figures to get approximate Canadian numbers; based on 2007 survey data, that would add up to nearly 280,000 Botox and 150,000 hyaluronic acid injections in Canada.

Toronto cosmetic dermatologist Dr. Fred Weksberg’s practical experience parallels the apparent trend: “My patient demand for fillers and Botox is growing every year,” he says. Dr. David Zloty, a clinical assistant professor in the department of dermatology and skin science at the University of British Columbia, says he began administering cosmetic fillers such as bovine collagen in 1995, but saw a marked increase in interest with the advent of fillers such as Restylane in 1998 and Juvéderm in 2004. “One reason is that, unlike bovine collagen, these newer volumizers don’t require pre-testing for possible allergic reactions, making the procedure more convenient,” Zloty explains. “Also, the effects last longer.”

The arguments against fillers

Not everyone, however, thinks that going for the needle is the route to looking good. Opponents point out that, taken to excess, these procedures can delete facial expression, with the worst-case scenario being a frozen-face look. What’s more, injections can be painful (although topical or needle anesthetics are an option) and, even though they’re promoted as requiring little or no recovery time, there can be unpleasant, if temporary, side effects. Dr. Joanne Willoughby, a dermatologist in Guelph, Ont., points out that both Botox and fillers come with a risk of bruising and “a very small risk of infection.” Also, she advises that those susceptible to cold sores take antiviral medication before treatment to reduce the chance of an outbreak.

Also, a Botox patient can end up with a noticeably drooping eyelid or an unintended eyebrow lift, says Willoughby. Women with exceptionally thin, fragile skin face the potential of “show-through” of the filler material, she notes. “And, very rarely, filler patients experience redness, temporary itching and swelling.”

Sociologist Laura Hurd Clarke, an assistant professor at the school of human kinetics at the University of British Columbia, questions the underlying message of all these heavily promoted anti-aging procedures. “It’s becoming socially unacceptable to look old,” says Hurd Clarke, who has spent 10 years on qualitative research into older women and their relationships with body image. “We live in a culture that equates physical signs of aging with the loss of social and sexual desirability.” She feels that “natural” has been redefined as beauty work that’s undetectable. “If a woman opts to do them, she’s supposed to look as if she hasn’t.”

Why women want the work

Chasing youth, though, isn’t the only motivation driving the interest. Jennifer Pettigrew of Etobicoke, Ont., is a 26-year-old self-employed esthetician who’s had Botox and Juvéderm injections to her lips. “I hated my thin lips,” she says. “But it took me a while to get up the nerve. I’m terrified of needles, and was worried about bad jobs I’d seen—you know, women who end up with ‘duck lips.’’”

But Pettigrew is happy with the results. “It’s so subtle. My upper lip is perked up a bit and there’s more volume. My mother had disapproved, but she barely noticed the difference and my boyfriend loves it.”

Zloty says that his patients under age 30 are mainly looking for added lip volume or to have acne or surgical scars fixed. As for Weksberg, the key motivator of his clients over age 30 is the emergence of vertical lines between the brows.

Calgarian Karyn Eales can relate. The fitness-oriented 32-year-old, who works as a coordinator in hospital administration, says, “I’d always taken good care of my skin, used expensive creams. But when I saw those lines that were forming between my brows, it really bothered me. I thought, ‘I’m way too young!’’” In the past year, Eales has undergone treatments with a range of fillers and Botox to get rid of those lines—and to correct what she describes as “sunken eyes.” As for the cost, she says, “It is expensive. But as a single woman, I like to look good. Maybe if I were married or had kids, I would have different priorities.”

The high costs of wrinkle fillers

Indeed, the cost of injectable procedures, which can range from the hundreds to thousands of dollars, represents a serious investment for most women—especially when you consider that the results are temporary. But doctors report that more and more Canadians are working them into their budgets. Zloty says, “Only 10 to 15 percent of my patients are money-is-no-object types.” Weksberg notes that most of his patients for Botox and fillers are working women.

Carolyn Berger is a case in point: A 41-year-old working mother of three in Toronto, Berger ramped up her skin-perfecting regime of acid peels and photofacials (laser treatments to rid skin of discoloration and textural irregularities) to include regular injections of Botox and Juvéderm after the birth of her last child. “I’m trying to delay the inevitable,” she says with a laugh. Berger says she now considers injections a normal part of her maintenance routine, like getting her hair and nails done and working out. “When people say they’re surprised I have a 15-year-old, I think that’s kinda neat. It’s flattering.”

Is peer pressure a motivator for women who seek these procedures? Weksberg and Zloty say it isn’t. “The number one reason I hear is a desire to look good, to look natural,” says Weksberg, admitting that there may be subtle pressure from celebrities in the media.

As for Hurd Clarke, she supports women’s right to choose how to age and concedes that the use of these “beauty interventions” helps some women feel better about themselves. Nonetheless, she wants women to think about why we place so much emphasis on appearances. “I still hold out hope that we can recognize that beauty isn’t just about looking young.”

What do you think about fillers and other cosmetic procedures? Share your thoughts in the comments.

This article was originally titled "Considering a treatment?," in the October 2008 issue of Best Health Magazine. Subscribe today and never miss an issue!