Dermal fillers are used to shape a broad scope of features — from the face all the way down to the feet. And while the use of fillers for foot comfort isn’t a new practice in the aesthetic space, it’s limited to a handful of practices across the United States, one of which is the Cosmetic Enhancement Center of New England in Portland, Maine.
“Following the ‘stiletto lift,’ women are able to fit into more stylish, sexier shoes,” says Christopher Toth, D.P.M., a foot surgeon, who performs the procedure at the cosmetic center.
Other candidates for this procedure include professionals who are on their feet the majority of the day, who may experience pain over time. “Extra padding in their feet will not only work well in any shoe that they wear, it will also result in less pain,” Dr. Toth tells The Aesthetic Channel. “The procedure is an alternative to the surgical procedure I would normally perform as a remedy to that deformity.”
Dr. Toth was trained in the filler procedure in New York City and has been performing it for the past five years, now averaging two or three treatments a month.
Contrary to what one might believe, it’s not the holidays or special events that are a primary motivator for foot fillers, according to Dr. Toth. “I do not think there is a time of the year that is busier than any other,” he says. “A lot of patients who opt for this procedure have heard about it through word of mouth or are patients who do not necessarily fit into a surgical criterion.”
Dr. Toth’s Technique
Dr. Toth uses a mixture of Sculptra (Dermik Laboratories/Aventis Dermatology) and local anesthetic in sterile water. “I use Sculptra exclusively because it is a good substance and it promotes collagen formulation,” he says. “The product seems to last a significant amount of time.”
Dr. Toth typically relies on one portal of entry for a single injection, then bends the needle and moves it around.
The range of filler for any one patient varies greatly and treatment is highly individualized.
About 80% of the time, Dr. Toth injects just behind the ball of the foot. “However, you biomechanically have to figure out the problem of the bones, how they move, and predict where most of the forces reside,” he explains. “Intuitively, if someone has pain in a particular area, you would inject directly under that area. But it is not that simple for the foot. You actually inject strategically around that area and then massage the filler to where you want it to go. In that sense, Sculptra is very much like Play-Doh.”
Additionally, as women age, their estrogen level deceases, “which means their fat content decreases too,” Dr. Toth says. “But everyone decreases their fat content differently. Some people still have certain areas that are fine and do not need filler, while others have areas that do. The map is different for everyone.”
Where Sculptra is placed and spread to is an important consideration, according to Dr. Toth. “Otherwise, when the patient starts walking on the filler, the filler will dissipate and disappear.”
Preparation takes about 5 minutes, followed by 3 minutes of actual procedure and 10 minutes of massaging, for a total of between 15 to 20 minutes. Dr. Toth uses a block of ice to help numb the skin, whereas massaging evens out the formed colloid. “You do not want to be injecting and leaving the filler as is, because you may cause more pain than benefit,” he states.
Dr. Toth’s patients are roughly equally split between having one or two feet treated. For the second foot, he waits 3 or 4 days, rather than scheduling both feet at the same time and risking a reaction.
Results & Complications
“If performed correctly, the procedure provides immediate pain relief,” Dr. Toth reports. There is also no downtime; however, patients are advised to take it easy for the first 24 hours.
The duration of effect varies, depending on the patient’s activity level and weight. A touch-up treatment is scheduled 5 months to 1 year later.
The most common complication comes from bad technique and lack of anatomy, according to Dr. Toth. “This can cause tingling and numbness; also, lumpiness and cosmetically poor [results]. You do not want to inject into the muscle or the skin. The injection needs to be perfectly placed into the tissue, similar to the face.”
As for outcomes, “I have yet to have a patient regret having the procedure,” Dr. Toth relates. “And many wish they had known about it 10 years ago.”
Dr. Toth says the filler procedure is becoming increasingly popular as a cosmetic procedure. “I think there is a preconceived notion among clinicians and patients that using fillers in the foot is not something they want to embrace,” he says. “But once they are educated, it is a no-brainer.”
Clinicians who already inject fillers can expect a short learning curve. “It is not easy to inject Sculptra. It is a very thick substance, so you have to feel and go into the tissues,” Dr. Toth says.
For more information on the procedure, visit the Cosmetic Enhancement Center of New England’s website.