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Injectable Fillers

Injectable Fillers

Soft tissue fillers are injected to restore fullness, enhance volume, and contour areas of the face such as the lips, cheeks and forehead. They are fast, effective ways to smooth facial lines and define the lip border. In addition, they can be used to fill in deep and shallow wrinkles that cannot be treated by BOTOX®. The results are immediate but temporary.  They also soften wrinkles or folds in depressed areas. The specific agent is chosen depending on the area to be treated, the intended duration of effect and other factors. The most common materials include:

  • Hyaluronic Acid Fillers
  • Hydroxyapatite and Poly-L Lactic Acid – Semipermanent Fillers
  • Permanent Filler – Bellafill
  • Fat Injections
  • Collagen

We use topical anesthetics as well as dental blocks (in selected patients) to numb the skin. Downtime and discomfort are very minimal.

Hyaluronic Acid Fillers

Almost all injectable fillers are largely made-up of  hyaluronic acid, a substance normally found in the skin, muscles, and tendons of mammals.  Hyaluronic acid (HA), suspended in a gel, is injected to soften lines and restore fullness or volume. This agent works by attracting water to create and replace volume.  All hyaluronic acid facial filler products are eventually absorbed by the body, usually within six to nine months, causing the patient to undergo repeat injections to maintain the desired look. The various types of HA differ by their density. The more dense the gel, the deeper it needs to be injected. These agents are used more for volume enhancement. The less dense fillers are used superficially to fill in wrinkles and fine volume adjustments in the lips and around the eyes. Due to their very extremely low side effect profile, versatility, and ease of use and storage, HA fillers are by far the most popular agents.

Uses

(*indicates an off-label use)

Brands

Treatments and Results

You will receive an anesthetic cream to the treated areas for 10 minutes prior to having the face cleaned. The injection session will take 10 -15 minutes and cold packs will be applied. After the session, you will receive specific instructions (activity, how to minimize bruising, etc.). The effects are immediately apparent. You may have mild bruising that subsides over the following few days.

Side Effects and Risks

Temporary bruising, swelling, lumpiness, possible infection, allergic reaction.

 

Semi-Permanent Fillers

These longer-lasting agents work by stimulating new collagen production in order to restore moderate to severe volume loss. They are generally injected deeper and work by providing volume and lift, ultimately softening deep folds. Unlike the finer HA agents, these products are not appropriate for fine lines, lips, and around the eyes.

Uses

(*indicates an off-label use)

Brands

  • Radiesse: Thicker, calcium-based filler stimulates new collagen production. Results last about 2 years.
  • Sculptra Aesthetic: Poly-L-lactic acid filler with long-lasting results (1-2 years), appearing after three or four treatments spaced several months apart.

 

Treatments and Results

You will receive an anesthetic cream to the treated areas for 10 minutes prior to having the face cleaned. The injection session will take 10 -15 minutes and cold packs will be applied. After the session, you will receive specific instructions (activity, how to minimize bruising, etc.).The results will be gradually apparent and can last one to two years, sometimes more.

Side Effects and Risks

Soreness, puffiness, bruising, lumpiness, possible infection, allergic reaction.

 

Permanent Filler

Bellafill is the only permanent filler. It is composed of synthetic microspheres in collagen that not only are not degraded, but also promote more collagen production. This agent is only for deep filling and is not appropriate for areas with thin skin or frequent movement such as the lips, fine lines, or around the eyes.  This product is only used to correct deep folds and wrinkles.

Treatments and Results

Prior to administration, an allergy test is required. While the FDA label places longevity at only 12 months, it has been shown to last five years or more. Unlike the HA agents which can be dissolved with hylaluronidase if needed, Bellafill can only be removed with surgical removal.

Side Effects and Risks

Possible allergic reaction, infection, or persistent redness. Granulomas (lumps) can occur years after injection and require surgical excision.

 

Fat Injections

Fat injections are more permanent than the popular HA dermal fillers. The patient’s own body fat is harvested and carefully reinjected to restore volume and sculpt the face. Prior to the reinjection, the fat cells are processed in order to maximize the amount of tissue survival and long-term results. Since the fat is from your own body, there is no risk of allergic reaction.

Uses

  • Under-eye Hollows
  • Volume Loss in the Midface and Jawline
  • Deep Nasolabial Folds
  • Thin Lips
  • Smile Lines
  • Bony/Aging Hands
  • Restoring Contour After Cancer Surgery or Trauma
  • Lack of Volume in the Buttocks

 

Treatment and Results

Liposuction is performed to harvest the fat cells from the hips, thighs, or abdomen. The harvested fat this then prepared and transferred into small syringes before being strategically injected. Although the results will be apparent instantly, it will be necessary to overfill, as some of the fat will be resorbed. Each patient resorbs the fat differently, and a secondary procedure may be needed in some cases.

Side Effects and Risks

Bruising and swelling at donor and recipient sites, lumpiness, possible infection.

 

Collagen Injections

Largely replaced by HA fillers, collagen injections have been available since the early 1980s. Collagen is a naturally protein used by your body to build skin and dermal texture. It was initially available as a bovine product, and eventually human-derived as well.

Uses

  • Fine Lines and Wrinkles
  • Nasolabial Folds
  • Thin Lips
  • Acne Scars

 

Brands

  • CosmoDerm (human-derived)
  • CosmoPlast (human derived)
  • Zyderm (bovine)
  • Zyplast (bovine)

 

Treatment and Results

Both human and bovine derived collagen contain lidocaine to minimize injection discomfort. Bovine collagen requires allergy testing prior to injection. The effects are immediate and generally last up to six months.

Side Effects and Risks

Bruising, swelling, tenderness, redness lasting up to a week; possible allergic reaction if bovine collagen is used.

 

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Juvéderm & Juvéderm Ultra

Juvéderm, another hyaluronic acid injectable,  is used to soften deep folds and reduce wrinkles in the faces of patients.  Approved in June 2006 by the U.S. Food and Drug Administration, Juvéderm’s prime use is removing nasolabial folds, or “smile lines,” creases of skin which run from the corners of the nose to the corners of the mouth. It is also used as a lip augmentation agent, and to fill in hollow places and scars on the face.  Juvéderm is also used by physicians to plump lips, which also lose fat and internal shape with normal aging, and for minor nose, chin and jawline augmentations.

 

Voluma

 

Juvederm Voluma XC

Juvederm Voluma XC®  (typically referred to as “Voluma”)  is the newest hyaluronic acid injectable and is FDA-approved for rejuvenating and filling in the cheeks.  It’s a quick, relatively painless way to fill in and lift sunken, droopy cheeks. Studies show it lasts up to 2 years. There is no downtime and usually very minimal bruising and swelling.

Radiesse®

RADIESSE® (formerly marketed as Radiance) is a cosmetic dermal filler that is used throughout the world to diminish the appearance of wrinkles, lines, and facial folds. In addition to the long-lasting results it provides as a cosmetic filler, RADIESSE® is also FDA-approved in the United States to treat oral and maxillofacial defects, vocal cord deficiencies, and is used in the treatment of facial lipoatrophy (facial wasting) in patients with the human immunodeficiency virus (HIV).  Off-label uses for Radiesse include chin or jaw augmentations or minor nose augmentations.

Belotero Balance®

Belotero Balance® is a hyaluronic acid (HA) injectable filler that completely integrates into the skin tissue. While some fillers are designed to rebuild facial volume and structure, Belotero Balance® specifically treats moderate-to-severe etched-in lines and wrinkles such as vertical lip lines above and around the lips and dark circles beneath the eyes.

 

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Restylane / Perlane

The Restylane family of products includes Restylane®, Restylane-L®, Restylane® Silk, Perlane®, and Perlane-L®. Restylane, Restylane-L, Perlane, and Perlane-L can be used to add volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). Restylane, Restylane-L and Restylane Silk may also be used for lip enhancement in patients over 21 years. Restylane Silk can be used to treat lip lines in patients over 21 years.