Facial Fillers – Juvederm, Perlane, Radiesse, Restylance and Sculptra
New and better ways to use facial fillers for facial folds and anti-aging
New York City, NY – As I perform more and more facial filler treatments, I am using less and less in the nasolabial folds and more in the mid-cheeks for a more youthful appearance.
Most patients seen in consultation for treatment with fillers point to their nasolabial lines and folds. The nasolabial folds are the lines and folds that go from next to the nostrils to the corners of the mouth. They are caused by the facial muscles inserting into the skin at that fold. Smiling, laughing, living creates the folds and etched lines in the overlying skin. Add this to sagging of the cheeks over this fixed line of attachment. The cheeks drape over the fold creating a mound that exaggerates the fold.
When patients with nasolabial folds are examined, most have both the fold and the mound. As explained above, the mound is partially draping of the skin and underlying fat/muscle over the fold. A third contribution is age related loss of volume in the mid-cheek. If we just fill the nasolabial fold below, patients might appear almost like a rhesus monkey. What most patients really need is refilling of the mid-cheek area, and then only a little filler is necessary for the nasolabial fold. By re-inflating the cheeks, the nasolabial mound and fold are lifted up and out creating a natural, more youthful facial appearance.
If you want to simulate what this looks like, just smile. Mid-face fullness might be one of the reasons why people look better when they smile.
Which fillers do I use? For first timers and those who need a little filler, I prefer 1 to 2 cc of Juvederm Ultra Plus. A little more, Radiesse and for the most volume and longest lasting result, Sculptra.
Steven J. Pearlman, M.D., F.A.C.S; Facial Plastic Surgeon
Facial Fillers New York City
New York City, NY – This is a filler update from the Fall AAFPRS meeting, where there was a big push from the new fillers on the block. Though Sculptra has been around for years to treat facial wasting, it was recently FDA-approved for cosmetic use to treat “shallow to deep smile lines (nasolabial fold), contour deficiencies and other facial wrinkles.” However, many of us facial plastic surgeons have already been using it for years as “off label” for cosmetic treatment of the face.
Over the past decade, we have taken a new look at facial aging. Faces don’t just droop and get wrinkles, often they lose volume. Dr. Sydney Coleman was one of the first doctors to disseminate that concept, and treated facial volume loss with fat liposculpture, which was a powerful adjunct to treating facial aging. Some patients really don’t need facelifts, and others need both volume replacement and lifting. Until Sculptra – as well as some of the other longer lasting fillers such as Radiesse, Perlane and Juvederm Ultra Plus – fat was the best option. However, fat rejuvenation is a surgical procedure that comes with prolonged healing and downtime, and some patients only retain 60 to 80% of the injected fat on average, so results are often unpredictable. And to inject more fat requires another semi-major procedure. You might also be one of the rare patients in whom 100% of the fat lasts, resulting in an over-filled face.
Alternatively, Sculptra, a non-invasive injectable, can treat volume loss precisely and effectively in just two to three treatments… no operating room, sedation or significant recovery required.
Results typically last two or more years.
Why Sculptra instead of other fillers? This is really a choice to be decided upon between physician and patient. As I mentioned above, Sculptra may require two to three treatments a month apart, lasting an average of two years before it starts to slowly go away. No other fillers last as long. So, do you want to have this “in and out” treatment with little to no down time and maybe a tweak in one and two months, or get treatments every 6 to 9 months with other fillers, which can be costly over time. Though Sculptra is more expensive, it really doesn’t cost more than shorter-lasting fillers when amortized over two years.
The “must-wear” look for fall.
New York is still buzzing from the recent fashion shows in Bryant Park. So what did I see? That fashions are always changing but one thing remains the same: beautiful models. What do all these models have in common? Spectacular cheekbones. Regardless of the trend for more “quirky” fashion faces what has remained the same for decades are those angular cheeks; they frame the face and create highlights that distinguish beauty and frame the face. Structured cheeks are also a sign of vitality. Great cheekbones highlight the eyes, too, adding overall balance to one’s facial features. Cheekbones are the foundation of a drop-dead gorgeous look.
Patients seeking celebrity cheekbones are fast on the rise. Not long ago, it required a surgical procedure with insertion of cheek or malar implants. This is still a feasible operation for those who desire long lasting results. However, with the myriad new facial fillers, I can create stunning cheeks without surgery.
The fillers that I use to create Runway Cheeks TM are hyaluronic acid: Juvederm Ultra Plus and Perlane, or calcium hydroxyl appetite: Radiesse. The procedure is performed in-office and takes just about 20 minutes. There is minimal discomfort and little-to-no bruising. You can go straight out to lunch, back to work, or shopping on Madison Avenue directly after. So, if you want to look like you just stepped off the runway, this procedure is your dream look and the right option for you.
As I perform more and more facial fillers to restore youthful cheeks, I continue to be excited about the wonderful changes we see with only one or two cc’s of filler. Most patients who are candidates either ask about treating nasolabial lines and folds (they run from the corner of the nose to the mouth). However if you look more closely at their cheeks, as people age beyond the mid 30’s we lose the baby fat that gave us youthful fullness. Remember those cheeks that your aunts and grandmother used to pinch?
Now, when I look closely at these cheeks, I often see a mound (cheekbones), hollowness beneath, then a nasolabial “mound” then the nasolabial fold. Filling just the nasolabial fold doesn’t go very far in making patients appear more youthful. What I prefer, and most patients agree, is to first restore volume to the cheeks. I use filler to restore volume under the cheekbones. Then I need only a little filler in the actual nasolabial fold since the volume restoration lifts the nasolabial folds up and out. On “beginners” we often start with only 1 cc (syringe) of filler. For more volume, 1 per side is sufficient. To enhance cheekbones, the filler can be tailored to each patients’ needs by highlighting, restoring or creating beautiful cheekbones as well.
What filler do I like to use? On a first-timer, I usually start with Juvederm Ultra. This is the smoothest, most mold-able filler and it gives the most subtle enhancement. I sometimes use Restylane as well but find that Juvederm is more mold-able. These fillers typically last from 6 to 9 months in the cheeks. For more volume and a longer lasting effect the next choice is Juvederm Ultra Plusor Perlane (basically, this is thick Restylane). These fillers provide more volume. Plus they often last from 9 months to a year. Want even longer lasting effects, especially for building high cheekbones? I will address this in a future blog. It is what I call Runway Cheeks. The next choice following hyaluronic acid fillers (Juvederm, Restylane and Perlane), I use Radiesse, for a 1 year plus result.
When patients have very hollow cheeks and require a large volume replacement. My first choice is Scuptra. Using one’s own fat for fat transfer is also an option.
So for beautiful, youthful cheeks there are many options. The best option is to come in or visit your favorite facial plastic surgeon for personalized recommendations. By the way, the same choices and process applies to melolabial folds or marionette lines that run from the corners of the mouth downward.