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Facial fillers replace skin substances that, when lost, cause wrinkles. The skin thins by loss of collagen and fluid. In youth, the skin remains plump from a natural sugar called hyaluronic acid that attracts and binds to the body’s water. Fillers are substances that are injected to fill in wrinkles and facial depressions that may come with age. With the advent of choices for facial fillers, we can choose the best for the specific problem and longevity.
What Do Facial Fillers Fix?
There are now so many fillers available, we prefer to categorize them by their ideal usage. Fillers can be used to treat three conditions:
- Superficial fine lines
- Facial folds and crevasses
- Facial volume loss
We all want fillers to last as long as possible, but don’t want bumps from over-injecting. Gradual, precise and pointed is our method. The most superficial lines, those that appear “etched” into the skin require the thinnest fillers. As the need for more volume replacement increases, fillers are placed deeper and can be thicker. Medium thickness fillers are used for actual folds in the skin and deeper crevasses, such as the naso-labial folds. Naso-labial folds run from the corner of nose to the corner of the mouth. Medium depth fillers also may be very effective for melo-labial folds that run downward from the corners of the mouth to the jaw; otherwise referred to as “marionette” lines. These thicker fillers are also longer lasting than the thin, superficial fillers.
Since there are a number of available fillers for fine and deep wrinkles, both may be used in the same patient, and in conjunction with one another. We often layer fillers in the same areas in order to plump folds and fill the lines that may lie in the depths of those folds.
The thickest fillers are more for volume enhancement for the face that needs to be “plumped up.” As the face ages, the cheeks get hollow in addition to droopy. Patients may need lifting as well as volume. In younger patients, however, facelifts can often be delayed by filling the cheeks. This can actually give a small lift as well and is called the “Liquid Facelift.” Of course, nothing substitutes for a beautiful and professional facelift if it’s a means to elevating jowls or excess skin under the neck. But we can go a long way in making you look more refreshed by starting with fillers.
Facelift VS Facial Fillers
To Lift or Fill the Face?
"I recently saw a patient who came in because I did a facelift on one of her childhood friends and she liked what she saw: a more youthful look without looking “pulled.” She had a facelift about 7 years ago and feels that it helped a little but the skin of her lower face is “wrinkley” with some excess skin under the neck and cheek folds. She sought out a few opinions of other doctors and the suggestions ranged from fillers to implants to a revision facelift. My first inclination was to suggest another facelift. This would help the jowls and extra skin under her neck. What concerned me is that when listening to this lady, she was more distressed about the way the skin hung around her mouth and narrowing of her cheeks.
"As a surgeon, facelifts are more interesting and fun for me to perform, plus this patient was basically asking if a revision facelift would be the best solution without specifically stating it. However, I felt that a facelift wouldn’t be the best initial solution for her concerns. I suggested that we first try Sculptra to restore volume to her face and fill out the deflated cheeks and areas around her mouth. A facelift can be performed later to lift the drooping facial skin and muscles.
"This is really about deciding priorities. I categorize facial aging into 5 categories: skin changes, dynamic muscle action, loss of volume, gravity and loss of elasticity. Everyone experiences all 5 as they age. It’s more a matter of what should be addressed and in what order. For this patient, I feel it is volume first (high volume fillers with longevity – Sculptra) then combat gravity and loss of elasticity next (facelift). The face ages in 5 ways: skin, muscle action, volume loss, gravity and loss of elasticity. When the question is to fill or lift the face, both the doctor and patient need to determine the best treatment plan per the patients priorities."
- Steven J. Pearlman, MD, FACS
Facial Volume Restoration
There are a number of options for facial volume restoration. The most natural technique is using one’s own fat. The fat is re-injected immediately after removing it from elsewhere in the body. This technique is called lipo-transfer. However, we now use it less than we did a few years ago because lipo-transfer is similar to a surgical procedure in preparation and healing time.
Plus there are a number of facial fillers available that can restore facial volume that may last for up to a year or more. These are Sculptra®, RADIESSE®, and the thinker Hyaluronic Acid products; JUVEDÉRM® Ultra Plus.
Medium Depth Fillers (Medium wrinkles):
- JUVÉDERM® Ultra XC
Deep Fillers (Volume loss):
Large Volume Fillers - (when patients require a larger quantity of facial volume enhancement)
- Fat lipotransfer; Spinning the patient’s own fat in a centrifuge and then depositing very small amounts with each of multiple passes. A patient’s fat is the most “natural” filler and the fat has a much better longevity. There is more swelling than with other fillers, but the results are smooth, natural, and often long lasting.
- Sculptra®; poly-lactic acid. Patients retain long lasting facial volume enhancement after two to four injections spaced a month apart. Sculptra® is a true volume filler for the face. It can restore youthful fullness to the cheeks, temples, and anywhere in the face there has been considerable loss of youthful fat. Collagen and hyaluronic acid products are best used for lines, folds and wrinkles. When you desire true restoration of fullness, Sculptra® may be the ideal substance.
- Restylane® Lyft™
- JUVÉDERM VOLUMA® XC
Under eye fillers/ tear trough fillers
Under eye fillers/ tear trough fillers are hyaluronic based fillers that plump up the hollows under your eyes. These fillers help to:
- Restore the padding in the juncture between the cheek and the lower eye
- Give you a well-rested and rejuvenated appearance
- Diminish the appearance of dark circles below the eyes
- Create a smoother facial look, free from undereye hollows
The smoother and finer gel solutions, such as those available in the Juvéderm Ultra and Restylane lines, are often used to subtly enhance the undereye area to give you an untouched, yet refreshed look.
Cheek fillers are used to restore lost volume to your cheeks as you age, or to enhance the contours of your face, for a more defined and youthful appearance. Cheek fillers are often composed of a thicker gel filler that holds its shape and has greater longevity than other fillers. Cheek fillers are an excellent option if you are looking to:
- Restore volume to sagging or hollow looking cheeks
- Raise the height of your cheeks
- Add youthful looking plumpness to your cheeks
- Restore moisture and firmness to your cheeks
- Tighten and add definition to your jaw line
Options for cheek fillers are those such as Juvéderm Voluma XC and Restylane Lyft.
Jawline fillers are often hyaluronic acid-based fillers that are used to bring definition to your jawline and the areas at your jaw and chin. Even by lifting the cheeks, the jawline and face are given a subtle lift. During your consultation your facial structure will be assessed to determine exactly where to add fillers for the most natural-looking definition. Many people choose jawline fillers such as Juvéderm and Restylane products when they are looking to:
- Add definition to the chin and jaw for a sharper and more sculpted facial appearance
- Add volume to the jawline to create greater balance and harmony
Deep line fillers
Deep line fillers are typically hyaluronic based fillers such as Juvéderm XC, Juvéderm Vollure XC, and Restylane Fine Line-L and Restylane Refyne. These fillers come in different consistencies depending on the severity of your facial folds or wrinkles that are being treated. Areas that require more volume to be smoothed will require a thicker gel filler than an area with finer lines and wrinkles. If you are looking at smoothing out facial wrinkles, dermal fillers can benefit you by:
- Adding volume to areas with heavy lines, wrinkles and creases to give them a naturally smooth appearance
- Rejuvenating your face by increasing volume, moisture, and plumpness to your skin while smoothing it
Before and After Gallery
FAQs Facial Fillers
What are the different types of facial fillers?
There are many facial fillers on the market. The fillers we choose are used for the specific area being treated: lines, folds, crevasses or frank volume loss. The most common are hyaluronic acid fillers (HA): JUVÉDERM®, Restylane®, JUVÉDERM VOLUMA® XC
What happens if I do not like it?
Hyaluronic acid fillers can be dissolved by using an enzyme called hyaluronidase.
Can you remove it?
See the above answer. But we suggest waiting one to two weeks since there sometimes is swelling from the injection that can may appear as asymmetry or over treatment.