Cosmetic Injectables... Which ones are the Best?

There are so many cosmetic injectables on the market today, it's difficult for a consumer to determine exactly what they want or need. Here are my opinions on the most popular cosmetic injectable treatments:

1. Botox: By far the best. Nothing works like it. Botox causes paralysis of certain facial muscles which cause wrinkles in the forehead, frown lines between the brows, and crow's feet wrinkles. It lasts 3-4 months on average and is the best "bang-for-the-buck," in my opinion. Plus, Botox injections are nearly painless if topical skin anesthetics are used.
2. Restylane: This is the most popular injectable "filler" today. This means the product is injected into wrinkles or the lips to fill them in by adding volume. I use this very regularly. It's best for filling in the nasolabial folds (the deep wrinkle from the side of the nose to corner of the mouth) and plumping up the lips. It is somewhat painful to have injected and can cause a bit of bruising in some. I often use local anesthetic injections for it. Restylane lasts around 6 months. Jessica Simpson has admitted to using Restylane.
3. Collagen (Cosmoplast, Cosmoderm, Zyplast, Zyderm): This used to be the most popular filler before Restylane came along. Collagen doesn't last as long (2-4 months on average) but is cheaper than Restylane and less painful to have injected. This is what Barbara Hershey had before she filmed "Beaches."
4. Hylaform / Hylaform Plus / Captique / Juvederm: These are all "Restylane substitutes." The first three were touted as comparable to Restylane but their longevity was disappointing (I saw 3 months for Hylaform and 4-6 months for Hylaform Plus). The newest one is Juvederm, and supposedly the results can last 6 months like Restylane. It is reportedly more comfortable to have injected as well. The jury is still out on this one.
5. Radiesse: This is another injectable filler. The benefit of Radiesse is that it lasts much longer than Restylane (over a year). However, I caution anyone who is considering having it injected into the lips. I have seen many cases where it has caused visible bumps which needed to be poked with a needle and the Radiesse squeezed out. It may be a good treatment for people who need long-term, deeper injections. Some people now inject it into noses to change the contour.
6. Artefill: This is a recently FDA-approved permanent injectable substance. Be careful with any permanent substance, as it can cause bad reactions even several years after it is injected. Physicians used to inject silicone into people's faces, with some disastrous results.
7. Fat: In my opinion, this is by far the best 'permanent' injectable treatment. I often perform facial fat grafting on my patients. I take fat from their tummy or thighs, purify it, then reinject it into the cheeks, under the eyes, and into the lips. It is real surgery, however, but can last for years.
Like with any medical cosmetic treatment, make sure you consult with a reputable physician before having it done. There are a lot of practitioners who are trying to do these injectable treatments with little or no experience or training. If you are not sure who to see, a board-certified plastic surgeon is usually a good choice.
If anyone has any experience with other injectables like Sculptra, I'd be interested to see what you have to say!

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.: