Want fuller lips? Maybe get rid of some of the old age wrinkles between your mouth and nose, or take care of the crow's feet around your eyes? When it comes to choosing the right product for the right situation, knowing exactly where to start might cause a little confusion. There are all sorts of things to consider: cost, pain, length of results, length of recovery time, and of course some options just might not work right in certain cases.

So to give you some tips to help compare your options, we sat down with some of the country's leading physicians to discuss the pros and cons of all the products on the market.

Attacking Wrinkles

One of the most common areas for wrinkles to cause cosmetic problems is in what is called the nasolabial fold, the line that stretches from your mouth to your nose. Until just a few years ago, doctors would use a product called Collagen to correct these wrinkles, but since the product is made from animal fat, use of this product required two allergy tests and a wait period of a month or more, making it a bit of inconvenience especially for first time users. As new products have hit the market that do not require such testing and wait time, Collagen has become more outdated and mostly used in patients who want to continue using the same product they always have.

Most of the products put to use now in the nasolabial folds are comprised of a material called Hyaluronic Acid, which does not require any testing or downtime while offering comparable, if not better, results. Here is how some of these new products compare:

Additional Considerations:

Restylane and Captique will both biodegrade completely overtime, while Radiesse, because it contains calcium, may sustain some fullness for an extended period of time. This is important if you are planning repeat visits, since with Radiesse it is likely that you will need less product injected with every return visit, thus lowering the cost of the procedure.

Comments from the experts:

"I use Captique in patients that are desirous of less bruising and swelling in exchange for a little bit less longevity." – Dr. Chris Dannaker, Rodeo Drive Plastic Surgery Center

"I probably use Restylane the most because it is a medium and has a high rate of satisfaction." – Dr. Michael Bruck, director of Plastic Surgery at Juva Medical Spa

"Anything will cause swelling. If I just took a needle and put it in and took it out it is going to cause swelling." – Dr. Elliot Jacobs, New York Plastic Surgeon

Plumping the Lips

This is another portion of the face that typically received Collagen injections, but now gets Restylane in a majority of cases. Though Captique, or similar products such as Hylaform (all made from Hyaluronic acids), can be used, Restylane is usually the choice of most physicians.

Radiesse, due in large part to its consistency and the fact that it contains calcium, often causes bumps or lumpiness when injected into the lips, and is usually not used in this application.

Comments from the experts:

"Any of the long-lasting fillers [such as Radiesse] can cause lumps in lips." – Dr. Dannaker

Filling Out the Cheeks and Jaw Line

When it comes to filling out larger areas of the face, such as the cheeks or around the chin and jaw line, typically a large amount of filler needs to be used. Though Radiesse and others can be used in smaller quantities for such applications, it is not very common.

Two of the most frequently used methods are Sculptra, a relatively new injectable filler, and fat grafting. With fat grafting, your body's own fat cells are harvested from donor sites during a minor surgical-like procedure under local anesthesia, and then injected in desired areas of the face. This procedure is more invasive than basic injections, but, although results can vary widely and are difficult to predict, fat injections can help develop living cells in the injected area with the possibility of longer term, sometimes even permanent results. Here is how the two procedures compare:

**Cost ranges reported here are greater than those reported by ASPS or ASAPS, are based on actual ranges given by doctors for the cost of an entire treatment, and are meant to reflect the total price that a patient might expect to pay.

Comments from the experts:

"Fat grafting requires a different level of [surgical] skill than the other products." – Dr. Bruck

"Fat grafting longevity is still controversial; it can last several years, but the inconvenience is great." – Dr. Dannaker

"Sculptra has a down side in that you don’t get immediate results." – Dr. Jacobs (Sculptra gradually takes affect, so results can sometimes take up to 6 – 8 weeks to be noticed)

The Brow, Crow's Feet, and the Upper Face

It is in this area of the face where BOTOX is used with great frequency. BOTOX does not work like the other fillers by adding volume to the injected areas. Rather, it paralyzes the muscle where it is injected, causing lines and wrinkles not to appear.

In effect, BOTOX can deactivate the muscles that relax the brow and help with overall brow elevation. It is often used to minimize horizontal lines of the forehead and crow's feet around the eyes. In the lower face BOTOX is often used to improve frown lines or lessen the appearance of neck cords.

The cost for a syringe of BOTOX is right around $400 (slightly more in certain regions of the country), and a single treatment will last somewhere around four months, though with repeat visits longevity tends to increase.

Comments from the experts:

"BOTOX really does work, and works well and consistently." – Dr. Dannaker

"It is hypothesized that if you use BOTOX on the same muscle and keep it paralyzed for 2 years that it will atrophy [causing permanent correction of lines and wrinkles]" – Dr. Jacobs

Combinations and Complex Treatments

In many cases just a single product may not offer you the best results. For example, if you have some really heavy, deep lines running from your nose to your mouth with lots of little surface wrinkles in the area, you might benefit from a combination of Radiesse and Restylane (or other superficial fillers). The Radiesse is injected at a lower level (beneath the skin) to treat deep lines while the Restylane helps reduce superficial wrinkles.

Combinations can also be used to help increase longevity. Adding BOTOX to a filler treatment can keep wrinkles away or lips plump for a longer time than fillers alone. Injecting Restylane over an area that has been treated with BOTOX could increase the lasting power an extra three months or more since the relaxed muscle is not acting on the injected Restylane and wearing it away faster.

The Other Fillers: Now and the Future

Just like Collagen is slowly giving way to newer products, the fillers that now enjoy the lion's share of the anti-aging market may soon face fierce competition from newer products that will be able to offer additional benefits. As Dr. Bruck says of these new fillers with new promises, "it will be hard not to try them."

Of course there should always be a good deal of caution involved. "I would warn people off of a perfect filler," says Dr. Dannaker, "it does not exist." There have even been some products to hit the market with great promise then fade away rather quickly due to high reports of complications and dissatisfied customers. Other more controversial injectables, like injectable silicone, may carry with them yet to be determined health risks and remain on the fringe of the market.

So if you are still weighing your options and unsure what is right for you, here is some advice offered by Dr. Jacobs that might help you on your way: "Do your shopping and check out 2 or 3 or more doctors before you make your decision."

Response from Our Readers

"I have been reading about fillers on the net for a couple of years.  Many years ago I had two scar revisions on my face.  I wanted to plump up some small areas later and was referred to a dermatologist. He did a great job and suggested having my upper lip plumped up.  The product he used was medical grade injectable silicone.  Actually when I had one of the two sessions a doctor from L.A. was being taught the procedure.  I have since been to a cosmetic surgeon and two dermatologists for other procedures and they commented on how well my upper lip looks.  It is permanent as well.  I really could not have taken any more injections in my lip so I was lucky only to have required two sessions.  I was told by the dermatologist who did it that my body reacted very well to silicone and therefore I only required two and that usually it was eight for lips.  As well, I was told that it was a procedure that took some time to really take full effect because the body produced collagen around the silicone injections and became larger so that had to be considered in determining how much and how well the patient reacted.  It actually took around 3 years before my upper lip became really full although improvement was immediate.  My upper lip is soft and I have full feeling. 

The reason why I am writing is because this procedure has received a lot of negativity.  I really think it should be considered for medical research because it is permanent and not priced anymore than other fillers."

- Anonymous, Toronto

Have your own comments on this article? Send them to editor@locateadoc.com.