It's safest to go to a doctor who is board certified in dermatology, plastic surgery, or an above-the-neck specialty. (A head and neck surgeon; an ear, nose, and throat doctor; or an ophthalmologist may have a cosmetic surgery subspecialty.) Just as important is experience with a variety of injectables.
Above all, don't let price or convenience— or the appeal of a Botox or filler party—sway you. "Don't have it done in a hotel room," says Lewis. "These parties are the antithesis of the way it should be done. When you receive Botox or a filler, you want proper lighting and to know exactly what you're getting. You don't want people sipping drinks and watching. Getting injected is not a festive occasion."
Here's how to find a doctor who will give you the look you want with the least risk of complications.
Make a list
Start by asking for recommendations from your family doctor, relatives, and friends. People can be surprisingly open about sharing resources.
Check the doctor referral services of nearby university-based medical centers and national medical associations such as the American Society for Aesthetic Plastic Surgery (ASAPS; www.surgery.org), the American Academy of Dermatology (AAD; (www.aad.org), or the American Society of Dermatological Surgery (www.asds-net.org).
Do a background check
Confirm the doctor's board certification with the American Board of Medical Specialties (www. abms.org). Membership in a professional organization like ASAPS or the AAD is a plus.
Set up a "go see" appointment
Call each doctor's office on your list and get some basic info (see "Questions to Ask," p. 175). Narrow your choices to one or two docs and schedule consultations. You're going to have an ongoing relationship with the physician you choose, so you want to feel comfortable.
I'll Have What She's Having
All fillers work in the same general way: They increase volume, either where no soft tissue existed or where it has diminished with age. Fillers can lift the depression of a crease, for example, or plump thin lips or flat cheeks. Fillers are often layered with one another and/or Botox, which relaxes the wrinkle - forming muscles.
"The art is in selecting the appropriate fillers to meet an individual's needs," explains Seth Matarasso, MD, a professor of dermatology at the University of California, San Francisco. He offers an example of the fine-tuning that may be required for a natural-looking mouth: A dense filler can be injected to define the lip's borders, a less-dense one to subtly plump them, and yet another to fill the fine superficial lines above the lip. "What works where depends largely on product's thickness," Matarasso says.
Here are the injectable you're most likely to be offered.
Your own tissue
(fat injections) The extra padding on your hips might seem to be the ideal filler because it's your own tissue out to be unpredictable. In some people, the transplanted fat cells resorb quickly; in others, they last for years.
Fat is retrieved and transferred through a large needle, so bruising may occur. And because some of the fat will be reabsorbed within a few weeks, the doctor will slightly overfill to compensate for the expected loss. The resorption isn't always balanced. "A lopsided lip, for example, can happen with any filler, but it's more likely with fat," says Theodore Kramer, MD, medical director of the Riverview Cosmetic Surgery & Skincare Center in Norwalk, CT.
Collagen
(bovine Zyderm, Zyplast; bioen-gineered Cosmoderm, Cosmoplast) Collagen, which gives skin its resiliency, is the granddaddy of all fillers. Injectable bovine (cow) collagen was FDA-approved in 1981 for lifting depressed acne scars and filling wrinkles. Major drawback: It's made from animal tissue and can cause an allergic reaction, so a skin test a month before treatment is essential. Plumping lasts for 3 to 4 months.
Cosmoderm and Cosmoplast are bioengineered collagen derived from human cells, so there is no allergy risk. Their lasting power is similar to that of bovine collagen.
Silicone
(Silikon 1000—FDA-approved for correcting retinal detachment) Medical-grade silicone injections have been slowly gaining in popularity because they finish off a wrinkle once and for all. Microdroplets deposited in the skin via multiple injections along a crease prompt the body to produce collagen to surround the foreign bodies, which lifts the area. But this method is permanent, meaning side effects (including red, inflamed nodules) and any mistakes (such as overplumping) are there for life.
Hyaluronic acid
(Restylane, Hylaform, Captique) Depending on the product, man-made gel versions of hyaluronic acid (HA), a sugar molecule, are derived from tiny pieces of rooster combs or bacteria grown in a lab. Once injected into lines, the material attracts up to 1,000 times its weight in water, thus filling I he crevice. HA's cushiony softness makes it a favorite for cheeks and lips.
The downside: The material has quite a sting, and swelling is obvious for a day or two. If injected too superficially a mistake that's most often made by inexperienced injectors—HA can temporarily produce tiny beading and inflamed larger nodules. HA lasts about 4 to 6 months.
PoIy-L-lactic acid
(Sculptra—FDA-approved to replace lost tissue in the faces of HIV-positive people) For more than 20 years, poly-L-lactic acid was used in absorbable sutures before doctors found that placing it deep within the skin revs up collagen production. "You inject it once a month, and new collagen gradually creates added volume. About four sessions works amazingly well," says Leslie Baumann, MD, a professor of dermatology at the University of Miami. Bonus; Sculptra is so thick, the plumping effect lasts up to 2 years. Side effects may include small bumps or inflammation within a year of treatment.
Calcium hydroxylapatite
(Radiesse— FDA-approved to treat vocal cord paralysis) This version of the natural cementing material found in teeth and bone is suspended in a water-based gel. Clinical trials for wrinkle filling are under way, but some doctors are already using it for deep wrinkles, jowls, and even botched nose jobs. It's so thick that the doctor must inject it deeply through a large needle, so there's more bruising than with other injectables, says Thomas Romo III, MD, director of facial plastic reconstructive surgery at Lenox Hill Hospital in New York City. The plumping may persist for 2 years or more.
Tags: cosmetic surgery, eye lid surgery, ear reconstruction, dr. romo, plastic surgery, lip enhancement, new york, romo, dr thomas romo, face lift, manhattan
