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    Turning Back the Clock


    "Some of the fat always gets absorbed by the body, so we always over do it," Antell says. "A disadvantage [of fat] is that it is a fairly thick material, so it is hard to use for fine lines. It's better for larger areas," Antell says.

    While not technically a filler, Botox injections are still Antell's first choice for the treatment of wrinkles.

    Botox or botulinum toxin is a purified form of the same botulism toxin that can cause serious food poisoning. Small doses of the toxin are injected into wrinkles, paralyzing them.

    "We use it between brows or on the forehead, and we can also use it to soften crow's feet on the sides of the eyes," says Antell, who's also a spokesperson for the American Society of Plastic Surgeons based in Arlington Heights, Ill.

    Perricone agrees. "We have been using Botox for awhile and we do not see any adverse effects, so we are staring to get a high comfort level with it."

    Another new filler on the block is injections of a gel called hyalaronic acid. Not yet available in the U.S., this gel "floats" skin cells rather then filling in the craters caused by wrinkles.

    Perricone says, "There is always a new procedure that supposedly works better and has less side effects but we have to wait and see. We are looking forward to better techniques and fillers in the future."

    That said, man-made materials like polymers or plastics and others "are nice because they are inert or harmless," he says.

    Another filler called fascia lata was originally used to raise deep scars. It is a small piece of human fascia (the material just under the fatty tissue) that is inserted under the skin to plump it up. It is used to improve scars, augment lips, and smooth out wrinkles.

    There also are hybrid fillers, which are mixtures of plastic and bovine collagen blended together to form partially permanent filler. Not yet FDA approved for use, these fillers work because while collagen dissolves after injection, the plastic skin spheres remain behind to plump up the skin.

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