Fillers are used to fill in wrinkles and facial depressions that may come with age. Many patients misunderstand fillers and sometime confuse them with BOTOX Cosmetic. Fillers are substances that are injected under the skin or lips to plump up the tissues. Facial fillers replace skin fluid that, when lost, cause wrinkles. In youth, our skin is plump from a natural sugar called hyaluronic acid that attracts water. As we age, our skin thins by loss of collagen and fluid.
Since there are a number of available fillers for fine and deep wrinkles, both may be used in the same patient. We often layer them in the same areas in order to plump folds and fill the lines that often lie in the depths of those folds. They can be given in minutes with a tiny needle to give definition to the lips and fill other wrinkles such as laugh lines. The results are instantaneous, producing a long-lasting (6-9 meses), natural enhancement, which is gentle and safe to the skin. You may return to normal activities within hours.
Restylane, Perlane, Juvederm & Ultra Plus
These are all crystal-clear biodegradable synthetic injectable gels. These products use no animal-derived materials, so there is no need for a spot test before treatment. This filler material (hyaluronic acid) is naturally occurring in our bodies and it attracts water, hydrating your skin.
Superficial Fillers (Fine lines and wrinkles)
Restylane and Juvederm are smooth consistency gels made of hyaluronic acid. These injectable gels are placed under the skin to reduce fine lines and wrinkles providing a smooth, natural look and feel.
Medium Depth Fillers (Medium wrinkles and folds)
Perlane and Juvederm Ultra Plus are clear medium volume injectable fillers with a larger molecular size to augment the lip and fill larger areas by lifting and adding volume. Medium depth fillers are used for folds in the skin and deeper crevices. Medium depth fillers are very effective for naso-labial folds, which run from the corner of the nose to the corner of the mouth. They may also be effective for melo-labial folds (marionette lines) that run down from the corners of the mouth to the jaw. They may also be used for lip augmentation providing plumping and volume. These fillers are also longer lasting than the thin, superficial fillers.
The thickest fillers are better for volume enhancement, and are used to treat the areas of the face that need to be plumped up. One option for large volume replacement are using one’s own fat. The fat is re-injected immediately after removing from elsewhere in the body. There is more swelling than with other fillers, but the results are smooth, natural and often long lasting.
Where are Fillers Used?
For the lips, fillers can increase lip size as well as enhance the definition. They can also plump out lipstick lines. In the lips, the filler is used to enhance the natural lip outline and definition that is lost with aging. It is also used to plump the lips to actually make them bigger and to show more of the lip. For many patients, one syringe may be enough to plump both lips.
For skin wrinkling, fillers are usually used for nasolabial folds (laugh lines) or bigger, deeper wrinkles. Fillers can also be used to augment facial anatomy as in making bigger cheeks, chin or filling in defects and scars. For nasolabial folds (laugh lines) the filler is injected to soften the fold. Patients must understand that the fold will not be totally eliminated (actually adults would look unnatural without any smile lines). For most patients with moderate to deep nasolabial folds (smile lines) a syringe of filler for each side is needed.
The newest application for fillers is the tear trough area under the eyes. Fillers can also be used to fill in the lines that are underneath the lower eyelids called the tear troughs. This area makes patients look hollow and by injecting fillers, it plumps out the depression and improves the dark circle look.
How are Fillers Administered?
Fillers are injected through tiny needles. Dr. Katz goes to great lengths to make this procedure is painless. All patients are first treated with numbing cream on the areas to be injected. If the lips are to be injected, several small dental local anesthetic injections are given in order to totally “numb” the lips and adjacent areas for a truly painless experience.
The filler is then injected in the lips, wrinkles or skin folds and takes only a few minutes. Ice is immediately placed on the lips following the injections. The lips generally swell a bit but most patients are able to return to work the following day. In rare cases, patients may experience significantly more swelling. It is also a good idea to refrain from blood thinners such as aspirin or drugs that delay clotting for 1 week to 10 days prior to treatment in order to decrease bruising during injection of fillers.
Dr. Katz recommends having the patient return in 1-2 weeks to check the results. Occasionally a touch up may be performed at your follow-up appointment. One should view filler injection as a sculpting process and in therefore sometimes multiple appointments may be required to provide optimal results.