- 1 Description
- 2 Options
- 3 Facial Volume Loss
- 4 Anatomy of Facial Features
- 5 Indications
- 6 Evaluation
- 7 Types
- 8 DERMAL FILLER PROCEDURE
- 9 Post Treatment Considerations
- 10 Frequently Asked Questions (FAQs)
- 10.1 What are dermal fillers?
- 10.2 What areas do dermal fillers treat?
- 10.3 Are dermal fillers safe?
- 10.4 Why are dermal fillers made with hyaluronic acid?
- 10.5 What is Juvéderm®?
- 10.6 What is Restylane® and Perlane®?
- 10.7 What is Radiesse®?
- 10.8 How much filler will I need?
- 10.9 How long does a dermal filler treatment take to complete?
- 10.10 How long do hyaluronic acid dermal fillers last?
- 10.11 What are the side effects of dermal facial fillers?
- 10.12 How is hyaluronic acid made in dermal fillers?
- 10.13 When will I see the results from my dermal filler treatment?
- 10.14 Will my face look natural after a dermal filler treatment?
Many patients wish to enhance or rejuvenate their aesthetic appearance, but do not want to undergo an extensive surgical procedure. Injectable dermal fillers provide an ideal solution for these patients, because they are non-invasive, require minimal post-treatment down-time, and are an effective means of correcting aesthetic changes resulting from aging, sun damage and facial volume loss. Often referred to as “lunchtime facelifts,” injectable fillers have become one the most popular cosmetic treatments in the United States, second only to Wrinkle Reducing injections (Botox / Dysport / Xeomin).
Dermal fillers are primarily used to restore lost volume to the skin and facial soft tissues. Common areas that are enhanced include the nasolabial folds (the folds at the junction of the upper lip and cheek), marionette lines, smile lines, tear troughs and creases that form along the forehead and upper bridge of the nose. Dermal fillers are also frequently utilized to “plump” and enhance the volume of patients’ lips, and to restore lost volume to the cheeks and temples. In addition to providing the instant cosmetic advantage of filling in facial lines and folds, dermal fillers can also stimulate your skin’s natural collagen growth, which may help prevent the formation of wrinkles and folds in the future.
The dermal filler market has drastically expanded over the past five years, and the availability of new products has made it easier to provide patients with many non-invasive alternatives for facial rejuvenation. Dermal fillers have advanced beyond their primary focus as treatment for facial wrinkles and folds, and are now utilized in more sophisticated applications involving facial sculpting and contouring.
Dermal fillers may be classified according to their source (human, animal, or synthetic), duration of action (temporary, semi-permanent, or permanent), and whether they act as a replacement filler, a stimulatory filler (stimulatory fillers stimulate the body to create tissue in the area injected), or a combination of the two. Primarily composed of hyaluronic acid (HA), replacement fillers offer instantly visible results and restore soft-tissue volume loss by occupying space in the deeper levels of the dermis or subcutaneous space. Commonly used replacement fillers include Restylane, Juvederm, Perlane, and Belotero. In contrast, stimulatory fillers offer long-term rejuvenation benefits by restoring depleted volume through the stimulation of fibroblast activity, collagen synthesis, and soft-tissue growth. Stimulatory fillers include poly-L-lactic acid (PLLA) and polymethylmethacrylate (PMMA), and calcium hydroxylapatite (CaHA), which can also function as replacement fillers. Commonly used stimulatory fillers include Radiesse and Sculptra.
With so many filler options to consider, it is imperative to have your injections performed by a skillful and experienced plastic surgeon. At Gabbay Plastic Surgery, located in Beverly Hills, CA, Dr. Joubin Gabbay M.D. is extremely knowledgeable about all of the latest dermal filler injectables, and will utilize his extensive knowledge of facial anatomy to determine the best treatment approach and filler to fulfill your specific aesthetic goals. Dr. Gabbay offers a wide range of filler injections for women and men in Beverly Hills, Los Angeles and Southern California seeking to minimize wrinkles, fill in folds or indentations, contour facial shape, soften fine lines, and enhance their cheeks or lips.
At Gabbay Plastic Surgery, we understand the pressures of maintaining a youthful appearance while simultaneously keeping up with hectic work and family schedules. We offer a multitude of convenient injectable filler options to enable our patients to enhance and revitalize their appearance with minimal interruption to their daily lives. We will help determine which filler is best for your needs (Restylane, Juvederm, Perlane, Belotero, Radiesse, Sculptra, etc.), and what area of facial enhancement will help you achieve your aesthetic goals (nasolabial folds, marionette lines, tear troughs, smile lines, forehead and brow lines, lip enhancement, etc.). During your complimentary initial consultation at our Beverly Hills, CA office, Dr. Gabbay will custom tailor a treatment plan that will achieve your goals of looking refreshed and youthful. If you would additional information about injectable fillers, please contact Gabbay Plastic Surgery today. We look forward to speaking with you, and to setting up your initial consultation with Dr. Gabbay.
Facial Volume Loss
Along with the development of fine lines and wrinkles, one of the primary visible signs of aging is facial volume loss, specifically in the mid-face, temples, and cheeks. Facial volume loss results from resorption of facial bones, the breakdown of the subcutaneous tissue, and the descent of the fat pads that takes place during the natural aging process or as a result of weight loss, illness, or medical condition.
Injectable dermal fillers provide volume and stimulate the formation of collagen in the face. Since wrinkles are accentuated by uneven soft tissue volume distribution, restoration of that soft tissue will improve the smoothness of the face – the results can be amazing and quite gratifying. For restoring facial symmetry and volume, dermal fillers are the first line of defense in the battle to correct aging facial characteristics.
Anatomy of Facial Features
Achieving desirable cosmetic outcomes and minimizing the risk of complications depends on the knowledge of anatomy and the appreciation for aesthetic facial proportions and symmetry. Facial aging is a combination changes in the anatomy and volume of facial structures, and successful rejuvenation must harmoniously balance both of these components.
The areas of the face that are most commonly treated with dermal fillers include:
- Dermis: The inner, thicker portion of the skin below the epidermis is composed of connective tissue containing collagenous and elastic fibers. Numerous blood vessels, nerves, glands, and hair follicles support the dermal skin from below.
- Subcutaneous Layer: This layer primarily consists of fat and fascia (a connective tissue framework that supports the skin, connecting it to deeper structures within the face).
Anatomical areas that are involved with facial aging:
- Eyelid-Cheek Junction—Ideally this area is a smooth transition from the eye to the cheek and it is a critical area when evaluating the aging face
- Cheek Fat Pad—Location of the fat pad in the face is important to facial contour, and tends to drop with age
- Upper Lip—As you age, this part of the lip looks longer and the red lips become thinner
- Jaw line – The smooth, sharp jawline tends to droop and soften with age
- The Jowels—this junction of the shin and jawline reveals drooping with age
- Chin Projection—A more prominent chin provides more definition to the neck. The chin can weaken with age
- Submandibular Glands—In some people these glands may be prominent on the side view of the neck, below the jawline. Drooping of these glands may contribute ot an ages appearance.
- Tragus—Part of the ear located on the face that changes with age
- Hyoid Bone—A critical bone in the neck that determines how much of an angle can be created in the neck
- Sternocleidomastoid Muscle—A neck muscle that is typically more prominent in me
- Nasolabial Fold— The lines that extend from the outer edge of the nostrils to the corners of the mouth become more prominent as you age
- Marionette Line—The downturned creases at the corner of the mouth and lines along an lower lip become more prominent with aging
Injectable fillers are primarily used to restore lost dermal volume and to treat the following areas:
- Prominent vertical wrinkles, (the “11s”) between the eyebrows
- Nasolabial folds (smile, laugh lines)
- Marionette lines
- Hollows under the eyes
- Hollow cheeks
- Scar correction (depressed scars)
- Wrinkles, lines, and folds
- Thinning lips
- Lipstick lines
- Dark circles under the eyes
- Brow drooping
- Nasal depressions
- Sagging cheeks
- Periocular melanoses and sunken eyes
- Dermatological diseases such as angular cheilitis, dermal atrophy, and AIDS lipodystrophy
- Earring ptosis or atrophic earlobes
- Volume loss in the neck
- Aging skin on the hands
If you are experiencing any of these aesthetic issues, and you are physically healthy with realistic expectations, you may be a good candidate for treatment with injectable dermal fillers.
If you are interested in seeking treatment with dermal fillers, the first step is to contact Dr. Gabbay at Gabbay Plastic Surgery. During your initial consultation Dr. Gabbay will listen to your concerns and analyze your facial anatomy, focusing on the areas that are causing you concern. If it is determined that you are a good candidate for dermal filler treatment, Dr. Gabbay will create a personalized treatment plan to ensure that you achieve the best possible outcome.
Hyaluronic Acid Wrinkle Fillers (Juvederm, Restylane, Belotero): Hyaluronic Acid is a naturally occurring substance in the body that is capable of holding many times its weight in water, and is responsible for keeping moisture in the skin and maintaining the skin’s volume. Hyaluronic acid levels decrease due to aging, genetics, and sun exposure, causing volume depletion from the skin. When hyaluronic acid-based dermal fillers are injected into or under the dermis, they replenishe the skin’s volume and restores a youthfully smooth, full appearance to the skin’s surface.
hyaluronic wrinkle fillers
Hyaluronic acid filler results last from several months to over a year, depending upon the composition of the specific filler. Studies have shown that repeated injections may help to stimulate the body’s own natural production of collagen, meaning that eventually, less filler will be needed to achieve the same look.
hyaluronic wrinkle fillers include:
- Juvéderm®: (Juvederm XC, Juvederm XC, Ultra, Juvederm Ultra XC) Juvederm is a non-animal biodegradable gel made of hyaluronic acid. Juvederm is FDA-approved for the treatment of moderate to severe facial wrinkles and folds, and its results can last up to one year.
- Restylane®/Perlane®: Restylane and Perlane are both made of a natural, biodegradable, gel-based hyaluronic acid. They are FDA-approved for the treatment of moderate to severe wrinkles and folds, and their treatment results can last six months or longer.
Collagen Wrinkle Fillers
The original collagen-based dermal fillers produced excellent results; however, because they were made from an animal source, they had a higher rate of allergic reactions. Newer methods for processing the collagen, along with the formulation of synthetic collagen fillers have made these injections safer and more widely applicable.
Some of the most common collagen-based dermal fillers include:
- Artefill®: Artefill was FDA-approved for use in the United States in 2007, and is considered to be a permanent dermal filler. It is composed of bovine collagen, lidocaine, and non-resorbable polymethylmethacrylate (PMMA) microspheres suspended in a water-based carrier gel. Because of the bovine collagen, skin testing must be performed prior to treatment. Artefill works well in the nasolabial folds and cheek regions.
- Cosmoplast/Cosmoderm: Cosmoplast is made from purified lab-grown human tissue, and lasts up to six months. Cosmoplast is FDA-approved for frown lines, crow’s feet, forehead lines, vertical lip lines, nose-to-mouth lines, lip border, scar filling, and deeper, more pronounced wrinkles. This dermal filler is one of the few fillers that is recommended for treating fine lines around the eyes
Synthetic Wrinkle Fillers
This category of wrinkle fillers is comprised of lab-made substances, many of which offer longer-lasting (sometimes permanent) filling of lines and creases.
Some of the most common synthetic dermal fillers include:
- Radiesse®: Radiesse is a gel-based filler containing calcium hydroxylapatite, and offers results typically lasting up to one year. Some clinical studies have indicated that the body begins producing collagen around the Radiesse micro-spheres, leading to longer-lasting effects over time.
- Sculptra®: Sculptra is composed of a synthetic poly-L-lactic acid (PLA), and is ideal for restoring volume to sagging, wrinkled, and aging skin, especially in the cheeks, chin, and temples. Sculptra works differently from other injectable products, as tiny particles of PLA are diluted in a suspension of sterile water (carefully implanted in the skin) and then molded for optimal results. The PLA particles stimulate the formation of new collagen in the skin, adding volume over time, meaning that the effects of Sculptra tend to last longer than many other fillers (in some cases effects can last up to two years after the first treatment session). The ingredients in this filler are made for deep injections below the muscles, and not designed for injection directly into fine lines.
DERMAL FILLER PROCEDURE
On the day of your dermal filler procedure, Dr. Gabbay will mark strategic points on your face as guides to the appropriate injection sites where the filler will be placed. Your injection sites will be cleansed with an antibacterial agent, and depending on the location and quantity of regions to be injected, the targeted area will be numbed with topical or local anesthesia. Dr. Gabbay will then inject the selected filler into the targeted areas on your face using a fine needle. You may experience a small stinging sensation, which will dissipate after a few moments. The entire injection projection takes only 15-30 minutes, after which, it is imperative that you are careful not to apply pressure to the treated areas, as this may cause movement of the injected filler. You may experience some swelling and bruising from the injections; however, most patients resume their normal daily activities immediately after their treatment. Your initial dermal filler results will be visible within 2-3 days; however, some fillers (ie. Sculptra) take a longer period of time before the full results become visible.
Post Treatment Considerations
There is minimal recovery and downtime following dermal filler treatments, although for 24 hours after treatment you should avoid strenuous exercise and consumption of alcoholic beverages, and you will be advised to wear sunscreen and avoid exposing the treatment area to direct sunlight. Potential (although rare) dermal filler complications include: infection, hypersensitivity reactions, swelling, acne, erythema, redness, pain, firmness, bumps, bruising, telangiectasia, sterile abscess, granulomas, lipoatrophy, and hypertrophic scarring.
Frequently Asked Questions (FAQs)
What are dermal fillers?
Dermal fillers are substances of various compositions, commonly injected under the surface of the skin, used for aesthetic volume rejuvenation. Because of the relative ease of use and impressive aesthetic outcomes, fillers are exceedingly popular; and due to the high demand, a wide variety of FDA approved injectable substances have been introduced into this field of the cosmetic industry.
What areas do dermal fillers treat?
The three “D’s” of facial aging include Decent, Deflation, and Deterioration; and as you age, you lose fullness in your face. Because of lost volume, hollowness takes over round facial features, and dermal fillers will correct the deflation portion of facial aging. In addition, dermal fillers are used for people who want to enhance their natural facial features (including the lips), and they can be injected into areas with fine lines or deeper wrinkles, folds and depressions.
Are dermal fillers safe?
While any medical treatment or procedure has inherent risks and potential complications, facial fillers have been proven to be safe and predictable. The earliest FDA approved fillers consisted of bovine (cattle) collagen, however, the majority of dermal fillers used today are not animal-based, and are typically biocompatible with living tissue, or a living system not causing immunological rejection. Many potential complications from facial fillers can be avoided by choosing a surgeon versed in facial anatomy and knowledge regarding the different fillers, such as Dr. Gabbay at Gabbay Plastic Surgery.
Why are dermal fillers made with hyaluronic acid?
Young, healthy-looking skin contains an abundance of a naturally hydrating substance called hyaluronic acid (HA) and as you age, sunlight and other factors can reduce the amount of HA in your skin. The lack of HA causes your skin to lose structure and volume, creating unwanted facial wrinkles and folds (parentheses lines around your nose and mouth), and hyaluronic acid fillers repair tissue as it improves joint lubrication and cartilage resilience.
What is Juvéderm®?
Juvéderm® is a smooth gel filler used to instantly smooth or soften wrinkles around your mouth and nose, and it is a non-animal product so the risk of allergy is remote. Juvéderm® can be used under the eyes to mask lower eyelid bags, or in the cheeks to achieve a more youthful appearance. Juvéderm® also works well in the lips, and it is relatively long lasting, depending on variables including the amount used and location of placement. Juvéderm® in the lips or facial folds will last approximately six months, while Juvéderm® under the eyes typically lasts over one year.
What is Restylane® and Perlane®?
Restylane® is a hyaluronic acid smooth gel filler that is designed to smooth wrinkles, plump lips, shape facial contours, and it can be used anywhere on the face for volume enhancement. Perlane® is identical to Restylane®, except that the gel particles are larger, and it works as an effective subdermal filling substance to correct nasolabial folds or for cheek enhancement. Restylane® results last approximately six months while Perlane® lasts 9-12 months. Both Restylane® and Perlane® are available with lidocaine infused into the gel, to diminish discomfort during treatment.
What is Radiesse®?
The formulation in Radiesse® stimulates collagenesis (the production of new collagen) resulting in increased volume for natural looking wrinkle correction that may last a year or more in many patients. Radiesse® consists of smooth calcium hydroxylapatite (CaHA) microspheres that are suspended in a water-based gel carrier, and over time, as the patient’s own soft tissue replaces the gel carrier, the newly formed collagen provides the desired long-term effect. Radiesse® is an excellent choice for correcting nasolabial folds or other midface deficiencies.
How much filler will I need?
Fillers typically come in approximate 1cc syringes, and smaller amounts are available for either very small correction areas or for touch-ups. The amount of filler needed for the proper correction varies between the proposed site of injection, the amount of lost volume, the depth of the lines, and wrinkles, and patient/physician preference. 1cc is typically adequate for lower eye bag camouflage or for lip plumping, and nasolabial folds usually require 1cc per side. Patients who want a “liquid-facelift” may require 6cc for a refreshed and rejuvenated appearance.
How long does a dermal filler treatment take to complete?
Treatment time varies depending on the amount of filler being used, the areas being treated, and your individual anatomy and needs. Most treatments involve the use of topical anesthetic, which takes fifteen minutes to take effect, and the application of the dermal filler takes another fifteen minutes to complete. Occasionally, multiple treatment sessions are booked in order to achieve the desired look.
How long do hyaluronic acid dermal fillers last?
How long the result of dermal fillers last depends on the type of filler used. Hyaluronic acid fillers typically last 6-9 months or longer (depending on the location and depth), and the lips do not last as long as the nasolabial folds or around the eyes. We have found that Hyaluronic acid fillers last more than a year when placed under the eyes to camouflage bags.
What are the side effects of dermal facial fillers?
Dermal filler side effects are usually mild to moderate (lasting 7 days or less), and may include temporary injection-site reactions such as redness, pain, firmness, swelling, and bump. Bruising occurs on occasion and is more likely in patients taking blood-thinning medications such as aspirin or Non-Steroidal Anti-Inflammatory drugs (NSAIDS). Certain herbs and vitamins may also thin the blood and increase the chance of post-treatment bruising, and that is why it is recommended that all blood-thinning medications be discontinued for 7-10 days prior to dermal filler treatment.
How is hyaluronic acid made in dermal fillers?
The hyaluronic acid in dermal fillers is biotechnologically produced by bacterial fermentation. It is then extracted, purified, and stabilized to increase its longevity in the tissue, and it is prepared in a gel that can be administered in syringes.
When will I see the results from my dermal filler treatment?
Results depend on the type of filler used and although you will see some immediate results, after the temporary redness and mild swelling subsides (2-3 days) you will see the final effects.
Will my face look natural after a dermal filler treatment?
Although some celebrities are noticed because they have had excessive facial injection treatments, Dr. Gabbay always provides aesthetic treatments that yield natural looking results. Your treatment with dermal fillers is not intended to radically change your facial appearance, and they should never make you look “unnatural”.