2020’s Filler Innovations Can Keep You Looking Younger, Longer
Dr. Shereene Idriss explains one of the biggest factors that’s aging you that you may never have heard of before.
As the saying goes, new year, new you, right? It depends on who you’re speaking with, but if you’re asking your dermatologist, they might explain that it’s not that simple. There’s no magical serum or cream that can completely turn back the hands of time, but with the recent innovations in cosmetic procedures, it is easier than ever to help your skin age gracefully. Fillers especially are one of the most popular options for people who are looking to lift, firm, or otherwise minimize obvious signs of aging, like fine lines and wrinkles.
There are always new research and innovations within the world of dermatology, so we sat down with top NYC dermatologist Dr. Shereene Idriss to get the 411 on the most exciting breakthroughs for 2020. From the two new filler formulations to the most requested cosmetic procedures—plus one of the biggest factors that’s aging you that you might never have heard of before—this is what we can look forward to in the skin-care market in the year ahead.
What has been the most requested procedure in the past few months, and what do you expect to continue throughout 2020?
“A lot of jawline addressment, wherein people want a more rigid, firmer, or more defined jawline. Not a different-looking jaw, which I have to re-educate some people about—you have to work in sync with the face. A strong jawline definitely saves the face as we age, since our chins and our jawlines sag. But your jawline has to align with your mid-face. It has to co-exist in a way that makes sense.”
Why do you think that is becoming such a popular request?
“I think it’s Instagram. It’s both a blessing and a curse. People are oftentimes seeing versions of themselves that are maybe not real. But even if you think of the big-name celebrities, like Kim Kardashian or Jennifer Lopez, they have very strong jawlines. They are associating it with being ‘beautiful.’ Some patients are coming in with that mind-set, versus being an actual candidate for that procedure. It’s really up to the physician to be true to themselves so that people don’t start morphing into these caricatures we’re seeing. [Some of] these crazy jawline fillers almost look like they’ve gotten an implant. It really doesn’t match the face.”
What about in terms of filler innovations?
“There was a rumor about Volite [coming] out in 2020. It’ll be interesting to see how a lightweight hyaluronic filler can replenish moisture in the dermis. [It’s] a lighter effect that helps with the texture of the skin. I also heard that Revance, the approved form of Teoxane—which is a resilient form of hyaluronic acid, meaning it’s longer-lasting—it’ll be interesting to see how we’ll incorporate it when using various fillers in the face. They’ve been using it outside of the United States for a while now. With regards to Teoxane, they have four different ones, three of which have been FDA-approved in the US, and they’re all indicated for different areas of the face. The fourth one is still going through approval. It’s like having different paintbrushes in your toolbox.”
Is there anything that doesn’t yet exist that you’re hoping to see developed within the world of fillers?
“I think that facial anatomy is so complicated when it comes to structure. There is no miracle product, like in skin care. I don’t think it would be good to have a filler that could address all of your problems, because when you think of the face, you want everything to work a little differently. You want it to be sturdier around the jawline to hold the face up, or along your cheekbones. You want it to be malleable along the cheeks or where you smile, so your face can move. It doesn’t make sense to have a miracle filler, in my mind.”
What about longer-lasting filler?
“It makes sense to me to have a long-lasting filler; however, it comes with a caveat. I don’t think that having super long-lasting filler is really beneficial because our bone structure changes so much as we age, especially in our 40s. So if you have a long-lasting filler over an ever-changing face, things can start to look wonky over time.
“If you look at [cheek] implants, you would have these patients come in, and there are a few who are a bit older because it’s not as trendy now or en vogue, but their cheeks are sitting [higher] and everything is aging around it, [so] they have a Cruella de Vil look because it’s not moving. With an aging face, you have to be malleable; you have to work with an aging face. You can’t be rigid.”
How much bone density are you losing when you start to age? What is the average percentage per decade?
“It starts in your 20s. There is a study from 2012 [stating that] bone structure reduces about 90 percent after menopause. Aging is associated with the decrease in the growth hormone secreted in the pituitary gland. It’s decreasing at 14 percent per decade. I don’t know if this is associated with bone resorption, but it’s significant. It can’t be overlooked. [Which is why] I feel strongly about not using semi-permanent fillers in the face. I think you can use them in different areas of the face to your benefit, but in the midface, area that’s actively changing, you have to grow with the face.”
Along with jaw filler, what is another type of treatment that you’re seeing more often with your patients?
“Younger and younger women are asking for under-eye [filler]. I think it has to do with the filter effect [that’s] going on, where people think they shouldn’t have a little line under their eyes when they smile. I’d say that’s normal. Sometimes you definitely should [explore under-eye filler] if the wrinkle is a little deeper, but I’d say those two [are the most popular].”
What is the process for using the filler under the eye?
“It’s a tricky area. I think more people think they need it, that they’ve lost volume in the eye area, when really their face is dropping. It’s better to lift the face laterally with filler around the eye, in my opinion, without really going for the under-eye filler. There are two ways you can do filler: with a blunt-edge needle—a cannula—or a sharp-edge needle. But it really depends on what the physician is comfortable using.
“Always [use] a lightweight filler for under the eye. I personally don’t do the eye without addressing the rest of the face. If you’re scared of fillers, you can always do the PRP [platelet-rich plasma] injections, which take your own blood and separate the growth factors. It’s still an invasive procedure, but it’s coming from yourself.”
As fillers have become more socially acceptable, do you think people are shying away from more invasive procedures, or are they fatigued by fillers and are searching for something else long-term?
“I’m very biased because I only see my patient population. The first question I always ask an older patient is ‘Are you someone who wants to get a face-lift in this lifetime, or are you completely against it?’ The person who is OK with it, I’m looking at their skin quality and anatomy and seeing if they’re a candidate for a face-lift. I would push them to get one, and then we can maintain it when they come back to me. A lot of people ask me to reverse or fix work. I think, unfortunately, there are a lot of people out there who just listen to exactly what their patient wants, and that can result in unnecessary amounts of filler to the face, without thinking about the surgical procedure as a choice.
“I always think about whether or not this age [at which to recommend a face-lift] will be pushed back because of all of the advances we’ve made to tighten and resurface the skin. I think that the age of having to get a face-lift is going to be pushed back over time. [Right now] people start to take it seriously at 55-plus.”
What is the average age of the first-time filler user in your practice?
“I’ve noticed three main peaks. The first one is 30 to 33, where they feel like over the past six months their face has shifted. The second one is 39 to 42, where the change happens more dramatically, maybe over a month or so. And then again, in your late 40s, where I get told over and over again, ‘I woke up one morning and I don’t recognize myself. Help.’ Volume loss starts to happen in your late 20s, early 30s, which makes sense if you’re thinking about bone density and all of that. You’ve probably lost weight, gained weight, et cetera.”
For a client who’s coming in and saying ‘I don’t understand why I look older, but I do. Please help.’ What is your strategy?
“I really look at the face. When you’re looking at aging, it’s a number of things. It’s volume loss; it’s if you have any built-in wrinkles in your face; it’s the color of your skin; it’s how elastic your skin is, and your bone structure. I will start with one and see if it works. Some people want Botox but have no lines. I try to tell them, ‘You don’t need it yet.’ There are women out there that listened to their moms [to take care of their skin] and look like little fairies and look impeccable. But there’s always the one beginning sign of [aging].”
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