Dermal Fillers

Choosing the right facility and physicians to perform your dermal filler treatment can make the difference between looking naturally great and looking “done” (or worse). It’s important to find a medical practice where only physicians perform injections (in New Jersey it is illegal for any non-physician to inject dermal fillers, including advanced-trained nurses), and one that uses many different dermal fillers, as each is better for different areas of the face and certain cosmetic concerns (some practices use one filler everywhere, with less than stellar results).

Volume We will determine the best approach to enhancing your lips based on your treatment goals, your anatomy, and your age. The vermilion border, the junction between the white and red part of the lips, is an important area to treat with dermal fillers. By injecting this region, we can define the lip border better, similar to wearing lip liner. This can also help with lines that cross through this area. To increase the volume we inject the body of the lip (red area). This can create a pouty look and avert the lip outwards so that more of red shows. As a general rule we would like the bottom lip to be one and a half times the size of the upper lip (or 40/60, upper to lower lip), though we can create other proportions, if the patient requests (a lip ratio of 1:1 is more popular in Latin America, and can create a beautiful, natural lip profile for many patients). Happy appearance The oral commissures are located in the corners of the mouth. This area usually increases in size with age. Filling this area turns the corners of the lips horizontally, or even upwards creating a more positive and happy appearance. Shape and curve The philtrum consists of the two lines in the center of the upper lip that connects to the nose. By enhancing this double-ridge, it is possible to give the upper lip more shape and curve, enhancing the sensuality of the lips. Upper lip The cupid’s bow or the V-shaped area in the center of the upper lip can also be enhanced with dermal fillers. Done in conjunction with the philtrum, it can achieve a pleasant overall shape to the upper lip.

Licensing and certifications for dermal fillers and other cosmetic treatments can be really confusing, so we’ll break down the details in a separate blog, but the answer is yes, our physician injectors are licensed to perform dermal filler injections, and they each have several years of experience doing so. Currently, only physicians inject fillers at our practices, because we want to ensure our patients have the safest experience possible, and achieve the best results possible. It’s also important to look for a practice like ours that performs these treatments all day long — you don’t want a doctor who dabbles in dermal fillers to be warming up on you! We honestly aren’t trying to toot our own horn here, but it’s important to do a little research and find a facility with the skill and the tools to treat you right. You can double-check the experience of your provider by asking to see their awards from the manufacturers of each dermal filler. Galderma (makers of Restylane, Sculptra, and Dysport), Allergan (makers of Juvederm, Kybella, and Botox), and Merz (makers of Xeomin and Radiesse) all award physicians based on skill and experience.

The best filler for your goals will likely be different from the best filler for your friend’s goals, even if you both want to treat the same area. The reason for this is that each person is unique, the changes occurring under your skin are different, and in order to make your results as natural-appearing as absolutely possible, we will need to use different types of filler for different treatment areas and different patients. This is why our practice stocks every single kind of FDA-Approved Dermal Filler, and we regularly use each of them, so that we are always able to grab just the right thing for you. We provide complimentary in-person consultations with our physician injectors, to ensure patients get the assessment and guidance they need in order to make an informed decision about their filler treatment.

Using an ultra-fine needle or a smooth-tipped cannula, dermal fillers are injected into the skin. The physician will massage the treatment area then continue injecting the filler along the length of the wrinkle or fold until the maximum correction has been achieved. We blend lidocaine into all of our dermal fillers to reduce bruising and make for the most comfortable treatment experience possible.

There are basically 7 types of fillers, and each type works a little differently: Hyaluronic Acid (Juvederm, Voluma, Volbella, Vollure, Defyne, Reyne, Silk, Lyft, Belotero, Restylane) Calcium Hydroxylapatite (CaHA) (Radiesse) Poly-L-Lactic Acid (Sculptra) Collagen with polymethyl methacrylate (PMMA) beads (Bellafil) Collagen Fat Transfer Illegal Substances (including silicone) Hyaluronic acid fillers are by far the most common. They provide soft, natural results as the molecules of filler attract and bind water molecules in the skin, stimulating the production of collagen. The volume beneath the skin increases, restoring a smoother, more youthful appearance. The body metabolizes and absorbs the injected hyaluronic acid over time. Hyaluronic Acid fillers have an antidote of sorts, called hyaluronidase, which is very helpful in our practice when patients come to see us upset about how their results from another practice turned out. Calcium Hydroxylapatite (CaHA) (brand name: Radiesse) and Poly-L-Lactic Acid (brand name: Sculptra) are solutions injected under the skin to stimulate collagen. They can be used to create stiff volume, which is useful for contouring bony areas of the face, or to smooth, firm, and tighten the skin, which can reduce wrinkles and cellulite. They have also even been used in butt augmentation. Collagen is a more permanent filler, and we tend to avoid is because our bodies are not permanent things – they change over time, and so it can be very difficult to create a result with these that will not look unnatural as the body around it changes with time. There are, however, situations where we do make use of these products. Fat transfer is a method of transferring your own fat, usually taken from your abdomen or love handles, to create a very natural and long-lasting result. Finally, illegal substances such as silicone are often to blame for the worst filler results – the disfigured and seriously ill patients you sometimes see on the news. It’s important to be an educated consumer because there are people out there who don’t know what they’re doing (or at least we hope that’s the case). Our physicians provide free in-person consultations where we educate the patient about what’s possible, what’s safe, and what their options are. Please feel free to schedule an appointment, at the very least you’ll walk away with the knowledge you need to stay safe.

We use numbing injections that can be customized to your preference to ensure the treatment is as comfortable (and numb) as you would like. Most fillers either come mixed with lidocaine, or we mix them with lidocaine prior to injection. Lidocaine is a numbing agent that’s very similar to what a dentist gives you prior to filling a cavity. Since a dentist injects that medicine directly into your nerve bundles, you feel nothing of a cavity being filled. This is called a nerve block, and we’re happy to do that for you if you really don’t want to feel anything. However, by putting the lidocaine in with the filler, we’re able to avoid those additional injections for numbing, and this lower dose of lidocaine wears off much faster, so you’re not fully numb for several hours after. This is the numbing most patients prefer, but again, we can customize this to your preference.

Although it varies by patient and depends on the particular dermal filler used, results from dermal filler injections are immediate and typically last for six to 24 months, depending upon the filler used and the area treated. Most patients report that the area treated continues to look improved even after the filler has been fully resorbed.

Immediately following the injections, you may experience: Minor redness generally lasts no longer than 1 hour, and for most patients, this dissipates before they leave the office (15 minutes) Swelling generally increases for the first 24 hours, before resolving within 48-72 hours. Certain areas swell much more, like the lips, and other areas don’t tend to swell at all, such as the temples. Tiny scabs may also form at the injection sites, though this doesn’t happen for most patients. It’s more common when a cannula is used. Don’t pick the scars, but you can apply makeup over them. They generally don’t last beyond day 2. Bruises are thankfully not that common in our patients (we take some measures to reduce our bruise rate because we know it’s what our patients worry about the most). If you do end up with a bruise, please call and let us know. We can do a laser treatment that will break the bruise up, and this makes the bruise dissipate in just a couple of days (vs. having to cover it with makeup for a week or longer). These symptoms typically disappear within two to three days. Allergic reactions are extremely rare. There is no need for bandaging and most patients are able to resume normal activities immediately following the treatment., even if they’re going back to work and don’t want their coworkers to know.

Laser treatments will not shorten how long the results of your dermal filler treatment will last. Many patients get terrific results combining the two.

Some fillers last forever, but most do not. Most fillers create results that last 6 months to 24 months, meaning you’ll want to schedule maintenance appointments to ensure your results remain excellent over time. There are a couple of things you can do to improve the longevity of your results, in fact, we made a video about it. Check it out here: https://www.reflectionscenter.com/maximize-botox-and-fillers-results/

Fillers made from hyaluronic acid can be dissolved using a substance called hyaluronidase. The following fillers are hyaluronic acid fillers which can respond to hyaluronidase: Belotero, Restylane, Restylane Silk, Restylane Lyft (previously Perlane), Juvederm, and Juvederm Voluma. Sculptra, Radiesse, and Bellafill are not hyaluronic acid and are not able to be dissolved.