When choosing a physician for dermal fillers, remember it’s “The Filler”, not the filler!
Dr. Weiner is a physician trainer for the Restylane Family of Products, Sculptra, and Bellafill and has Presidential Elite Status (Highest Level of Volume Use) for Galderma (Restylane/Sculptra/Dysport).
We are offer a large variety of fillers which includes:
- Restylane L
- Restylane Refyne
- Restylane Silk
- Restylane Lyft
Dermal fillers are now mostly used for volume replacement and not just for filling lines and wrinkles.
The aging face is the summation of several different factors. Skin pigmentation (hyperpigmentation, solar lentigos) and textural changes (wrinkles, pores) are the results of accumulated UV damage (sun damage), age related tissue changes (loss of collagen, thinning dermis) and over-activity of the facial muscles. These skin issues can be improved with lasers, chemical peels, neuromodulators (Botox or Dysport) and a high quality skin care regime that includes some form of Retin A (or retinoid) and growth factors. However, the most significant reason a face “looks old” is due to volume loss. As a person ages, fat, muscle, and bone are lost leading to:
- Temporal wasting which also causes laxity of the skin around the eye
- Bags under the eyes
- Droopy upper eyebrows and eyelids
- Tear trough and malar (cheek) groove formation
- Sagging or loss of well defined cheeks
- Deepening of the nasolabial folds
- Jowls and marionette lines
- “Pointy” chin
- Lengthening of the space above the upper lip (because of bone and fat absorption)
- Hollowing in the area in front of the ear
- Loss of the well defined jawline
- Loss of lip fullness, “smoker’s lines”
- A nose that appears longer (actually it’s not, but looks that way because the surrounding tissue has resorbed)
Another “by-product” of volume loss is overall facial skin laxity. Up until recently, the consensus among plastic surgeons was that the loose skin was mainly the result of the effects of gravity. This lead to the rational for tightening the face with facelifts. Unfortunately, many people who had this procedure, had tighter skin but actually looked worse. The surgeons weren’t accounting for the volume loss, and faces looked windblown or skeletonize.
In reality, many people can be completely improved with fillers for volumization and avoid surgery altogether, or at least put if off for several years.
The popularity of dermal fillers has grown from filling the smiles lines and lips to placing them in just about every aspect of the face. Fat loss is the primary reason for the volume lost in the face and there are dozens of named fat pads throughout the face. The most popular products, such as Restylane, are made from hyaluronic acid (HA), a naturally occurring component of the skin and joints. There is a “dissolver” called hyaluronidase which can be injected into the filler and within hours to days can remove any misplaced product. This is a nice safety valve for the patients that have some hesitations about the procedure.
Another class of fillers is called “collagen stimulators.” These products when injected, stimulate the body to produce collagen. Newly formed collagen can last years if it was not subject to breakdown by UV exposure, oxygen radicals, and aging. Radiesse, Sculptra, and Bellafill fall into this category. These products last longer than the HA fillers, with Bellafill approved for 5 years, Sculptra approved for 2 years, with Radiesse lasting about 12-18 months.
How are dermal fillers administered?
Dr. Weiner has been using blunt cannulas for his filler injections since 2012. Only 5% of physicians use this technique. With use of cannulas, the procedure has less pain, less bruising, and less downtime. Most importantly, there is increased safety with cannulas. The chances of vascular occlusion are minimized with cannulas because entering a vessel is significantly more difficult when the tip is rounded (cannula) vs a needle (sharp). Needles are used for lip injections and with the dermal injections associated with Refyne and Defyne.
Which areas are commonly injected?
The areas injected with dermal fillers are:
- Nasolabial folds (lines from the nose to the corners of the mouth)
- Lips (for fuller lips)
- Under the eyes in the tear troughs
- Forehead creases (usually only after Botox® administration)
- Cheeks (to enhance and lift the cheeks)
- For Jowls Improvement
- Marionette lines (vertical lines from the corner of the mouth and downward)
- Frowning mouth (used to turn up the corners of the mouth)
- Chin crease (soften this area), and for Chin Augmentation
- Nasal area (to hide humps)
- Wrinkles around the mouth and cheek area, “Smokers” lip lines
- Temples (fill in hollows found in weight loss, athletes, and in age related loss)
- Preauricular (in front of ear area, particularly common in people who have had facelifts)
How long do the dermal fillers last?
Dermal fillers can last anywhere from 3 months, up to 18 months or longer. Sculptra and Bellafill are the longest duration fillers and can give sevaral years worth of correction. The exact duration is determined by the area of placement and the dermal filler used. In general, the more muscle movement, the less longevity of the filler. Dermal fillers are gradually reabsorbed and when they are fully absorbed, you can expect to go back to your pretreatment appearance. It is recommended to have touch up injections rather then wait until complete absorption occurs.
Duration of Fillers
Measure of G’ (Lifting ability of the dermal fillers)
Note the higher G’ of the Radiesse, Perlane (Lyft) and Restylane vs the other Juvéderm products. This ability to lift is why Dr. Weiner has chosen these products to use in the cheeks over Voluma or Juvéderm.
Afterwards, what can I expect?
One can expect some post treatment swelling for a couple days, which may last up to one week. It is therefore recommend to not have this treatment within 2 weeks of any special occasion that is planned. Bruising can occur and can last up to 2 weeks but with blunt cannulas, bruises are much less common. If one develops a bruise, we offer complimentary Excel V laser treatments which will decrease the duration to just a couple of days. Sleeping with the head elevated on 2-3 pillows leads to less swelling and should be done for a couple of days.
Restylane®, Restylane Lyft, Restylane Silk, Restylane Refyne, Restylane Defyne
Restylane has been approved in the US since 2003 and has been used in over 20 million patients worldwide. It now consist of a family of products including Silk, Lyft, Refyne, and Defyne. It is composed of crossed linked hyaluronic acid (HA). HA is a naturally occuring substance found in the skin, joints, and throughout the body. Each of the different products are specifically suit for various indications and areas of the face.
Restylane is composed of similarly sized HA particles, with a concentration of 100,000 per ml. Lyft, a “cousin” of Restylane, is exactly the same as Restylane, except that it’s concentration is 10,000 particles per ml. Restylane Silk is composed of 500,000 HA particles per ml.
Dr. Weiner has been recognized as Presidential Elite Status for Restylane, which places him among the top volume user of Restylane products in the US. He is a lecturer and physician trainer of injection techniques for Galderma, the parent company of Restylane.
Sculptra is a unique filler. Its roll is to improve large areas of volume loss. It forms a scaffolding in the cheeks, temples, preauricular area, nasolabial folds and perioral area. It is typically done in 3 sessions, with about 6 week intervals. The PLLA composition of Sculptra acts to stimulate one’s collagen. Collagen generation takes about 3 months to begin, and is often only starting to be appreciated by 6 months. Its full correction is seen about 9-12 months after administration. The initial correction subsides after about 2 days because the injected material is mostly water. Dr. Weiner is one of the few physicians in the US who used blunt cannulas for the Sculptra injections. This leads to more comfortable injections, less bruising, and safer treatments.
Sculptra has recently been popularized for use in areas off the face. Dr. Weiner has used Sculptra in the decolleté, cellulite, and in the buttocks (for both cellulite and enhancement).
Bellafill is a collagen stimulating filler that can be considered a permanent filler. It is composed of poly methyl methacrylate (PMMA), a synthetic material, which has been used in the operating room since 1949. The filler is composed of millions (per cc) of symmetric, identical spheres of PMMA, that are a little bigger than a white blood cell. They are suspending in bovine collagen which is absorbed in 4-6 weeks. There is a chance of an allergic reaction of the collagen, so all people need to be tested (by placement of a small quantity in their forearm) before getting Bellafill. The correction obtained by the Bellafill is long lasting because the body can’t break down the PMMA. As the body digests the bovine collagen, it is creating its own collagen in response to the PMMA spheres. Studies have shown that the correction at 5 years is even better than the 1 year result. The only other fillers that come close are fat and silicon. Fat requires a harvesting procedure (liposuction) and is very difficult to fine tune. It also has unpredictable “take” so touch ups are the norm. Silicon, is not an FDA approved filler, and requires multiple procedures to get to the end result. It has also been noted to have a significant risk of granulomas, something that has not been borne out with Bellafill.
Bellafill has recently been FDA approved as a 5 year filler with safety data showing minimal risks of complications at 5 years.
Bellafill is also the only approved filler for improving acne scarring. It is best used for the rolling (saucer like) scars which distensible (smooth with stretching). Often Bellafill is combined with the Genius procedure to get the best results. Smaller scars, ice pick scars, and boxcar scars can’t be treated with Bellafill.
Bellafill is typically injected in a kit of 5 syringes (for cosmetic uses), but many people will require more than this. Also, it is probably best to plan the full correction in 2 stages – with the first one being about 2/3 of what is actually needed and upon a follow up visit 2-3 months later, the fill is completed.
Certainly Bellafill is not for everyone getting filler. The best candidates are patients with mild-moderate volume loss who are experienced with other fillers and have “injection fatigue”. Although the cost upfront is more than other fillers, it is more economical than all other fillers when considering its longevity. One other very important factor is to choose your physician carefully. The results of Bellafill are at least 5 years, so you want to go to a very experienced injector who is very comfortable with using blunt cannulas (the preferred method for filling) and knows the anatomy of the aging face extremely well.
Radiesse is a FDA approved filler that is known for its longevity. It has been reported to last for 18 months. Occasionally, a small “touch up” is required at about 6-9 months to achieve this duration. The composition of Radiesse is microscopic spheres of calcium in liquid slurry. The longevity of the correction is the result of the body creating new collagen in response to the Radiesse. The liquid portion of the filler is absorbed in 3-6 months and when that is absorbed, but before the collagen is completely integrated is when a touch up might be needed.
Radiesse is an ideal filler for the nasolabial and marionette lines and is The Aesthetic Cliniques preferred filler for raising the corners of a dropping mouth. One great benefit to using Radiesse is its longevity, and that it comes in 1.5 cc syringes, which is 50% more then Restylane and nearly 100%. In addition, 1cc of Radiesse corrects approximately 30% more then 1cc of Restylane.
A recent study has shown that Radiesse has the highest satisfaction rate among consumers of all the dermal fillers in the 97% range.