Trapped in tabloid nostalgia, we looked in the mirror at dermal fillers and their longevity.
“So is there lead poison in cosmetics? At least your skin color will attract all the guys!” Natalie Paris and Amy Atkinson rap in “House of Holbein”, Tony’s No. portrait of Anna Skala by Hans Holbein.
History knows that the road to beauty innovation is littered with ruts, potholes and sharp rocks that can burst a tire and derail a train car. Shortly after the death of Anne the Rock (she was one of the few wives of Henry VIII of England to survive the marriage), the Spirit of Saturn, a simple mixture of water, vinegar and lead carbonate, was also taken into account. Venetian crayons are in fashion. The world of skin whitening. By the 1700s, physicians were prescribing turpentine—a toxic solvent distilled from the resin of living trees, most commonly used as a paint thinner—as a diuretic that imparted a “pleasant violet odor” to urine. Much later, while working on The Wizard of Oz, 17-year-old Judy Garland was encouraged to smoke four packs of cigarettes a day. But I digress.
Now, with the sheer force of science, we know it’s better not to put lead on your face, spray paint thinner, and smoke for beauty, though I won’t deny the popularity of nicotine. For most medical innovations, especially if they become close-to-consumer products after FDA approval, long-term effects will only become apparent after thousands of people freely use them.
A beauty trend that has defined the last generations is dermal fillers, which became popular in skin clinics and beauty salons about 25 years ago. The term “filler” most commonly refers to a temporary injection of hyaluronic acid used to refill the nasolabial folds, chin, lips, cheeks, and lacrimal pits. The reverence for the “rejuvenating” properties of hyaluronic acid originated among celebrities and socialites, and then spread to ordinary people. Then, sometime in the last century, we started seeing pictures of pouty, twisted faces in every tabloid. “He must be getting old,” the then doctor said, sincerely believing everything that is written on the packaging with the filler. “Twelve to eighteen months,” some said. “Six months to a year,” others said, and still do. For most of the past 30 years, no independent study has challenged this claim—until now.
In 2020, cosmetologist and founder of the Victorian Cosmetic Institute, Dr. Gavin Chan, posted a video on his YouTube channel debunking myths about the durability of fillers, which amassed a staggering 564,000 views. Chen’s exploration of this issue is purely coincidental. “One patient wanted to sue me because her fillers lasted too long, claiming that I would use permanent [fillers],” he told me. “Another patient had a filler around the tear trough. We found that he had been there too long. [Their eyes] looked swollen and broken,” and an investigation began. “I sent her to cosmetic radiologist Mobin Master, who did an MRI and found that the filler was still there.”
Impulsive research in collaboration with Chan inspired Master to conduct a comprehensive study on his own. He published his findings in the Journal of the American Academy of Plastic Surgery in July 2020 in which he concluded that hyaluronic acid MRI signals were present in all 14 patients who had not received hyaluronic acid in the past. Two years of scanning patients with injections. One of the patients was last treated with hyaluronic acid 12 years ago and the compound is still present. The results of this small-scale study directly challenge the concept of packing life.
“So far, he has done more than 100 specialized MRIs of the face and found that most [filler patients] had no effect for more than two years,” Chan said of Master’s extended study, “especially the eyes. face.” An MRI seems to be a handy tool for tracking alien hyaluronic acid, which is outdated. In the pictures, it appears as a bright white spot that emits the same signal as the liquid. And, unless you’re the Chase Crawford character on the hit TV show The Boys, you don’t have a drinking bag hidden in your face.
Chen told me about Master’s Newtonian curiosity. Probably, we all remember the story of Sir Isaac Newton, who stuck a long sewing needle into his eye to learn about the phenomena of light and color. The master’s operation was less grotesque: “He asked someone to give him [hyaluronic acid],” Chen recalls. “He scanned himself every three months for 27 months. The fillers stayed on his cheeks and jawline. Excellent.”
But how could the pharmaceutical giants not recognize their products? It seems strange that a company that wants to maximize sales encourages customers to buy it as often and with great enthusiasm as possible. At the risk of being mired in a conspiracy and being dragged into a muddy abyss by anti-vaxxers and various QAnon advocates, I decided to look into clinical studies of popular manufacturers of hyaluronic acid fillers: Allergan (manufacturer of Juvéderm), Galderma (Restylane). and Teoksan (Teosial). Allergan notes that “Most patients require a single treatment for optimal wrinkle reduction results, which can last from 9 months to a year,” while Galderma of Lausanne recommends that “Restylane can be seen in the nasolabial fold for up to 18 months.” lasting effect.” According to the Teoxane website, “hyaluronic acid dermal filler treatments are not permanent and typically last up to 22 months.” . Chan added, “Longevity” will be visual based. Usually they don’t say that it dissolves.”
So how do you explain a filler that shows up on an MRI and is barely visible to the patient after 18 months? “From what I saw on the MRI, I think there is some spread,” Chan said. “Cheek or chin filler looks crisp the first time you use it. After a few weeks, it’s completely different. After a few months, it’s different again. Maybe people think the filler doesn’t last long. Time because the initial effects don’t last long—they wear off.”
Overflow has become a common problem among beauty church goers, Chan said, calling it an “overflow epidemic.” He tells stories of patients who sometimes come in to have their fillers dissolved and then, once the procedure is complete, want the fillers to be returned immediately. “They have not seen their real face, cheeks, lips or eyes for 10 years,” he said. “I want the dissolutions to be more fashionable.”
However, the trend may be on the rise. Earlier this year, Courteney Cox admitted to The Sunday Times that all of her fillers were gone. It wasn’t long before Love Island’s Molly May-Haig also got rid of her injections, telling Cosmopolitan that people compared her to Family Guy’s Quagmire.
So, what should be the ideal procedure for the patient not to overfill the face? Chen definitely has ideas. “Ideally, anyone who has had fillers before should get a scan,” he said. “It may be that instead of a filling, you need to dissolve and remove part of the old filling before we put in a new filling.” Ultrasound appears to be a viable, albeit less effective, alternative. “Sometimes the ultrasound can’t tell if the old filler has integrated into the tissues of the face, and you can’t [decipher it],” Chan explains.
Profhilo is the latest innovation in hyaluronic acid fillers. Manufactured by the Swiss pharmaceutical company Institut Biochimique SA (IBSA), Profhilo is known as a “bioremodeling solution”. Chan told me how fundamentally different it is from the dermal fillers we see so far. “[It's] a filler that smooths out the skin,” he said. “He won’t get any bigger anyway.” Thus, it can be assumed that the Swiss invention will not cause puffiness in your face, although its long-term effects are yet to be studied. Time will prove everything.
Post time: Aug-31-2022