Looking younger no longer means you have to look fake or frozen. Dermatologist David Harvey, MD, of Piedmont Healthcare & the Dermatology Institute For Skin Cancer + Cosmetic Surgery explains how new advances in the field of cosmetic fillers provide opportunities for aging gracefully. Cosmetic fillers, also known as dermal fillers, can be used to plump and restore the middle region of the skin, referred to as the dermis, to help patients achieve a more youthful look. The skin changes over time as it thins, stretches, and wrinkles. Factors such as bone loss and gravity also take a toll on appearance. Patients see this manifest in the mirror when they observe lip thinning, laugh lines and crow’s feet. Fortunately, there have been significant advances in cosmetic procedures using dermal fillers over the past decade. Many new products and advanced techniques now allow us to work smarter and more precisely to address some of these unwanted changes. Collagen used to be the “go-to” filler in the past for dermatologists and plastic surgeons, but the recent boom in products containing hyaluronic acid (HA) has changed our approach. Today, I never use collagen—it’s all about the HA. HA is naturally-occurring protein sugar that is abundant in the skin—cosmetic fillers containing HA are manufactured to mimic those found in human dermis. This is important for me and my colleagues because it means that we don’t have to pretest for skin allergies. Another nice aspect of utilizing HA fillers is that they’re reversible; if for some reason there is a need to remove extra HA (that forms an unwanted bump or contour irregularity) a simple enzyme injection can safely correct the problem. Today, there is a plethora of HA fillers in the market that target specific areas. For example, one new HA product that I’m excited about using is Restylane Silk. This filler has been modified to be delicate and easier to inject. It is placed in the superficial dermis, so it’s an attractive option to use in the lip and areas around the mouth. Juvederm Ultra is another HA which is wonderful for lip augmentation. These products flow elegantly and allow the skin to plump in a soft and natural way. Another cosmetic filler that has a novel role is Bellafill. This product is exciting because it was recently approved by the U.S. Food and Drug Administration (FDA) to correct acne scars. This means that we now have a much simpler option for acne scar patients who don’t want to go through laser resurfacing or dermabrasion. Bellafill is comprised of bovine (cow) collagen and a polymethylmethacrylate (PMMA) matrix. The collagen portion of Bellafill provides immediate volume and lift, and the PMMA matrix stimulates the skin to produce its own collagen over time. This unique combination has been proven effective for at least five years—another benefit. Advances in cosmetic fillers aren’t limited to the products themselves. We are also utilizing newer techniques for better outcomes. For example, 10 years ago, if a patient had a prominent nasolabial fold (fold between the nose and lip), we would have injected directly into the fold and a little above it. Today, we have advanced the technique by injecting into the medial and lateral cheek areas. Patients love the appearance of properly placed cheek filler, especially when using products such as Sculptra or Juvederm Voluma. These exciting advances have allowed us to refine and target specific areas with more skill and artistry. To achieve the result you’re looking for, it’s crucial to find the right dermatologist or plastic surgeon. Your injecting physician should be board certified, and make sure that he or she has lots of experience with the procedure or product you’d like. You don’t want to be the guinea pig for a new product or technique. Develop a relationship with your physician and make sure that he or she is someone you can trust. Ask to see ‘before and after’ photos of previous patients so you can gauge the doctor’s level of experience and also get an idea of what to expect for yourself. Go as slow as you want—the doctor should be your advocate. With the right product, plan and partnership, you can achieve the youthful look you desire safely and successfully. ** Note: the author has disclosed that he has no financial conflicts nor serves on any boards associated with any of the products mentioned.