From the Cream to the Needle

Created on 25th September 2008

Sandra Howard investigates what can be done when expensive beauty creams no longer have the desired effect

Smooth, plump and glowing skin is at the top of every woman's wish list. But what happens when you wake up to the grim reality that the overnight beauty fairies have stopped visiting?

It seems only yesterday that a generous application of the latest age-busting cream and an early night was all you needed to awake looking refreshed and rejuvenated.

But at a certain point in our lives - between mid 30s to late 40s - skin creams no longer seem able to work their magic for many of us. We still feel young on the inside; it's just our wrinkly foreheads and deepening nose to mouth lines that leave our self-confidence in tatters.

So, do we fork out on yet another skin cream, full of pseudo-science promises, or do we book in for a full on face-lift? Thankfully many of us are waking up to the fact that there is a middle ground. Nonsurgical cosmetic treatments are ideal for women who believe surgery is one step too far. These treatments are no longer considered extreme and the preserve of film stars and celebrities, but are becoming mainstream.

A recent report by Mintel revealed that the market in nonsurgical procedures is booming, with the number rising from 230,000 in 2006 to 472,000 in 2007. It noted a particular surge in demand for Botox and wrinkle fillers.

Consultant dermatologist Dr Russell Emerson, founder of Hove Skin Clinic, near Brighton, thinks we are kidding ourselves that a skin cream is the answer to smoothing out our faces.

"There is only so much a cream can do as it doesn't penetrate into the dermal layers of the skin. Creams sit on the surface of the skin and although they are important for conditioning and sun protection they are not going to turn the clock back."

Five star creams full of hi-tech ingredients definitely don't come cheap either; super posh cream Crème de la Mer serum costs £1500 for three months' supply. Even those on more modest budgets are spending a significant amount on antiagers, despite little research to demonstrate that they work.

Non-surgical treatments are becoming not only more accessible but more affordable too, with an average Botox treatment costing £250-£300 and a filler such as Restylane £350-£500. The affects of Botox last around four to six months and fillers up to twelve months.

Dr Emerson said: "Unlike skin creams, Botox and a reputable filler such as Restylane can deliver action to the dermis where it is needed to see real visual benefits.

"Hyaluronic acid, the main ingredient in fillers, not only plumps out wrinkles but it adds suppleness and softness to the skin. It is a natural substance found in the body that diminishes as we age.

Botox is ideal for the upper face and can achieve some fabulous results smoothing out the forehead and lines around the eyes. Fillers are used for the nose to mouth lines and for plumping areas such as the cheeks, décolletage and the backs of our hands, which lose volume as we age."

Dr Emerson said that at his clinic he finds the vast majority of patients want a natural enhancement rather than a tight artificial look as favoured by some LA celebrities.

He added: "It is a big ste for women to take but the most important, thing is that a reputable product with a proven track record is used and that a trained professional administers it."

Dr Emerson tackles the questions we all want answering:

What are dermal fillers?
Dermal fillers are substances that are injected below the surface of the skin to fill in lines and wrinkles and add volume to the cheeks and chin.

What types of filler are
there?
Dermal fillers can be temporary or permanent. Many doctors, myself included, are wary about using permanent fillers as they are more prone to complications, and difficult to reverse. Fillers containing hyaluronic acid are safest as they can be dissolved if untoward problems occur.

How do temporary fillers
work?
By using a series of small injections just under the skin, the product will fill lines and wrinkles, which will naturally be reabsorbed into the skin.

Will I need more than one type of filler?
All fillers come in different gel size particles and we use different grades of thickness of fillers for different areas.

How safe are fillers and
Botox?
Botox has had many years of clinical use and has a lot of research to support the safety of its long-term use. Similarly, hyaluronic acid fillers have a proven track record, particularly products such as Restylane, which has been injected into more than 10 million women and men. Temporary fillers without animal proteins, allergens or chemicals are perfectly safe. More permanent fillers are prone to becoming lumpy and hard. More research is needed on non-hyaluronic acid fillers to assess their long-term safety.

What are the risks?
Most people experience some tenderness and bruising that lasts a few days. Some swelling may develop for one to two weeks. Serious side effects are rare. Botox can cause drooping of the eyelid if injected too close to the eye. Allergy can develop with fillers but the risks are very small and typically affect less than 1 in 2000 people. Badly administered fillers can cause lumps and unevenness that may require correction.

Will there be any long-term ill effects to my health?
No, we are not aware of any long-term problems with Botox or hyaluronic acid fillers. More permanent fillers may cause long-lasting lumpiness and are generally best avoided.

How long will my appointment be and will it hurt?
A typical Botox appointment would be for 20 minutes and the injections take five to ten minutes. Fillers take longer especially if a topical anaesthetic cream is required to numb the skin before injections. Most filler appointments take 30 minutes plus time for the topical/ local anaesthetic. The injections are relatively painless. Some soreness may last one to two days.

Can I go straight back to work?
You can, but it would be advisable to go home after the treatment. Your face may feel a little sore and the needle marks take a few hours to subside.

How do I pick a filler suitable for me?
Your dermatologist will tell you what will work best on your skin type. Always go for approved brands with the CE - mark of approval. Hyaluronic acid fillers are considered safer and can be reversed in the rare event that problems develop.

What will happen if I stop using Botox and fillers - will I suddenly go back to looking older overnight?
No. Most fillers are absorbed into the body gradually and disposed of naturally. It would typically take twelve to eighteen months for a hyaluronic acid filler to completely dissolve. Botox lasts four to six months but may have some affect for eighteen months or longer. CSMUK