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Most dermal fillers are made of hyaluronic acid, which is naturally present in your body's cells. Hyaluronic acid injections are commonly used to restore volume, contour cheeks, plump lips, fill-in hollows, correct facial lines and folds, and rejuvenate hands, to name just a few uses! Upon injection, they readily attract and hold moisture for instant plumping and hydrating effects.
Juvederm and Restylane, are currently the most popular families of hyaluronic acid fillers. Properly placed, these fillers can make a big difference in the nasolabial lines from nose to mouth, marionette lines from outer lip corners to chin, jowling, and cheeks. Depending on the site of placement, typical duration averages about a year.
Allergan Juvederm fillers include Juvederm Ultra and Ultra Plus, Juvederm Voluma, Juvederm Vollure, and Juvederm Volbella. Galderma Restylane fillers include Restylane, Restylane Lyft, Restylane Refyne and Defyne, and made expressly for lips, Restylane Kysse.
Other Volumizing Fillers
Radiesse (calcium hydroxylapatite) and Sculptra (poly-L-lactic acid) are two well-known collagen stimulating volumizing fillers.
When injected into soft tissue, they produce an inflammatory response that encourages collagen growth around the injected product. As a result, they reinforce the skinâ€™s foundation and provide long-lasting results (up to 1-2 years).
Radiesse’s texture and composition makes it perfect to fill hollow temples that give that "peanut head" look, and also create amazing "snatched jawlines" by contouring the lower jaw. Hyper-dilute Radiesse can be injected into the décolleté chest area to refresh and rejuvenate those lines caused by aging, sun damage, and sleeping on our sides. Other areas for hyper-dilute Radiesse include wrinkled knees, horizontal neck bands, and crepey underarms.
Radiesse was the first FDA cleared volumizing filler for back of the hand rejuvenation. Aging hands have prominent veins and sunken hollows that plump up beautifully when injected with Radiesse.
Sculptra is a a wonder for thinner faces, faces with all over fat loss sometimes attributed to runners or just aging. Injected at the optimal depth into the facial tissues, Sculptra will gradually help re-grow your own collagen to fill it in, but will not make you look “puffy!” It also helps the skin’s surface improve in texture and tone—bonus!
Since Sculptra grows your own collagen, we can also inject it into the buttocks to increase fullness and to lift sagging and loose buttock skin. Ask us about Sculptra butt-lifts!
Advancement in Filler Techniques and Composition
Have you noticed the evolution in filler recommendations and injection techniques that has happened in the last decade? We are no longer chasing wrinkles and folds.
Instead, we are creating scaffolding and foundational structural support to restore lift and replace natural looking volume using today’s highly advanced techniques. Injecting just the nasolabial folds or splitting a syringe between cheeks aren’t valid treatments anymore because we now know better!
I have patients who dictate where to place the fillers based on old knowledge, but where YOU think you need filler may in fact not be the best area to inject. Of course, it is always a discussion between patient and injector, but I suggest being open to previously unknown options. For the best results—not just so-so results—it’s important to be open to your injector’s suggestions and recommendations.
How Many Fillers Do You Need for the Best Results?
Do you remember when injectors would only inject the nasal labial folds (lines from nose corners to outer corners of the mouth)?! We were chasing the folds and plumped them up! What we now know is that multiple syringes of filler in strategic places are needed for optimal results.
Newer hyaluronic acids are less chemically modified, more like the natural hyaluronic acids found in our bodies, are designed for dynamic facial movement, and will last longer. Some last up to 12-15 months!
Did You Know
- We know that a single filler in the face can be underwhelming.
- 40-year olds and up typically need multiple syringes.
- It takes FIVE 1mL fillers to equal a single teaspoon!
- Cheek filler does MORE than replace lost volume. Structural cheek filler also supports the upper lip and smile lines and reduces the appearance of the nasolabial folds (parentheses from outer nostrils to mouth corners). The latest advancements in filler technique recommend 4 syringes in the cheeks alone!
- For better definition of the lower face, current injectable techniques recommend jawline and chin fillers. This improves the jowls, creates scaffolding under the lower lip to help with “The Joker” lip and downturned lip corners.
- Small chins can accentuate your nose, and a weak jawline makes your chin appear larger! The latest recommendations are for multiple syringes in the jawline and chin to balance your facial features to enhance your attractiveness.
- Results are dependent on number of syringes
What if I Hate My Fillers?
If you've had Restylane, Juvederm or another HA filler they are reversible! Hyaluronidase is the enzyme that dissolves facial fillers. This is beneficial in cases when you have an extra lump or imperfection that you don't like. For safety reasons, it's also good to have the option of being able to dissolve the filler.
Often if it is a patients first exposure to hyaluronidase, we will do a patch test on the arm to ensure the patient is not allergic to the product before proceeding with dissolving filler in facial tissues.
A history of allergic reaction to wasp or bee stings represents an increased risk of allergic reaction to hyaluronidase and should be considered as a relative contraindication, as the venom of stinging insects might contain hyaluronidase and this mechanism might be the source of sensitization in affected individuals. Unless there is a past medical history of allergic reaction or anaphylaxis to hyaluronidase or insect bites, previous history of allergy seems unrelated for the administration of hyaluronidase and it can be safely performed.
Just like overfilling can happen with filler, so can over dissolving. this is why we tend to go slowly and in stages, choosing the right concentration and unit to inject, however at times a patient's response is beyond our control.
It is normal to get some natural hyaluronic acid temporarily breaking down (adjacent area) but this quickly regenerates with out own bodies natural HA product within a few weeks, and ultimately collagen remodelling that happens 2-3 months post.
If a patient is looking for some aesthetic adjustments, and wants to go ahead with dissolving, they must understand that they might also need to replace areas that may have dissolved unevenly with dermal filler. If the treatment was performed at another clinic, then this will be at the patients expense.
In addition to re-treatment, hyaluronidase can be repeated as soon as 2 days, however 1-2 weeks is encouraged to add more dermal filler in a previously dissolved area to ensure all swelling and injury has resolved and the patient is back at baseline.
Is it Safe to Get the COVID 19 Vaccine After Fillers?
The Amercian Academy of Dermatology says that prior use of fillers should not prevent someone from getting the COVID 19 vaccine. Read more about their full recommendation.
Injectables are extremely versatile and can help women and men enhance, improve or reverse the signs of aging. It can be used to treat virtually any part of the face, including:
- Under eyes
- Folds around the mouth
Fillers last 9 months to 18 months depending on the amount injected, filler used and area. Higher-movement areas (mouth) tend to have a shorter duration than areas that move less (cheeks).
Treatment cost varies by area and desired outcome, but expect $500 to $3000 for full facial correction.
Fillers can be used on various areas of the face to enhance your look or roll back time.
I wanted to say that I am very happy with the treatment Dr. Amiry did for me. The changes he made were "the exact right thing!" 🙂
What a great experience! After my treatment, I could tell an immediate improvement in my facial contour and for several days afterwards. Family and friends have commented on how great I look! The staff & Dr. Amiry all make my visits something I look forward to.
Excellent work with fillers and Botox. Dr. Amiry listens carefully and seems to have that special knack of knowing what the customer wants and needs. Always pleased with the results!
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