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Dermal fillers have increased in popularity over the last two decades with a global expansion of cosmetic fillers. In the past, the only means for facial improvement was through plastic surgery. Now, with the advent of a myriad of injectable fillers, dermatologists  are able to restore a more youthful appearance, in just one hour, without cosmetic surgery.  In the United States, the use of dermal fillers has grown exponentially. At last count, approximately 3 million dermal filler procedures were performed in the United States this year. Statistics from the American Society of Plastic Surgeons show an increase in the millions of facial filler procedures versus the previous year.

Juvederm Voluma 2 weeks

Before & After photos: Juvederm Voluma 2 weeks

Hyaluronic acid fillers, such as Juvederm® and Restylane®, combined with injectables such as Botox®, Dysport®, and Xeomin®, have transformed cosmetic procedures forever. The best dermatologists, like Dr. Michele Green in NYC, are able to replace lost volume to cheeks, chin, jawlines, temples, nasolabial folds, smooth lines and wrinkles, plump lips, and restore and rejuvenate the entire face. There are many different type of fillers, also called soft tissue fillers, which are currently utilized by dermatologists and cosmetic surgeons.  Depending on the size and chemical makeup of the injectable filler, each is best used in different parts of the face or body, with the outcome of producing a more youthful appearance.

Before & After Photo: Aquagold, Dermal fillers and VBeam

What areas can dermal fillers or “wrinkle fillers treat?

  • Treat Nasolabial folds or smile lines
  • Treat deep and fine lines
  • Smooth out lines around the mouth and oral commissures, Marionette lines, and Frown lines
  • Treat thin lips and plump and rejuvenate them
  • Treat the lines above the lips (“smoker’s lines”)
  • Increase volume in the cheeks, chin, temples, jaw line
  • Improve sagging skin, are rejuvenate the jaw line and jowls
  • Replace lost volume in the hands
  • Rejuvenate the décolletage, arms, and knees
  • Restore volume and enhance buttocks (BBL)

What are the different type of Injectables used?

  • Collagen was the original injectable filler used in the United States. Collagen was derived from bovine collagen, and as such carried with it a higher incidence of allergic reactions. Collagen injections were manufactured in two forms, Zyderm and Zyplast, with Zyplast being thicker and lasting a bit longer.  Cosmoderm and Cosmoplast were also very popular collagen based dermal fillers. These types of collagen injections, however faded quickly after 3 months and constant maintenance was required.  Due to its increased risk of allergic reactions and it lack of longevity, Collagen injections quickly was replaced as a wrinkle filler when hyaluronic acid fillers were discovered.
  • Hyaluronic Acid is a naturally occurring substance that is already present naturally in your skin.  Hyaluronic acid fillers are gel-like substances, which are soft, and are used to replace lost volume and treat lines and deep wrinkles. Hyaluronic acid binds to water when injected, and softens and hydrates the skin. After 2010, the FDA approved hyaluronic acid fillers compounded with lidocaine to make these dermal injections more comfortable for the patients. Hyaluronic acid has the unique ability to plump and hydrate the skin.  Most hyaluronic acid fillers are compounded with lidocaine to minimize the discomfort from the cosmetic injections. Hyaluronic acid fillers are believed to have long-lasting effects. There have been recent studies which show that repeated injections of hyaluronic acid fillers stimulate the body to produces its own collagen. Over time, with the new collagen stimulated, there may ben less dermal filler needed to achieve the same cosmetic effect.
  • Juvederm Dr. Green was one of the first doctors in New York to incorporate JUVÉDERM treatments into her practice. This advanced formulation of hyaluronic acid (HA) can be used for deep lines and wrinkles, and results can last up to 12 months. There are many different types of Juvederm injections as some are designed strictly for the smile lines and some are distend for the fine lines around the mouth. The Juvederm family of dermal fillers are currently the number one injectable filler in the United States.
  • Juvederm Ultra Plus XC and Juvederm Ultra Plus – is composed of a hyaluronic acid gel, which has the same exact formula, accept the XC form contains lidocaine. Juvederm is injected into the skin and acts like a sponge to fill in winkles and fine lines and areas of volume depletion. It has a bit thicker consistency than Juvederm Volbella, and is used commonly as a filler treatment for smile lines.  Juvederm Ultra Plus is a very popular dermal filler for lip augmentation.
  • Juvederm Voluma – Voluma is one of the most popular filler treatments.  Voluma is designed to help restore youthful contours by plumping up the cheeks and chin where the aging process has caused volume loss. This advanced formulation of hyaluronic acid can last up to 18 months. Juvederm Voluma was designed to replace the lost volume in the cheekbones and malar area.
  • Juvederm Volbella Volbella was designed to treat fine lines, in particular the lines around the mouth and for “smoker’s lines.” Juvederm Volbella lasts approximately 12 months in duration, depending both on the amount of product and the area injected.
  • Juvederm VollureVollure was designed to treat the smile lines or nasolabial folds. Juvederm Vollure has a longevity of 18 months  which is very appealing due to the decreased need for constant re-injection.
  • Restylane and Restylane-L – Restylane is specially formulated to re-populate the loss of hyaluronic acid that is partially responsible for the appearance of aging and the development of wrinkles. Restylane and Restylane-L contain the same dermal filler, but Restylane-L is compounded with lidocaine to minimize the pain of injections. Restylane was originally FDA approved in 2003 for the treatment of nasolabial folds, and Restylane-L in 2010. Restylane injections can last approximately six to nine months. Restylane is used for a natural soft look on lips, smile lines and other areas of the face.  In addition, Restylane is injected into hands frequently to replace lost volume for hand rejuvenation.
  • Restylane Lyft – Restylane Lyft was originally marketed under the name Perlane, and is similar to Restylane, except the particles are larger in size and can be used for deeper smile lines, winkles, or volume correction. Restylane Lyft has been recently FDA approved for augmenting cheekbones and volume lost in that area of the face. Restylane Lyft is also used commonly in the oral commissures as it has the highest G prime of any dermal filler. Restylane Lyft typically lasts 9 to 12 months in duration.
  • Restylane Silk – Is a dermal filler which was FDA approved in 2014 for fine lines in the perioral area, and lips, due to its smaller size molecule.
  • Restylane Refyne & Restylane Defyne – are the newest Restylane products which are designed with XpresHAn Technology™  which allows movement of the face in the areas it has been injected. Restylane Refyne treats moderate lines and wrinkles whereas Restylane Defyne treats moderate to deep winkles.
  • Belotero Balance – Belotero is a thin hyaluronic acid filler designed to treat fine lines and wrinkles.  Belotero replaces lost hyaluronic acid caused by the natural aging process, filling in fine lines. Its unique properties offer a soft, even correction to those delicate areas of the face such as lip lines, and the tear trough area under the eyes. One of the benefits of Belotero is that it is much less likely than other hyaluronic dermal fillers to cause the tyndall effect.
  • Bellafill – was originally FDA approved in 2007 as Artefill.  Bellafill is composed of nonresorbable polymethylmethacrylate (PMMA) microspheres suspended in a water-based gels compounded with bovine collagen and lidocaine. This synthetic injectable was originally approved for smile lines.  It has now gained in popularity to treat acne scars. Since this product contains bovine collage, skin tests are required to make sure that the patient is not allergic to this filler. Bellafill has been reported to last for more than five years in duration.
  • Radiesse – Radiesse is an injectable filler made of calcium hydroxylapatite, which replenishes the lost collagen under your skin and promotes an increase in your natural collagen production. Radiesse can last up to a year in duration and can be for for pan-facial rejuvenation.
  • Sculptra – Sculptra is a safe, effective cosmetic injection that is made from Poly-l-lactic acid.  Sculptra is a liquid injection and can be injected at the same time as other dermal fillers.  Sculptra is technically called a “collagen simulator” since it helps your skin rebuild its own natural collagen. By injecting Sculptra into the deeper areas of the face, you are boosting the skin’s natural collagen production to have even longer lasting results. Due to Sculptra’s ability to be used in multiple anatomic locations in the face, it is an ideal product for pan-facial rejuvenation. The results of Sculptra injections last up to two years.

Botox, Juvederm Voluma and Vollure – 2 weeks before / after

Autologous Wrinkle Fillers

Fat Grafts are a procedure where your own fat is surgically removed from other areas of your body, such as your stomach or buttocks, and injected into your face. Since fat grafts depend on liposuction to harvest the fat, and costly purification processes, it has lost a great deal of popularity in the past years. There is also no simple way to reverse fat grafting if you are unhappy with the cosmetic results.

Platelet-Rich Plasma Injections (PRP), is a type of autologous wrinkle filler which is extremely popular due to its holistic approach. Blood is drawn from your arm, centrifuged in a special machine, and the platelet rich plasma removed and injected into your face. Some patients choose to have microneedling with PRP at the same time to help with fine lines, texture, and tone.  The effects of Platelet-Rich Plasma (PRP) injections can last more than a year. Since the blood is taken from your own body, this is a very natural and holistic approach to cosmetic injections an skin rejuvenation.

What are the side effects of filler injections?

Uneven or poor cosmetic results: If you are unhappy with your filler procedure, the good thing about hyaluronic acid fillers, such as Juvederm and Restylane, is that they can be easily dissolved with hyaluronidase. Hyaluronidase is in injection which dissolves unwanted hyaluronic acid fillers.  Some facial fillers such as Juvederm Voluma are thicker than other types of filers and may require repeated injections of hyaluronidase to dissolve it.

Bruising is another potential adverse event from any filler injection at the injection site.  To avoid the side effect of bruising, Dr. Green always recommends discontinuing any potential blood thinners such as Aspirin, Alleve, Motrin, Multivitamins, Fish oils or other herbal supplements which cause bruising, to avoid any unwanted downtime.  Arnica Montana, an herbal supplement, can be taken a few days before your cosmetic fillers to minimize bruising.

Discoloration is another potential side effect as a result of bruising.  After the bruising starts to improve, the area can appear discolored for a period of time. This is a temporary side effect and Dr. Green recommends using a good cover-up or makeup, along with your skin care products, to conceal the area until it resolves. It is important to use sunscreens daily after dermal fillers to help protect against this hyperpigmentation and to avoid increased sun damage and wrinkle formation.

Tyndall Effect is a bluish discoloration known to happen after some hyaluronic acid fillers injected.  If the hyaluronic acid filler is injected too superficially, the injection area can appear blue. This color change can last several months in the treated area and can be reversed with hyaluronidase to dissolve the dermal filler.

Allergic Reactions is a potential problem with any injectable.  Patients can develop small bumps or nodules at the site of injection. These bumps can usually be dissolved with hylauronidase injections.

Swelling and Redness are common side effects at the site of injection.  Icing the treated area immediately after your injections, minimizes this reaction.

Black Market dermal fillers have become a problem in the past few years. Make sure you are receiving FDA approved cosmetic fillers which are make according to authorized guidelines to avoid any potential side effects.  Don’t purchase injectable fillers outside a medical office, since you do not know the quality or material which the product is made from. It is so important to consult a reputable board certified dermatologist, like Dr. Michele Green, for your cosmetic injections, to have the least risks of adverse reactions and the best cosmetic results.  Dermal fillers are classified by the FDA as medical devices and the use of such injectable fillers should only be used by board certified dermatologists and plastic surgeons who have experience with these procedures.

What is the cost of facial fillers?

The cost of dermal fillers varies from injector and location.  A board certified dermatologist or board certified plastic surgeon, will generally be more expensive than a clinic or spa, who has nurses or ancillary specialties performing these cosmetic injections. It is important to do your research and Google the injector and make sure that they are using FDA approved dermal fillers to avoid potential side effects. Board certified dermatologists, like Dr. Green, have special advanced training in dermal fillers, and have been injecting soft tissue fillers for over 25 years.

Never let price alone determine who should be injecting dermal fillers in your face.  Dermal fillers are considered a medical device by the FDA since it is a serious medical treatment.  If the price is far less than standard cost, it is likely the you are receiving a different quality product or the experience of the injector is an issue. All wrinkle fillers should be performed under sterile conditions, in a medical office, and not at a “party”, private home, or unlicensed spa.  Dr. Michele Green is a member of the American Society of Dermatology and they closely regulate the best practices and safety of dermal fillers.

What to Expect During the Consultation?

If you are interested in dermal fillers you would consult Dr. Michele Green in her private NYC cosmetic dermatology office. Before and after photos are taken for your records, and a complete medical and cosmetic intake is completed including current medications, allergies, cosmetic procedures, type of fillers, and surgeries. If you are taking blood thinners you will be asked to refrain from taking them for at least one week before your filler procedure. Dr. Green would examine your facial structure with you and make recommendations for the best cosmetic injections. The nurses will then numb you with a topical lidocaine cream that stays on for 30 to 60 minutes to increase your comfort. The treating area is then cleaned with alcohol and you will be injected with the best dermal fillers to create the most youthful appearance.  Ice compresses are applied immediately after the procedure to minimize and bruising or swelling. Dr. Green will ask you to return in two weeks to fully assess the cosmetic result of the filler injections.

Combining Dermal Fillers with Botox and Lasers

Botox is often combined, at the same visit, with dermal fillers to treat the wrinkles around the forehead, glabella area (furrow between eyebrows), and the lines around the eyes (crow’s feet). Botox and Dysport are neurotoxins which relax the muscles of facial expression and soften these lines and prevent new wrinkles from forming in the injected areas. Many patients have Botox and Juvederm injected on the same day.  Hyaluronic acid fillers, such as Juvederm and Restylane, are a more temporary option than synthetic fillers such as Sculptra and Bellafill, which last longer.  Many patients combine hyaluronic acid fillers with longer acting, deeper fillers like Sculptra, since this will add great deeper structure to the face, which may have lost a lot of volume from aging. Multiple dermal fillers can be combined with different kind of fillers to create a “liquid face lift”.  This procedure allows Dr. Green to treat multiple areas during the same visit, such as the marrionette lines, smile lines, temples, chin, and replace volume in the cheeks, lips, or under the eyes.  This technique allows Dr. Green to sculpt and reshape facial contours and provide complete facial rejuvenation.  In addition, lasers such as the V-Beam laser for redness and Fraxel for pigmentation are combined with dermal fillers to enhance your facial rejuvenation.

If you’re frustrated by the appearance of deeper lines and wrinkles caused by volume loss, there’s finally a solution that can help. Contact us online today or call 212-535-3088 to learn more about whether dermal fillers may be right for you.

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