What to know about making them last longer

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What to know about making them last longer


Caving in to tabloid nostalgia, we peer through the looking glass at dermal fillers and their longevity

“So what the make-up contains lead poison? At least your complexion will bring all the boys in!” rapped Natalie Paris and Aimie Atkinson in “Haus of Holbein”, a song from the Tony-nominated musical comedy Six satirising Hans Holbein’s famous portrait of Anne of Cleves. 

History knows the path of beauty innovations as one scarred with ruts, potholes and sharp rocks that can pop tyres and derail a carriage. Not long after Anne of Cleves’ death (she was one of the few wives of England’s Henry VIII to survive marriage), Spirits of Saturn – a simple mixture of water, vinegar and lead carbonate also known as Venetian ceruse – was all the rage in the skin-brightening world. By the 1700s, doctors prescribed turpentine – a toxic solvent distilled from the resin of living trees most commonly used as paint thinner – as a diuretic that gave urine a “pleasant violet smell”. Much later, while making The Wizard of Oz, the 17-year-old Judy Garland was famously encouraged to smoke her way through four entire packs of cigarettes a day. But I digress.

Close-up of the face of a woman getting a beauty injection on the forehead. Anti-aging, rejuvenating treatment, skin care concept.

Now, by the sheer virtue of science, we know better than to rub lead into our faces, guzzle paint thinners and chain-smoke in the pursuit of pulchritude, though I won’t go so far as to deny the popularity of nicotine. With most medical innovations, especially if they end up as consumer-adjacent products after FDA approval, the long-term effects only transpire after thousands of people have been using them liberally.

The cosmetic trend that defines recent generations is dermal fillers, which became prominent in skin clinics and beauty salons around 25 years ago. The term “filler” most commonly refers to a temporary hyaluronic acid injectable used to replenish volume in nasolabial folds, chin, lips, cheeks and tear troughs. The reverence for hyaluronic acid’s “rejuvenating” properties began with celebrities and socialites before trickling down to regular people. Then, sometime in the noughties, we started seeing pictures of blown-up, distorted faces in every tabloid. “Must be ageing,” doctors back then would say, wholeheartedly believing whatever was printed on the filler packaging. “Twelve to 18 months,” said some. “Half a year to a year,” stated others – and still do. For the better part of three decades there were no independent studies to challenge such claims – until now. 

In 2020, Dr Gavin Chan, cosmetic physician and the founder of the Victorian Cosmetic Institute, posted a video on his YouTube channel debunking the myths about the longevity of fillers, which gained a staggering 564,000 views. Chan’s exploration of the issue was pure serendipity. “There was one patient who wanted to sue me for her fillers lasting too long, claiming that I’d put in permanent [ones],” he tells me. “There was another patient who had filler around the eyes in the tear troughs. We found out it stayed there for too long. [Their eyes] looked puffy and bad,” And so the investigation began. “I sent her to Dr Mobin Master, an aesthetic radiologist, who did an MRI and found the filler was still there.”

The impulsive study in collaboration with Chan inspired Master to conduct comprehensive research of his own. He published his findings in the journal of the American Society of Plastic Surgery in July 2020, where he concluded that hyaluronic-acid magnetic-resonance imaging signals appeared in the scans of all 14 patients who hadn’t had hyaluronic acid facial injections in the past two years. One of the patients had last taken hyaluronic acid treatments 12 years previously, and the compound still showed up. The results of this small-scale study directly challenge the perception of filler longevity.

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“By now, he’s done a total of more than 100 dedicated facial MRIs, finding most of [the patients had fillers] left well beyond two years,” says Chan of Master’s extended research, “especially around the eyes and mid-face.” It seems MRI is a handy tool in tracking down alien hyaluronic acid that overstayed its welcome. It shows up in the scans as a bright white spot, emitting a signal identical to that of fluid. And, unless you’re Chase Crawford’s character in the cult TV show The Boys, you won’t have sacks of water hidden inside your face naturally.

Chan tells me of Master’s Newtonian curiosity. We all, perhaps, remember the story of Sir Isaac Newton sticking a long sewing needle into his eye to understand the phenomena of light and colour. Master’s manipulations were less grotesque, “He got someone to inject him [with hyaluronic acid],” Chan recalls, “He scanned himself every three months for 27 months. The filler stayed in the cheek and jawline the whole time.”

But how is it possible that pharmaceutical giants aren’t fessing up about their products? It seems entirely too bizarre that a company wanting to maximise sales would encourage customers to buy into it as frequently and enthusiastically as humanly possible. At the risk of stepping into the quagmire of conspiracy and being dragged into the abyss of dirt by anti-vaxxers and various QAnon encomiasts, I decided to look into clinical studies by the manufacturers of popular hyaluronic-acid fillers: Allergan (maker of Juvéderm), Galderma (Restylane) and Teoxane (Teosyal). Allergan’s states, “Most patients need one treatment to achieve optimal wrinkle smoothing, and the results last about nine months to one year,” while Lausanne-based Galderma suggests that “you can see lasting results for up to 18 months in nasolabial folds with Restylane”. According to the Teoxane website, “Hyaluronic acid dermal filler treatments are not permanent and usually last up to 22 months.” At the same time, Master’s study concludes that the residual hyaluronic acid filler distributed by the aforementioned brands stayed in the cheeks, tear troughs and lips after two years of its administration. Chan adds, “The ‘longevity’ will be based on visual effects. They don’t usually say it dissolves.”

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So how to explain fillers appearing on the MRI while being virtually invisible to the patient after 18 months? “I think there’s some spreading, from what I can see on MRI,” says Chan. “The cheek filler or jawline filler looks sharp when you first put it in. A few weeks later, it’s completely different. Months later, it’s different again. Maybe people feel that fillers last only a short time because that initial effect is short-lived – they flatten.”

Overfilled faces have become a widespread (no pun intended) issue among the frequent attenders of the Church of Cosmetology, according to Chan, who calls it “an overfilling pandemic”. He tells stories of patients sometimes coming in to get their filler dissolved, and then, once the procedure is done, wanting the filler right back. “They haven’t seen their real face, cheeks, lips or eyes for 10 years,” he says. “I wish dissolving became trendier.”

Nonetheless, that trend, might be on the rise. Earlier this year, Courtney Cox confessed to the Sunday Times about having all her fillers dissolved. Shortly after, Love Island’s Molly Mae-Hague also got rid of her injectables, telling Cosmopolitan about people comparing her with Quagmire from Family Guy

So what should be the ideal procedure that ensures patients desist from overfilling their faces? Chan certainly has some ideas. “Ideally, anyone who’s had filler before should have a scan,” he says. “Maybe you need dissolving, not filling, to take out some of that old filler before we put new ones in.” The cost associated with MRIs is often a hurdle in this case. Ultrasound seems a viable – albeit less effective – alternative. “Sometimes ultrasound can’t tell whether old filler integrates into the tissues of the face, and you can’t [decipher it],” Chan explains. 

Profhilo is the latest innovation among hyaluronic-acid fillers. Produced by the Swiss pharmaceutical company Institut Biochimique SA (IBSA), Profhilo is marketed as a “bio-remodelling solution”. Chan tells me how fundamentally different it is from the dermal fillers we’ve seen so far. “[It’s] a filler that smooths the skin,” he says. “It doesn’t volumise, in any case.” One can thus assume the Swiss invention won’t be the cause of your puffy-eyed pillow face, though its long-term effects are yet to be studied. Time will tell.





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