Dermal Fillers

Dermal fillers are gel-like substances that are injected under the skin to enhance your facial features or restore lost volume. As we age, our skin can lose elasticity, and we might notice wrinkles, sagging, or a more hollow appearance in areas like the cheeks, lips, and under the eyes. Dermal fillers help to plump up these areas, smooth out wrinkles, and add definition to features like the lips or jawline. The procedure is quick, usually taking less than an hour, with little to no downtime. Injections are administered using either a cannula or needle, depending on the treatment area. The results are immediate and can last from several months to a couple of years, depending on the type of filler used. It's a popular, minimally invasive way to achieve a more youthful, refreshed look without surgery.

Filler Volume Guidelines

For localized areas such as the lips or smile lines, lower volumes are needed around 1 - 2 ml.

For mature patients and those needing correction in multiple areas, higher volumes are required often 2-5 ml and multiple sessions to achieve the desired results. These amounts serve as general guidelines, as individual needs may vary

Possible Side Effects

Common side effects include Swelling and bruising. Less common side effects include Lumps or nodules, and extremely rare instances of arterial injections. Knowledgeable and precise injection techniques minimize these risks. Hyaluronic acid fillers are reversible using an enzyme called Hyaluronidase.

Mid-Face (Cheeks)

Dermal fillers can enhance the cheeks by adding lift, volume, and definition, providing an immediate and striking improvement. Subtle changes in how light reflects off the cheekbones can significantly impact the appearance of aging and volume loss. Enhancing the cheeks ties together the upper and middle thirds of the face, creating a more harmonious overall look.

Benefits of Mid Face Dermal Fillers

For most patients, cheek rejuvenation with dermal fillers yields a remarkable transformation. Key benefits include:

Volume Restoration: As we age, we lose bone density, fat, and collagen, leading to sunken cheeks and a tired appearance. Strategic use of fillers can restore volume, giving a more youthful and vibrant look.
Lifting: Fillers can achieve a lifting effect, sometimes referred to as a "liquid facelift." By injecting fillers in targeted areas, such as the lateral, mid, and medial cheeks, we can enhance the lift and contour.
Contours and Highlights: By placing fillers along the high point of the cheekbone, we can accentuate contours and highlights. This technique enhances light reflection, mimicking the effects of professional makeup without the actual makeup.

Types of Treatments for Mid-Face

The choice of filler depends on the patient’s age and volume loss:

For Younger Patients: Soft, lifting hyaluronic acid fillers are used to accentuate the cheekbone’s high point and create a youthful swoop.
For Mature Patients: A combination of structural or foundation fillers for volume replacement and softer fillers for highlighting is used. This approach addresses bone resorption and volume loss. Collagen-stimulating fillers (e.g. calcium hydroxylapatite and poly-L-lactic acid) may be used as well. This combination allows for both immediate results and long-term collagen stimulation.

Nasolabial Folds (Smile Lines)

The nasolabial folds are common targets for cosmetic treatments. Proper filler placement can support and reduce the appearance of these lines without adding excessive volume, leading to a more natural look.

Addressing Nasolabial Folds

Volume should be used to lift rather than just fill in lines. Typically, fillers that are flexible and move with smiling are used in this area . Treatment of the Mid-Face is commonly performed along with the nasolabial folds to help with a natural appearance. Typically, 1-3 ml are used in a treatment session, depending on the depth of the folds and level of correction needed.

Fillers in this area correct between 12 to 36 months.

Chin Filler and Facial Shaping

The chin is a key feature in facial aesthetics, anchoring the lower one-third of the face and contributing to a balanced profile. Subtle enhancements to the chin can sharpen the jawline, reduce jowls, and improve the neck’s appearance. The chin’s shape affects the overall facial balance. Proper chin projection helps enhance the face’s profile. For patients with round faces, volume addition can elongate the face and provide support to sagging jowls and neck.

Dermal fillers can define and enhance the chin, jawline, and jowl areas, balancing the facial profile. Subtle or dramatic changes can be achieved, depending on the individual’s needs.

Volume Guidelines

Subtle Changes: 0.5 to 1.0 ml
Contouring and Strengthening: 1.0 to 4.0 ml
Jawline and Chin Contouring: 3.0 to 8.0 ml

For jawline and chin contouring, a combination for Dermal Fillers and Collagen-stimulating injection are preferred due to their structural support and longevity.

Hand Fillers

Hands can show signs of aging such as brown spots, wrinkles, prominent veins, and volume loss. Dermal fillers and fat transfer can restore volume, improving the hands' appearance. Treatments are quick, painless, and offer instant results with no downtime.

Hand rejuvenation addresses the visible signs of aging on the backs of the hands, where skin is thinner and more susceptible to changes from sun exposure and aging. This treatment replaces lost collagen and fat, masking age-related changes. A cannula or precise needle injections are use for filler delivery, which is pre-mixed with numbing agents for comfort. Dermal Fillers can provide immediate correction however Collagen-stimulating injections are preferred for their longevity and volume.

Volume Guidelines

Typical Amount: 2 to 4 ml per hand.

Temple Fillers

Volume loss in the temples can create a hollow appearance, which fillers can restore, potentially lifting the brows and improving facial harmony. Volume restoration in the temples can address shadows and hollowing, often seen with aging or a lean physique. Enhancing this area can also provide a subtle brow lift and improve the overall contour.

Typically both hyaluronic acid fillers for immediate results and collagen-stimulating fillers for longer-lasting improvements. Typically, 2-4 ml of filler is required, depending on the degree of hollowing. Some patient require multiple sessions to achieve adequate correction. Temple fillers generally correct between 18 to 36 months. The exact duration depends on the filler type and individual metabolism.

Techniques and Risks

Both needles and cannulas are used for this area. The needle technique involving a single entry point can provide projection, while cannulas used for dermal fillers and collagen-stimulating fillers can improve shadowing and hollowing. Risks include mild swelling, bruising, and rare arterial injections, which are mitigated by precise techniques.

Jawline Fillers

Defining the jawline is crucial for balanced facial aesthetics. Dermal fillers can enhance the jawline, impacting side and oblique profiles and reducing jowls and marionette lines. The jawline affects overall facial aesthetics, contributing to angularity and balance. It’s important for both men and women, especially as bone resorption can weaken the jawline with age.

Various fillers, including hyaluronic acid and collagen-stimulating types like calcium hydroxylapatite and poly-L-lactic acid are used in this area. The choice depends on the clinical needs. For hyaluronic acid fillers. results are observed immediately whereas

Collagen-stimulating fillers show optimal results 3-5 months post-procedure. Radiesse is commonly used for its long-lasting volume and lift. Treatment volumes have an average range of 2-6 ml for hyaluronic acid fillers and 4.5-6 ml for collagen-stimulating fillers.

Tear Trough Fillers

The tear trough, a delicate and intricate zone beneath the eyes, is a challenging area to rejuvenate. It intersects with the skin of the lower eyelid, the medial and central cheeks (often referred to as the lid-cheek junction), and the deeper bony structures of the face. Effective treatment with hyaluronic acid dermal fillers can significantly improve this area, reducing shadows and dark circles. Multiple factors contribute to the appearance of shadows, including genetic pigmentation, thin skin, underlying vascular structures, the trough itself, and skin laxity. To achieve the best results, these factors must be addressed comprehensively.

The tear trough is the depression that runs from the lower eyelid to the cheek. A pronounced trough can create shadows, giving the face a fatigued appearance and accentuating dark circles. These troughs can be inherited from a young age or become more pronounced due to age-related volume loss.

Dermal fillers provide a non-surgical solution for addressing deep tear troughs. Hyaluronic acid is the most frequently used filler for this purpose. Fillers function by replacing lost volume and stimulating collagen production, which reduces shadows, fills the trough, and lessens the appearance of dark circles.

Treating the tear trough itself requires a very minimal amount of filler, typically less than 1ml. More often, additional filler is needed to support the surrounding structures, particularly the lid-cheek junction. Generally, to achieve a satisfactory comprehensive correction of cheek-eyelid junction, a 2-3 ml may be necessary, depending on the patient’s anatomical features and the extent of age-related volume loss.

Dermal fillers in the tear trough area typically correct between 9 to 24 months. The actual longevity of the filler can vary based on the type used and how quickly an individual’s immune system metabolizes it. Notably, fillers in this area tend to last longer than the advertised durations due to the reduced movement around the eyes compared to more dynamic areas like the lips.

Under-correcting the tear trough area is often intentional. Hyaluronic acid fillers can absorb water over time, which may lead to increased swelling and puffiness if absolute correction is initially achieved. This can create a less desirable outcome than a slight under-correction. If necessary, additional filler can be added later, but excessive initial filler might require complete dissolution and reapplication.