Botox works best at smoothing wrinkled foreheads and crow's feet around the eyes, but thanks to our ever-increasing obsession with fending off the tides of time, there's a new generation of products - skin plumpers/fillers/injectables - that has cropped up to fill in where Botox leaves off. So many different injectable options mean you practically need a road map, so we consulted Boston-based dermatologist Dr. Rachel Herschenfeld, our Skin Sense columnist, on what works for different areas of the face.

Nasolabial Folds, Marionette Lines
"The ones most commonly used for treating lines around the nose and around the chin area are hyaluronic acids, or HAs. Restylane and Juvederm Ultra are great for filling creases in this area. Perlane and Juvederm Ultra Plus are thicker and can fill deeper folds." Herschenfeld applies a topical numbing cream or injects an anesthetic to reduce pain. Two recently approved HA fillers, Elevess and Prevelle Silk, already contain lidocaine, a local anesthetic, and other HA fillers with anesthetics are also in the works, which, according to Herschenfeld, should make treatment much more comfortable, especially in super-sensitive areas like the lips.

A Lunchtime Lift
Evolence, which won FDA approval this year, is also ideal for filling nasolabial folds, can last up to 12 months and may produce less bruising than other HA fillers. This, says Herschenfeld, makes it an option for patients who want to be treated and look great the same day. For thinner-skinned areas - under the eyes and in the lips -- another formulation, Evolence Breeze, is now in the testing phase.

Sculpt and Shape
Dermatologists can not only fill in lines and creases; new products also allow them to sculpt and shape aging faces. Herschenfeld says that Sculptra and Radiesse, which stimulate the body's natural ability to form collagen, can be used to fill hollows under the eyes, to rebuild cheekbones, fill in sunken temples and even smooth the jawline. "Although they cannot tighten skin the way surgery can, they can produce striking improvements in appearance without cutting, stitching, scarring and all the down time that comes with a facelift," says Herschenfeld.

Questions, comments? Send an e-mail to Dr. Herschenfeld.

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