DERMAL FILLER

Over the last 15 years, dermal fillers have revolutionized the beauty and cosmetics industry. Patients of all age groups are seeking the newest and best non-surgical treatments to reduce signs of age and fatigue and enhance their facial beauty. While facial aging is classically associated with wrinkles and fine lines around the face, volume loss and redistribution at deeper tissue levels play a major role in the development of skin folds and the displeasing contours we see with age. For patients who are not seeking a traditional facelift or not a candidate for surgery, dermal fillers have evolved as highly effective, non-surgical solution for facial aging.

As with any cosmetic treatment, it is important to seek a certified, expert injector who understands facial anatomy and the aging process in detail. This is critical for achieving a natural result and minimizing the risk of complications. Your injector should also be well versed with the variety of filler products on the market. Dr. Giriraj Sharma provides dermal filler treatment in Newport Beach, California; contact our clinic today to schedule your filler consultation!

WHAT ARE FILLERS?

Fillers are FDA-approved biocompatible substances which can be injected underneath the skin, in different tissue planes of the face. When injected conservatively and at the appropriate depth, fillers can create a very natural enhancement of facial contours. This helps you look refreshed and reverses signs of facial aging.

Juvederm® (Allergan Inc.), Restylane® (Galderma S.A.) and RHA® (Revance) filler lines all consist of hyaluronic acid (HA). HA is a natural biomolecule which exists in our skin, joints and eyes. In the skin, HA attracts water which allows the skin to become more hydrated. Injected HA can help reduce fine lines and wrinkles when injected superficially, or replace volume losses when injected at deeper levels.

Radiesse® (Merz) is made of calcium hydroxyapatite (CaHA), which is a mineral which naturally exists in our bones. Radiesse helps restore facial volume and stimulates collagen production. Effects of Radiesse typically last longer than that of HA fillers.

Sculptra® (Galderma) consists of poly-L-lactic acid (PLLA), a synthetic material which is completely biocompatible and biodegradable. Injected PLLA stimulates fibroblasts in our skin to produce collagen. The new collagen helps to restore facial volume and smoothen out wrinkles and folds in our skin.

Each filler has unique characteristics. Key variables include viscosity and elasticity – measured by G-prime (G’) – and cohesivity. These are all properties which determine which locations of the face a filler is best suited for (e.g. cheek, under-eye, lips), which tissue planes (depth level) are appropriate for injection, how the filler will behave (soft vs. firm) in our natural tissues and the longevity of the filler. It is critical that your injector understand the properties of all available fillers in detail.

HA, CaHA and PLLA fillers are all temporary fillers which are naturally resorbed by our body. Depending on its properties, a filler can last approximately 1 to 2 years. An advantage of HA fillers is reversibility. Hyaluronidase is an enzyme that breaks down HA, and can be injected where filler is to be dissolved. This is important if a patient has an unsatisfactory outcome from a previous injection, if filler has migrated to an undesired area of the face, or if there is a rare complication associated with the filler.

Fillers can be used on male or female patients, patients of all skin types and ethnicities and patients of all ages who are good candidates. Filler effects are seen immediately, with minimal post-injection swelling.

COMMONLY TREATED AREAS

Nose (Learn More)

Temples

Under-eyes / tear trough

Cheeks

Chin

Lips

Nasolabial folds

Marionette lines

Pre-auricular (facial contouring)

Jaw angle and jawline

CONSULTATION AND TREATMENT

The first step of your filler consultation will be an in-depth discussion of your medical history, including prior surgical and non-surgical treatments for your face, and your specific goals. Dr. Sharma will conduct a facial analysis to determine your skin quality, areas of volume loss or redistribution and regions where filler may be beneficial. Next, you will have a detailed discussion of your facial anatomy and available treatment options to help you achieve your goals. This includes what filler types would be best for your face, what to expect during and after treatment and potential risks of treatment.

A filler treatment can be performed the same day as your consultation. The process is typically less painful than first-time patients may imagine. Topical numbing creams and ice packs are typically used; these help make the treatment process smooth and comfortable. Depending on the location where filler is to be injected, Dr. Sharma uses either microcannulas (e.g. under-eyes; nasolabial folds) or needles (e.g. cheek; chin) to apply filler.

After treatment, you can drive yourself home or return to work the same day. Minor swelling and bruising at injection sites are not common but possible, and typically resolve within 3 to 5 days. We ask all filler patients to avoid exercise, drinking alcohol or massaging their face for 24 hours after treatment.

FILLERS VS BOTOX

 NEUROMODULATOR (Botox)FILLER
MOLECULENeuromodulator: Botulinum toxin type AFillers: Hyaluronic acid (HA), Calcium hydroxyapatite (CaHA), Poly-L-lactic acid (PLLA), etc.
FDA APPROVED PRODUCTSNeuromodulator: BOTOX Cosmetic®, Dysport®, Xeomin®, Jeuveau®Fillers: HA: Juvederm® line, Restylane® line, RHA® line.
*Each line has multiple products with variable properties
CaHA: Radiesse®
PLLA: Sculptra®
PURPOSENeuromodulator: Injected into facial muscles to weaken the strength of muscle contraction. Prevents or reduces the appearance of fine lines and wrinkles around the face. Can provide subtle, temporary “lifts” of small areas (eyebrows, lips) by weakening opposing muscles.Fillers: Injected in superficial, medium or deep levels of the face to treat fine lines and wrinkles, restore areas of volume loss and improve facial contours. Certain fillers can also stimulate collagen production.
TREATMENT LIMITATIONSNeuromodulator: Does not restore lost or descended volume, does not improve deep skin folds (e.g. nasolabial fold) or facial contour.Fillers: Can improve contour, but do not provide a true “lift” of descended facial structures as seen with a surgical facelift. Can migrate to an undesired area or result in a vascular occlusion (blockage of a blood vessel) if injected by an inexperienced provider with improper technique, incorrect tissue depth or location.
DURATION OF EFFECT (AVERAGE)Neuromodulator: 3 to 4 monthsFillers: 1 to 2 years (filler dependent)
REVERSIBILITYNeuromodulator: Non-reversible, but effect wears off in months.Fillers: HA products are reversible with injection of hyaluronidase. CaHA and PLLA fillers cannot be directly reversed.
*The above 3 filler types are all biodegradable and temporary.
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