A Discussion of Injectables

The field of injectables has really blossomed in the past few years.  We have progressed from collagen which was stiff and only lasted 3 months to a wealth of choices which last much longer. This discussion will try to help sort out these choices for you.

Hyaluronic acids (Juvaderm, Voluma, Restylane, Resylane Lyft (previously Perlane), Restylane Silk, Bolatero and others) have brought easy-to-use, longer-lasting (up to 2 years), clear and reversible products to the market. They have different particle sizes and, therefore, each is appropriate in different areas of the face. They can actually be dissolved if the patient does not like the effect.  I like to use these fillers throughout the face – in the cheeks, because these tend to flatten over time, in the hollows under the eye, in the nasolabial area (the grooves on the sides of the base of the nose), in the marionette area (the indentation just in front of the jowl because filling this can hide the jowl), or the parenthesis area (the indentations on the side of the mouth either above or below).  They can also be used to give a patient a chin instead of a chin implant.  I also like to use filler more superficially around the chin to fill in the dents and lines that we tend to develop there as we age.  Filler can even be used in the earlobes if these have “shriveled.”  It can also be used beneath the brow to give an illusion of a brow lift and make the eye look both softer and more open.  It can be used in the lines of the neck or in the temples as these become hollow with age or weight loss, or in the forehead instead of botox to make it smoother.

A new innovation since 2011 has been to dilute the hyaluronic acid fillers with lidocaine containing epinephrine prior to placement.  This minimizes visibility of the filler in terms of color or lumpiness yet is still long-lasting.  It also hurts less and bruises less because of the lidocaine which numbs as it injects and the epinephrine which causes the blood vessels to constrict temporarily.  Dilute filler to the hands is another good option. Dilute filler also gives us something to inject into sharp lines of the face such as “lipstick” and cheek lines.  If you have diffuse wrinkles, a laser may still be the best option, but for specific lines, filler works very well.

An even newer innovation in my office since 2013 has been to use an infrared “vein finder” called AccuVein so that I can avoid the veins of your face and minimize the risk of a significant bruise.  This technology has been very popular with our patients.

Radiesse is a long-lasting filler, but it has the color and consistency of toothpaste, so I only use it deep in the face on the cheekbones, along the jaw or under the chin where it cannot be seen or occasionally to re-inflate a nipple reconstruction that has lost some volume.

Sculptra is a unique volumiser.  It generally and diffusely fills the face.  It is ideal for a patient, say a runner, who is slender but feels his/her face is looking gaunt with age.  It can also be used to volumise and rejuvenate hands that are starting to look bony.  The disadvantage of Sculptra is that although it lasts about 2 years, several sessions are sometimes necessary, and it can be a little pricey compared to other fillers.

Fat is in some ways the best filler because it is permanent where it takes.  The problem is that even with the most current techniques, how much fat grafting will survive is unpredictable.  For this reason, if I already have a patient under anesthesia for some other reason, fat grafting will be only a minimal charge and well worth the effort.  As a “stand-alone” procedure, it is not worth the cost, in my opinion, because of this element of unpredictability.  It should also be used cautiously in the lips.  In patients who tend to put on weight, the lip will expand with weight gain and cause a strange-looking deformity.

The risks of fillers are minor.  They include bruising and swelling.  Allergic reactions are EXTREMELY rare. The bruising is usually minor especially now that we are using the vein finder.

I believe that diluted Restylane Lyft, formerly Perlane, in the hollows under the eyes is probably the most rejuvenating filler of all, but occasionally (about 5% of the time) it can look puffy because it holds onto water (hydrophilic).  If you develop unusual puffiness that persists beyond a few days, I can melt it out and use another filler which doesn’t puff but may not last as long (Restylane Silk).  In my opinion, it is very important to receive your injection from an experienced injector who is very familiar with facial anatomy so that inadvertent injection into the blood vessels and nerves of your face is extremely unlikely and your safety is more guaranteed.

There are medications and herbals that can increase bruising and bleeding you should avoid for two weeks before receiving fillers. These are:  Advil, Aleve, Alka Seltzer, Anacin, Anaprox, Aspirin, Ascriptin, BC Powder, Bufferin, Coricidin, Dristan, Ecotrin, Empirin, Excedrin, Fiorinal, Feldene, Ibuprofen, Indocin, Lortab, Midol, Motrin, Naprosyn, Nuprin, Pepto Bismol, Percodan, Sudafed, Vitamin E and Voltaren. Tylenol is fine!  Many herbals can cause bleeding — Echinacea, Ginko Biloba, Ginseng, Licorice Root, St. John’s Wort, garlic tablets — and others have not been studied well enough to know what impact they will have, so it is prudent to stop ALL herbals two weeks before receiving fillers.

Fillers can be very transformative for a reasonable cost and little down-time.  Some have called them a “liquid facelift,” but I think that is a little exaggerated and mainly a marketing ploy.  Nonetheless, my filler patients are some of my happiest.

For your information, each filler product has a rewards program. Please go to ASPIRErewards.com for all Restylane products and brilliantdistinctionsprogram.com for Juvaderm, Voluma and Botox to sign up if you are interested.

It will be a pleasure to discuss fillers with you.  If you have any questions, please call my office (804) 320-8545.