FAQ’s – Fillers – What are they?

Fillers are substances that are injected into the skin of the face to add volume where it has been lost subsequent to the aging process, or when it was not present in adequate amounts all along.

Fillers can be classified as temporary, semi-permanent and permanent. Temporary fillers last up to about one year, semi-permanent fillers last for a few years and permanent fillers last for the life of the patient. Although it may seem best to choose a permanent filler because it does not have to be administered again, remember that the aging process is a dynamic process and that the skin will gradually thin as aging proceeds. What may look good today may be very noticeable under the skin in five or ten years.

 

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What do fillers treat?

As fillers ad volume, they are ideally suited to treat lines of the face that result secondary to atrophy of the skin and sagging of the skin due to gravitational influences. Examples of these areas are the nasolabial folds (the creases between the lips and the cheek), the marionette (puppet) lines which are natural downward extensions of the nasolabial folds, and the corners of the mouth.

Fillers can also add volume to areas that have lost their fullness, again secondary to subcutaneous atrophy. This includes the tear trough area (the curved indentation at the junction of the lower eyelid and the upper cheek), the area over the cheekbones, lips (upper and lower), pre-jowl recess (the part of the jaw line in front of the jowl and behind the chin – fillers here help mask the outline of the jowling), and the cheeks.

Fillers can also be used to augment the nose and change the contour (“a rhinoplasty without surgery”) and supplement the use of Botox in the glabella area of the forehead (the “11″ lines above the root of the nose)

What are the types of fillers?

Collagen is a substance obtained from the dermis (a layer of the skin). Originally produced from bovine (cow) tissue, recent advances in recombinant DNA technology have allowed it to be produced in such a way that it resembles the chemical structure of human collagen, thus eliminating the allergic reactions occasionally seen with Bovine collagen and the need for allergy testing. Although Collagen can produce some nice results, the main problem with it is the relatively short duration of the result, typically a few weeks to a couple of months. For this reason, Collagen is rarely used in my practice.

Hyaluronic acid (Restylane®, Hylaform®, Juvéderm®, Perlane®) is a substance also found in human dermis. Unlike collagen, allergy to hyaluronic acid is not an issue; therefore skin testing is not required. Hyaluronic acid is prepared either by recombinant DNA technology (not from a human or animal source but in the laboratory) – Restylane, Juvéderm, Perlane or from Rooster combs – Hylaform. The differences in the various preparations are essentially related to the concentration of hyaluronic acid or “HA”, the size of the HA molecule and the degree of “cross-linking” of the HA molecule. Cross-linking helps prevent degradation of the HA and enhances the duration of the result. Typical indications include the nasolabial folds, lips, pre-jowl sulcus (the space between the chin and the jowls – filling this space tends to mask the jowls), the tear-trough area (the curved depression below the eye), cheeks and malar eminences (the prominent area of the cheek below the eyes), and glabella.

Hydroxyapetite (Radiesse®) is a substance found in bone. It is dissolved in a gel matrix. The gel is eventually absorbed by the body, and replaced with collagen. This product tends to last longer than HA. It is especially useful in correcting deep nasolabial folds, but also works nicely on the malar eminence, cheeks and pre-jowl recesses. It is not recommended for use in the lips.

What fillers do we offer?

In our office, we offer several of the more commonly used fillers:

Restylane®, Juvéderm Ultra® and Juvéderm Ultra Plus® – these are non-animal derived hyaluronic acids – a naturally occurring substance that plays a vital role in hydrating your skin and replenishing its natural volume.

Restylane typically lasts about five months, Juvéderm® has been FDA approved to last up to about one year. Juvéderm Ultra Plus is a little more robust formulation for volumizing deeper wrinkles and folds.

Radiesse® is a gel matrix of Hydroxyapetite crystals, which is a naturally occurring mineral found in the body. Over time, the gel matrix is absorbed by the body, and replaced with collagen. Radiesse typically lasts one year or longer.

Do I require skin testing to see if I am allergic to the fillers?

None of the fillers used by Dr. Epstein are derived from animal tissues; therefore skin testing is not required. Restylane and Juvéderm are examples of NASHA  – Non-Animal Synthesized Hyaluronic Acid.

How are the fillers administered?

Fillers may be administered in one of several ways. Topical application of local anesthetics such as ELA-Max® will numb the skin. There may be some discomfort during injection, but we have found this to improve with longer application of ELA-Max. We recommend application of the anesthetic cream just prior to traveling to our office, then re-application at the office and again a few minutes prior to treatment.

A dental block consists of a few injections of a local anesthetic into the mouth to create numbness around the entire mouth including the lips and nasolabial folds. It has been our experience that this is the best method of anesthesia when injecting the lips.

Local anesthesia can be injected directly into the area to be treated. Local anesthesia can also be mixed with Radiesse and injected with significantly reduced discomfort without the need to use a dental block or injections of local anesthetic prior to injection of the filler.

Can fillers be combined with Botox?

Yes. In some treatment areas, such as the lips, there can be a synergistic effect when Botox is combined with fillers. Upper lip lines are caused by muscle activity (Botox relaxes the muscles) as well as by loss of volume of the lips (Fillers add the necessary volume).

Do you ever mix different types of fillers at one time?

Yes. There is no problem with using different fillers on different portions of the face, matching the problem area with the optimal filler substance.

How do I decide which filler is right for me?

Dr. Epstein will listen to your concerns and perform a comprehensive assessment of your facial anatomy. He will then make recommendations and help you to decide what course of treatment is best for you.

How long does a treatment with fillers take?

Including the anesthesia, a typical filler treatment takes about ten to twenty minutes.

What is the downtime?

Bruising and swelling are not uncommon after filler treatments. Hyaluronic acids (Restylane, Juvéderm) have a slight inhibitory effect on platelet function, which may contribute to bruising. Bruising may occur fairly soon after treatment, lasting for several days. Swelling maximizes on day 3-5, so do not mistake swelling for “over correction”. After about one week, the swelling should be mostly resolved, but this varies among individuals. If you have a special event where you cannot afford to have a bruise on your face, you should schedule treatment no sooner than 1 – 2 weeks before the event to allow any bruising to resolve.

Is there anything I can do beforehand to minimize the downtime?

Avoid substances with aspirin and non-steroidal anti-inflammatory agents (NSAID’s) such as Motrin and ibuprofen within one week of your treatment.

What is the aftercare?

Arnica/Bromeline oral supplements are well known to reduce swelling and bruising. Bruising is usually easily covered up with camouflage makeup, which may be applied immediately. Application of cold packs (20 minutes on, 20 minutes off) for the first few hours up to the first 24 hours, and keeping your head elevated the first two days will also help to minimize swelling and bruising. If you feel any small irregularities or “lumps”, you may massage them until they feel smoother.

If I have an important event scheduled, can I have a filler treatment?

It is not advisable to have a filler treatment if you have an important event scheduled in the next week or two where your facial appearance is important.

Can I do this on my lunch hour?

From a time standpoint you can, but if the immediate appearance of your face is important, you may wish to do this when you do not have to return to work. It will also be easier to apply cold packs at home than at work.

Are fillers reversible?

The fillers described above are generally not reversible; the effects will fade over time. The effect of hyaluronic acids such as Restylane and Radiesse can be diminished with injection of a drug called hyaluronidase, but the indication for this is extremely limited.

When should I schedule a follow up appointment?

Two weeks after treatment. By then all the swelling should be resolved and it will be easier to assess your result.

When should I schedule my next treatment?

This is a very personal decision. As duration of effect varies among individuals, the area treated and the type of filler material injected, the best way to answer this question is for you to return when you feel the desire to add additional volume in a given area of your face.

What if I have additional questions?

Please feel free to contact our office at 631.689.1100, or email us at botox@epsteinplasticsurgery.com. Our staff would be most happy to assist you in any way they can.