Taylor R. Pollei, MD
Fellowship Trained Facial Plastic Surgeon offers dermal fillers in Beverly Hills and Mission Viejo CA
What is the Goal of Dermal Filler?
Pollei Facial Plastic Surgery is proud to offer dermal fillers such as Juvederm at our Beverly Hills and Mission Viejo locations. First off, patients routinely get neurotoxins (e.g Botox) and filler confused. Neurotoxin (Botox, Xeomin, Dysport) is used to treat lines, creases, and furrows that are created by muscle movement. They will have no effect on wrinkles, creases, or fine lines that are present at rest. These are treated with dermal fillers (Restylane, Juvederm, Belotero, Voluma, etc..)
The goal of dermal filler can be to soften fine lines, minimize creases, or volumize larger areas of the face. Some patients utilize filler to treat a specific area that is a concern, such as very deep cheek folds, lips that are thin or have little volume, or marionette lines that cause jowling. Other patients utilize filler on a routine basis to delay facial rejuvenation surgery or use it after surgery to make small changes. Unlike surgery, the filler has a temporary effect lasting from months up to two years depending on the filler substance used. The exact filler that is best for you depends specifically on the intended outcome, as well as duration, skin thickness, and cost. One of my favorite parts of the facial rejuvenation discussion is to help determine what is my patient’s biggest concerns, and what are the best ways to address them.
What Exactly is Dermal Filler?
Unfortunately, there is no “one line” answer to this question. Not only are there many brands of filler, there are many different filler types and substances used. One of the originals used was collagen, but due to concern for allergy, the fact that it was permanent, in other issues, it is no longer injected much. Radiesse is a very thin paste that is still used by some injectors but has largely been replaced by hyaluronic acid fillers (HA fillers). Sculptra works in a series of injections to stimulate your own body’s collagen production. It does not have an immediate visible effect, but over a period of weeks to months results in facial volumization and an improvement in the overlying skin quality. Finally, hyaluronic acid fillers are the most commonly used class. They are reversible, customizable, and come in many different formulations from thin to thicker, short duration to a long duration. They have an immediate effect with visible results present at the time of injection.
The most commonly used fillers are manufactured by Allergan (Juvederm, Voluma, Volbella), Galderma (Restylane, Lift, Refyne, Defyne) and Merz (Belotero, Radiesse). Obviously, the best filler for you depends on your circumstance and desired outcome. There is no cookie cutter approach and it requires a team effort between you and me to come up with the best game plan.
How is Dermal Filler Injected?
Typically I will utilize a topical anesthetic numbing cream to start. This is usually left in place for 20 to 30 minutes. In addition, using ice on the skin immediately before the injection is helpful. The area to be injected is aggressively cleansed with both alcohol as well as Hibiclens to prevent infection. Depending on where the injection is being placed makes a difference with what size needle, the length of the needle, or if a blunt tipped cannula instead of a needle is used. Sometimes the filler is threaded in a thin string or could be injected in individual aliquots under the skin. Filler that is thicker tends to last longer and is used for volumization as it is placed deeper, often just adjacent to the bone. Conversely, thinner fillers that are meant for fine lines are placed superficially within the dermis.
What Areas Are Most Often Treated with Dermal Filler?
Filler can be used almost anywhere in the face. Areas that are less commonly treated include the upper eyelid, seen in patients where the superior orbital rim becomes very visible and the upper eyelid looks skeletonized. Similarly, patients with significant hollowing in the temples can benefit from filler, where both Sculptra, as well as Voluma, are more commonly used.More commonly treated are areas of the midface: The tear troughs can be filled either by directly placing filler in that specific area or by placing deeper filler into the cheek which rejuvenates the entire cheek and lower eyelid at the same time. The nasolabial fold (the line next to the nose traveling down towards the corner of the mouth) is a common area of filler injection since it gets more pronounced as the soft tissue of the cheek descends towards the upper lip. Also commonly treated are fine lines around the upper and lower lip, and even the corners of the mouth, which tend to turn downward into a slight frown with age.In the lower part of the face, the jawline can be injected to camouflage the marionette lines or add volume to a mandible that is not very strong. Excessive filler in the lower part of the face is importantly avoided since it can lead to a bottom-heavy face or a more square or masculine appearance.
Lastly, a filler can often be used in areas where individual creases or lines are seen such as deep lines in the glabella (central brow or forehead) even after Botox has been utilized to decreased movement. Similarly, sometimes scarring can be addressed with filler as can overall facial asymmetries.
Are There Any Side Effects or Risks?
Although uncommon, there are both small side effects and more serious risks with the use of dermal fillers. Just like with any injection there is a risk of bruising, swelling, and discomfort. The risk of bruising is slightly higher in patients that are on medications like aspirin, coumadin, high-dose ibuprofen, and other medications that affect platelets or the body’s ability to clot. Although not necessarily a side effect, there are times when patients want their filler to be removed, which is done with a simple and safe enzyme injection in the office. This is one of the gigantic benefits of hyaluronic acid fillers.
One of the more serious risks of dermal filler can occur if at the time of injection blood vessel under the surface became blocked, resulting in possible skin loss or even scarring. Allergic reactions are possible, but since hyaluronic acid is a substance found in the body, it is considerably safe for injection. It typically does not migrate, nor does it develop nodules, or cause pain in the area where it is injected.
Contact our practice to learn more about dermal fillers where we serve the Beverly Hills, Mission Viejo, and South Orange County areas.