The use of Facial Fillers on the rise as alternative to plastic surgery

Lynn Shapiro, 59, of Bridgeton, N.J., has no idea how much she has spent on twice-a-year facial injectables in the past few years, and she’s not interested in finding out. She just knows that she likes the way she looks and is thrilled about the way she feels. “Whatever I’m spending,” she says, “it’s worth it.”
Baby boomers received more than 1.1 million injections of Botox and hyaluronic acid in 2009, a 15 percent increase over the year before, according to the American Society of Aesthetic Plastic Surgery, and the trend shows no signs of slowing.

The generation whose mantra could be “50 is the new 30” does not intend to grow old gracefully. It doesn’t want to age the way its parents did, and it doesn’t have to. In the past eight years, a new field of cosmetic medicine has emerged, focused on fillers and injections and giving anyone with a credit card the option of looking younger and more refreshed without going under the knife.

But it can be costly. Injectables such as Restylane, Juvederm and Radiesse range from $345 to $800 a syringe, depending on the doctor. And they last only six to nine months before a redo is needed.

“When you add it up over time, it can be more than the cost of a surgical procedure,” says Scott Bartlett, professor of surgery at the University of Pennsylvania and chief of pediatric plastic surgery at the Children’s Hospital of Philadelphia.

In Shapiro’s case, the desire for facial rejuvenation arose in 2002, shortly after she recovered from a serious operation to remove a growth from her spine.

“When I learned it was not malignant, I began to look at life differently,” she says. “I wanted to do the things that would make me feel better and enjoy myself more.”

Since then, she has had countless injections with facial fillers to treat depressions under her eyes and chin, and with Botox to erase the lines in her forehead. In February, she had blepharoplasty to remove excess fat from her upper eyelids.

“The skin over my eyes was droopy and made me always look tired or angry,” Shapiro says. “I was neither.”

Blepharoplasty is the most common cosmetic surgical procedure performed on baby boomers, ahead of face-lifts and liposuction. There were 70,218 done last year, down from 91,806 in 2008, according to ASAPS. Experts say the trend is due to the dismal economy and the rising use of fillers, injections and skin-tightening lasers.

“In today’s times, when people can’t afford to be away from work for long, alternatives to blepharoplasty are more attractive,” plastic surgeon Kevin Cross says.

Still, eyelid surgeries are here to stay, he says.

Cross is medical director of Deme, a glitzy aesthetic center with locations in Center City and Devon that assembles specialists in cosmetic surgery, dentistry, skin care, nutrition and mental health.

But it is not just plastic surgeons who specialize in injecting facial fillers and Botox. Dermatologists, internists, general practitioners and ophthalmologists do it, too. The administering of fillers is a lucrative business that caters to men and women who crave instant youth. They are willing to pay for it out of pocket, as insurance rarely covers the procedures. Shapiro’s fillers and eye surgery were done by Marc Cohen, who is board-certified in ophthalmology and cosmetic surgery. Cohen has offices in Voorhees and Bala Cynwyd.

“Eyelids are the most complicated and challenging part of the face on which to work,” Cohen says. “They are delicate structures, and the key is to achieve a look that is natural, attractive and preserves function.”

Over the years, Cohen says, the approach has changed significantly. “Pick up any magazine and you’ll see that people look younger when they have fairly full upper eyelids, not the hollowed-out Marilyn Monroe look that people used to envision when they considered cosmetic eye surgery. So we remove less tissue than we used to and we use fillers – both under the brow and beneath the lower lids – to add volume and create those more youthful, sweeping curves.”

Fillers do not replace surgery, but they can often postpone it. Meanwhile, the plumping up of wrinkles and lines, creating cheekbones and voluptuous lips, can restore the sought-after look of days gone by. And for those without the sagging necks and bulging jowls that beg for face-lifts, fillers may be enough to satisfy them.

Twenty-five years ago, Penn’s Bartlett could not have imagined how dramatically the field of facial rejuvenation would change, he says. With the arsenal of techniques available today, he suggests consulting someone with “more than one club in his bag.”

“If you go to someone who does nothing but inject, that’s all he’ll be able to offer you,” he says. “A plastic surgeon who uses many different strategies and understands the anatomy of the face can tell you what’s best for you.”

Marianne Daria of Bryn Mawr is not quite a baby boomer, but at 43 she wants to get a head start against aging. Several times a year, she visits the Havertown office of internist Norbertus Robben, whose practice now is only cosmetic medicine. Patients say they receive pleasing results and modest prices.

Daria receives treatments with Botox and fillers and has had nonsurgical laser skin tightening. Fillers such as Restylane, Juvederm and Radiesse can range from $345 a syringe (Robben’s price) to $650 to $750 (Cross’ price) or even more. Skin-tightening treatments generally begin at over $1,000 depending on the type of treatment and who’s giving it.

Robben asks his patients to prioritize what bothers them most, and typically they’re on target, he says. Most often, they point out the nasal labial folds, the marionette crevices that run from the corners of the lips to the chin, the hollows under the eyes and the “smoker’s” lines above the lip – which all can be addressed with fillers. “If they are looking for more than what I can offer them, I’ll suggest they see a plastic surgeon,” Robben says.

Toni Rosen, 52, a French and Spanish teacher who lives in Bryn Mawr, doesn’t think she’s ready for plastic surgery and likes the results of the fillers she gets from Cross a couple of times a year. She has had the lines above her lips treated, as well as the depressions under her eyes and the deep folds between her nose and mouth.

If she remembers to stop taking her once-a-day baby aspirin a week before the procedure, she says, she experiences no bruising. Otherwise, she may have a minimal black-and-blue marking that lasts for three or four days. The numbing cream that is applied a half-hour before the procedure keeps her pain-free while Cross is injecting her.

“Every doctor has a different aesthetic sense,” Rosen says, “and Dr. Cross is a perfect fit for me.”

When Rosen first came to Deme in April 2008, she was also seen by Betsy Rubenstone, a licensed aesthetician and director of Deme’s medical skin-care division. Since then, she has seen one of Rubenstone’s aestheticians for microdermabrasion and a laser treatment. Every day, she cares for her skin by using brightening exfoliation pads, a hydrating mask, a peel/bleach cream and a tinted moisturizer, all products Rubenstone prescribed for her.

“I like having healthy-looking skin,” she says, “but I won’t go to extremes. I’m putting my money into the fillers because I think they make such a difference. The guy behind the counter at the pizza place used to tell me I looked tired when I felt peppy and full of energy. Now I realize it was just that my face was losing volume and my cheeks were beginning to sink in. I’m going to go back there and see what he says now.”
By GLORIA HOCHMAN
For the Inquirer