Dermal Fillers

In the beginning, man and womankind stumbled upon the neuromodulators, Botox, Dysport and Xeomin. Neuromodulators denervate muscles causing them to relax. Her wrinkles smoothed and she knew it was good. But, in an ironic moment of clarity, she realizes there’s a difference between sagging and aging skin, and the result of a repetitive action.

At first, we tried filling the lines. This proved unsatisfactory because gravity was not the cause of the aged look, but the effect. A youthful face, as defined by the “ Ogee Curve,” exhibits convexities and arcs, reflects light and contains ample volume. The Ogee Curve” is defined by a convex sloping of the cheek from the infraorbital rim, below the eyes, over the cheek, followed by a concave curve from the lower portion of the cheek toward the jaw.

With aging, volume loss, specifically bone and fat in the cheeks and hollows flattens the curve. The facial muscles sink towards the surface of the skin, which in itself loses thickness, elasticity, and tone. The convexities straighten then become concave.

Instead of reflecting light, the skin looks shadowy. Lifestyle choices including sun exposure, a poor diet, inadequate exercise regimen, and hormonal deficiencies result in a look as old as we are. B-the-by, the volume loss occurs seven years before gravity takes effect.

What to do? What to do?

Enter dermal fillers. Replacement fillers diminish facial lines and spaces, restore volume, recreate the Ogee Curve, and are safe, less costly and less painful than an invasive facelift. They plump thinning lips, soften facial creases and wrinkles, remodel facial contour deformities, diminish lower lid shadows, and improve the appearance of scars.

Remember, dermal fillers and neuromodulators for that matter, do not achieve the same results as a full on face, brow or eye lift. These nonsurgical techniques are great, but they are temporary solutions requiring repeat treatment.

A variety of materials are used as Replacement Fillers. These include:

  1. Calcium Hydroxylapatite -(Trade name: Radiesse)
  2. Hyaluronic acid -(Trade names: Juvederm, Perlane, Restylane)
  3. Polyalkylimide-( Aquamid)
  4. Polylactic acid– ( Sculptra)
  5. Polymethyl-methacrylate microspheres (PMMA)- (Bellafill)

The Skinny on Each:

  1. Calcium hydroxylapatite: (Radiesse)
    A mineral-like compound.found naturally in human bone calcium hydroxylapatite is indicated for moderate-to-severe depressions found in nasolabial folds, marionette, and frown lines.Calcium hydroxylapatite enhances cheek fullness and improves volume in areas of facial wasting common among HIV-positive patients.Produced animal and animal product free, calcium hydroxylapatite lessens allergic reactions, produces a natural result, doesn’t migrate and has an excellent safety record. It is not recommended for lip injection.
  2. Hyaluronic acid: ( Juvederm, Perlane Puragen, Restylane, Belotero Balance)
    a. Hyaluronic acid occurs naturally in the skin, subcutaneous and connective tissue, joint cartilage and synovial fluid. It improves skin contour and reduces irregularities in the skin due to scars, injuries, acne, cheek hollows, nasolabial folds, frown lines, marionette lines, lip thinning, smoker’s lines, facial scars and “that worried” look.
  3. Polyalkylimide ( Aquamid ): Treats deep wrinkles in the nasolabial folds and fills depressed scars. It plump lips, enhances cheekbones, the jawline, and replaces facial volume lost due to age. Aquamid is recommended for facial wasting from HIV medications.
  4. Polylactic acid ( Sculptra): Polylactic acid stimulates collagen production after injection.Known as a stimulator, Sculptra is non-toxic and biodegradable. Polylactic acid works best in the lower half of the face to fill laugh lines, plump lips, soften deep nasolabial folds.
    a. Sculptra stimulates collagen production.
    b. Results appear gradually over several months.
  5. Polymethyl-methacrylate microspheres (PMMA)-( Bellafill )
    a. PMMA treats medium-to-deep wrinkles, folds, and furrows, particularly nasolabial folds. It also fills out pitted scars and augments thin lips.

PMMA requires multiple injections to create volume. Full effects may not be evident for up to three months.

Which Filler for Specific Tissues? (1)

  1. Superficial Dermis : Belotero Balance, Restylane Silk
  2. Mid Dermis: Restylane, Juvederm Ultra, Belotero Balance, Restylane Silk
  3. Deep Dermis: Restylane Lyft, Juvederm Ultra Plus, Radiesse, Bellafill
  4. Subcutaneous Fat : Juvederm Voluma, Restylane Lyft, Bellafill, Sculptra
  5. Subperiosteal (on bone): Juvederm Voluma,Restylane Lyft, Bellafill, Sculptra

Treatment Areas

  1. Tear troughs
  2. Ear Lobes
  3. Hands
  4. Cheeks and Nasolabial Folds
  5. Temples
  6. Jaw Line
  7. Brow Lift
  8. Glabella
  9. Lips
  10. Perioral area
  11. Oral Commissure and Marionette Lines
  12. Chin Crease

Safety or What Can Go Wrong? (2)

Severe complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

  • Acne-like skin eruptions
  • Asymmetry
  • Bruising, bleeding from the injection site, swelling
  • Damage to the skin that results in a wound and possible scarring
  • Infection at the injection site
  • Lumps
  • Palpability of the filler under the surface of the skin
  • Skin rash with itching
  • Skin redness
  • Under- or over-correction of wrinkles
  • Blindness
  • Skin necrosis (ulceration or loss of skin from disruption of blood flow)

These risks and others will be fully discussed prior to your consent.

Although good results are expected from your procedure, there is no guarantee that you will be satisfied with your results. Is it possible to achieve optimal results 100% of the time? Of course not. Fillers dissipate over time. To maintain your correction, you will need to consider repeating the injection process at varying intervals. (3)

  1. Esthetic Training Institute, Training Manual for Medical Professionals, 2011, 41.
  2. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/safety
  3. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/safety