Most of us lose volume in our face as we age causing our temples, cheeks and eyes to hollow out, our lips to thin, our jaw lines, cheeks and necks to sag, and wrinkes to appear. With time, we look gaunt, skeletonized and well, just old. Volume in a face is a marker of youth—loss of volume, aging. None of us are immune.
The Surgical Approach
Facelifts, eyelifts, and brow lifts tighten and lift sagging eyelids, eyebrows, cheeks, necks and jowls but do not replace lost volume. Cheek and chin implants restore volume very effectively to these facial areas, but require surgery with an associated downtime. Fat transfer from the abdomen or thighs to the face is often used to restore volume, however, to date the durability of the beneficial effect is both unpredicatable and unreliable. Repeated fat transfers are often required to sustain the improvement.
The Non Surgical Approach
Dermal fillers such as Restylane, Restylane Lift, Voluma, and Bellafill when injected under the skin have been used to restore facial volume with great success over the past many years. Complications are few, downtime nil, and results pleasing, While fillers don’t, in general last as long a surgery, they can substantially make you look much better for quite a while. They can even be used to fill out a volume depleted face after a facelift.
Reflating the Volume Depleted Face
After 4 syringes of Lyft
What are Dermal Fillers?
The dermal fillers we commonly use are of two different types, the ones consisting of hyaluronic acid— Restylane, Restylane, Lift, Restylane Silk, Voluma, and the PMMA filler, the longer lasting Bellafill.
Hyaluronic acid is a normal constituent of our skin, subcutaneous tissue, and connective tissue. When natural hyaluronic acid is specially treated and injected under the skin, this modified hyaluronic acid attracts and holds water, adding volume to the area injected, lasting until the body degrades it, anywhere from six to eighteen months after injection. The increase in volume that results from implanting one of these fillers under the skin improves overlying facial creases and wrinkles, enlarges lips, making the face appear more youthful.
Bellafill is an injectable dermal filler composed of microspherules of polymethylmethacyrlate (PMMA), suspended in bovine (derived from cow) collagen with a small amount of lidocaine (local anesthetic) added. Orthopedic surgeons have been using PMMA safely and effectively for decades in joint replacement surgery. Unlike the other fillers, the PMMA is not readily absorbed by the body and forms a far more lasting scaffold for collagen production wherever it is injected. That is, the benefits of Bellafill injections are extremely durable, lasting many years. Like many of the other non permanent dermal fillers, Bellafill is FDA approved for improving nasolabial folds (smile lines). This product has been used successfully for years in Europe and Canada.
How Do We Use Dermal Fillers?
Our goal with filler is to add volume to your face, restoring your more youthful contours. We implant them to improve facial wrinkles and creases such as the nasolabial fold (the crease between the nostrils and the corner of the mouth), frown lines (especially in conjunction with neuromodulators such as Dyport), and wrinkles on the cheeks. These products are particularly useful to enhance and augment the cheeks, lips, temples, and fill vertical wrinkles above the upper lip. We inject dermal fillers under the skin in the lower eyelids to eliminate dark circles, hollowness, and to hide bags there. For many patients, the improvement after dermal filler injections is not only satisfying, but also quite dramatic.
Frequently asked questions
Dermal fillers come in pre filled syringes and are injected just underneath the skin using very fine needles or cannulas into the area to be improved. Prior to injecting a dermal filler, we often numb the area to be filled with topical anesthetic cream. As we inject the area, we can also chill the overlying skin with an iced roller resulting in additional anesthesia.
This combination of topical anesthesia and cold reduces any pain from the injections to a minimum. Additionally, all the fillers we use contain local anesthetic, so that after a few passes the area to be enhanced is totally numb. The implantation of a dermal filler takes between 20 and 45 minutes depending on how many syringes are used.
A young Mick Jagger
Mick today, markedly volume depleted
You will see improvement from a dermal filler immediately after it is injected. On average with hyaluronic acid filler, this improvement will last about 6 to 18 months. After the first two or three injections, most patients find they can go increasingly longer intervals without reinjection. Bellafill lasts much longer up to seven years.
No! You can return to your normal activities without restriction following the dermal filler implantation procedure as soon as you wish. The area injected, particularly the lips, may be swollen and numb similar to visit to the dentist. The numbness will disappear in one or two hours.
All of the neurotoxins are extremely safe when used in the matter described above. All the dermal fillers we use are either FDA approved for filling facial wrinkles, for augmenting volume, or both. Many have been used for almost a decade here and much longer in Europe. They are exceedingly safe products with few side effects. Occasional bruising, swelling, lumpiness, and/or tenderness at the implantation site can happen but all disappear within a few days.
Allergies to these products are very rare. As for any cosmetic procedure done around the mouth and particularly to the lips, we customarily provide a prescription for an antiviral agent to prevent any outbreak of cold sores (oral herpes virus).
We like to use Restylane in the “troughs” that many people have under their lower eyelids. Restylane here is exceedingly effective in blending the lower eyelids with the upper cheek concealing the lower lid bags and giving a more youthful look. In this location, a single injection of filler can last many years. We also use Restylane to shape and elevate the eyebrows and it is extremely effective to improve the contours of the nose.
This product is particularly useful for improving fine vertical wrinkles above and below the lips.
Restylane Lift (formerly known as Perlane L) is our “go to” filler. We use it in most every area of the face: to plump up lips, to augment the cheeks, to fill in the nasolabial folds (folds from the nose to the corner of the mouth), the marionette lines (the folds from the corner of the mouth down to the jawline), to elevate the jowls, to restore a youthful jawline, and fill in hollow temples.
Voluma is approved for use to elevate the cheeks restoring youthful volume there. It is a wonderful product when used as indicated and lasts about 12-18 months.
We use Bellafill much like we use Restylane Lift, to improve almost any area of the face except directly in the lips or under the eyes. It is an extremely long lasting product and because of that, we can slowly build up the facial volume by using prior Bellafill implantations as a scaffold or foundation for additional injections, knowing that the prior enhancement will remain.
Some people are allergic to the bovine collagen component of Bellafill, therefore a skin test (a tiny amount of this product, injected under the skin of the forearm) is required prior to the initiation of Bellafill injections. We provide these skin tests for no charge.
It is helpful to apply ice packs to the treated area(s) for several hours to reduce any potential swelling and bruising, both of which can occur. Should any swelling or bruising appear over the first few days after a treatment, rest assured that it will resolve quickly. Expect some achiness in the areas treated, especially a low grade headache if the temples are filled. This can easily be remedied by over-the-counter analgesics such as extra strength acetominophen (Tylenol) or ibuprofen (Motrin). Make-up can be applied in an hour or two after a treatment.
Small palpable lumps can occur in the injection area and to avoid these, we ask you to gently massage the treated areas 5 minutes morning and evening for about a week after the treatments. Persistent lumps while possible are very infrequent.
If Bellafill was used, initial filling of the treated areas will start to recede in three to four weeks almost back to where you started as the bovine collagen component of it is resorbed. Soon after the PMMA, starts stimulating collagen formation and the area starts to reinflate. After about 8-12 weeks this process is complete and what you see in the mirror will last many years.
We price all our fillers by the syringe with discounts offered if more syringes are purchased. Some smaller areas such the lips, lower eyelids, nasolabial folds, etc. may only require only one syringe or two syringes. However, to adequately rejuvenate a volume-depleted face, multiple syringes are usually needed to make a noticeable difference.
At the time of consultation, we will go over in detail where and how much filler we should use to give you the result you desire. If you have to, it is always best to wait until you can afford enough filler to do the job rather than try to get by with too little and end up disappointed.