What areas of the face can be improved with fillers?
Fillers are most often used for the nasolabial folds (crease between the cheek and upper lip, also know as the smile lines), the marionette folds (the crease extending from the corner of the mouth to the chin), and for augmentation of the lips. In the case of shallow folds and lines, gel fillers such as Juvederm, Restylane, Hylaform, Elevess, and Prevelle Silk work best. Typically 1.0-1.4cc of product is adequate to deliver the desired result.

Radiesse, which is a higher density paste, is usually better suited for individuals with deep nesolabial folds and marionette folds. The thicker paste provides more volume for filling these areas. One syringe of Radiesse delivers 1.3cc and is usually adequate to treat these areas.

The ideal filler for lip augmentation and lip lines preserves their soft supple feel. Collagen perfumes well in this location, but unfortunately lasts only 2-3 months. Gel fillers like Juvederm, Restylane, Hylaform, and Prevelle Silk are also good options and typically last 4-6 months.

The under eye area is a common concern s we age. In some cases, the hallowness and dark circles can be addressed with Juvederm, Restylane, Prevelle Silk, Elevess, OR Radiesse. Because of the thin nature of the under eye skin, any filler must be injected into the deeper subcutaneous tissue where the filler will absorb more quickly. Fat, on the other hand, is an excellent permanent filler options for this area.

Crow’s feet and forehead lines are considered dymanic lines; they arise as a result of muscle movement. Botox Cosmetic is the treatment of choice for these lines. When Botox Cosmetic alone is not enough for the deep vertical lines between the eyebrows, the gel fillers can aid in the improvement. Studies show better and longer lasting improvement of these lines with the combination of Botox cosmetic and gel fillers.

Are any filler materials permanent?
Artefill if the only FDA approved non-absorbable filler for the correction of wrinkles knows as “smile lines”. The unique microspheres in Artefill are not absorbed by the body. These microspheres provide the permanent support that skin needs for long lasting wrinkle correction. In a US Clinical trial study, full wrinkle correction was maintained throughout the once year of the study. However European studies have demonstrated up to ten years of effectiveness with similar products.

What should I expect following my filler injection?
With all wrinkle fillers, you can expect mild swelling and redness for the first 24-48 hours. Occasionally there is mild bruising which typically disappears in 3-7 days. Less common side effects include rash, persistent swelling or redness, and increased sensitivity or all injection sites. One other rare potential side effect of all dermal fillers is lumps or unevenness. Unevenness for gel fillers usually responds to massage within 5-7 days. In the case of Radiesse or Artefill, lumps may have signal a tissue reaction. Massage is encourages however further treatment may be necessary.

What improvements can be made in the cheek areas with fillers?
As we age, several events occur around the eyes, cheeks, and midface which contribute to a “tired” and aged appearance. Most notably, we lose fat in our face. This leads to loss of the normal cheek highlight, dark circles under the eyes, and hollowness of the cheeks. Volume restoration is often the treatment of choice. Typically fat transfer to the site or cheek implants provide the best improvement however in selected cases fillers can be used.

Gel Fillers are often used in the under eye area:
This is an area of very delicate and thin skin therefore filler should be injected deep under the eyelid muscle layer. Due to the location of the filler, the results may not last as long. Radiesse has also been injected into this area but is not recommended as the white color of Radiesse may show through very thin transparent skin.

Sculptra is used extensively for AIDS patients with moderate to severe lipoatrophy of the face. It can also be used for the fat volume loss changes which occur with chronological aging. In these cases, several Sculptra injection sessions are nor necessary to achieve the desired result.

How should I choose my Doctor?
All of the currently available filler substances are safe and effective when used correctly. The skill of the injection is easy to learn. What is not easy is recognizing who is a candidate, which of the myriad of fillers and procedures will give the best results, and lastly treating complications and side effects should they arise.  A properly trained physician goes through a complex paradigm of treatment options for every patient. The goal of any treatment with fillers should be to achieve the best possible improvement with the least amount of risk.  The knowledge and expertise comes through years of proper residency training and experience, not from a weekend course. Always check your Doctor’s credentials, qualifications, and look for board certification in facial plastic surgery, plastic surgery, or dermatology.