Facial Fillers: A Personal Note

by Peter T. Pacik, MD, FACS

Facial fillers are not new, but it is only recently that we have products that are safe, effective and last longer than the 3 months of collagen injections.

Plastic surgeons are fully aware that volume loss of the face needs to be replaced with volume. A face that is smooth in the area of the cheeks but hanging around the mouth (perioral wrinkling) responds poorly to a face lift, but can respond dramatically to facial fillers. Nasolabial creases, marionette folds and facial creases are improved by adding bulk beneath these folds. Deep wrinkles in the area of the frown lines, and strong muscular activity in this region, create not only wrinkles but also deeper furrows. A combination of facial filler plus Botox will help smooth out these areas.

Each facial filler has specific indications and some doctors prefer the use of one to the others. In our practice, we commonly use JUVEDERM™, Restylane®, Perlane®, Radiesse® and fat grafting. We prefer to avoid the use of permanent synthetic fillers such as ArteFill® because if the patient is unhappy with the resulting appearance, it is difficult to remove the permanent synthetic filler.

We do not use collagen any longer because it is short lived (3 months) and requires pre-testing. Sometimes we will start with JUVEDERM™ or Restylane® to see how the patient responds and whether or not the patient is pleased with the results. Restylane lasts about four to six months, longer (about 9 months) when used with Botox because of the reduced muscular activity. Not all facial wrinkles and folds are suitable for the combined therapy; however deep frown lines respond well. Forehead wrinkles and crow's feet usually respond quite well to Botox alone.

JUVEDERM™ and Restylane® are also the favored facial fillers for lip lines and lip furrows, as well as to enhance the fullness of the lips. Lip lines may be genetic, or acquired because of smoking, or constantly drinking from the nipple of a water bottle. We also use Radiesse® to enhance the upper part of the lips and like the long-term results; however, short-term there may be some unnatural rigidity of the lips. Radiesse lasts 1 to 2 years; therefore, less frequent injections are needed and no pre-testing is required. We still treat lip lines with chemical peels as needed, the difference is that we now have available facial fillers to help add volume, which makes for a more pleasing, longer-lasting result. We prefer the use of Radiesse for nasolabial creases, facial creases, droopy corners of the mouth and marionette folds, when temporary filler is desired. The same areas described also benefit from fat grafting.

Radiesse Injection for Nasolabial Folds
Left: Pre-injection, Female, Age 41; Right: 3 months post-injection. Patient first injected with Restylane, then Radiesse.

Chemical Peel/Laser of the mouth area
Female, Age 44, non-smoker. Left: Pre advanced skincare regimen, Phenol-Croton oil peel and laser of the mouth area. Right: 9 month follow-up laser of the mouth; 1 year follow-up Phenol-Croton Oil Peel; 15 months on Obagi Nu-Derm Advanced Skin Care Regimen

Fat grafting may not be permanent and may require additional fat or facial filler at a later date.  As with synthetic facial fillers, such as JUVEDERM™, Restylane®, Perlane®, Radiesse®, touch-ups may be needed. Periodic touch-ups, to avoid a return to the original condition, will allow the benefits of facial fillers to last a much longer time. Droopy eyebrows, especially the outer areas, can be "lifted” by adding volume, such as JUVEDERM™, Restylane®, Perlane®, Radiesse®  or fat grafting. The nasolabial folds, facial creases, angles of the mouth, and marionette folds as well as midface loss of volume,  all respond well to synthetic facial fillers and fat grafting. Lip enhancement is appropriate at any age, for fuller lips during youth to senile loss of volume in older patients. Fat grafting and facial fillers are used in the region of the cheeks and for the enhancement of the cheek bones (malar prominences). This is also true for small chins. Chin enhancement can now be achieved by any of the facial fillers described, including chin implants.

So you can see that a great deal of thought goes into the selection of the proper facial filler that is most appropriate for your needs. They all work differently, and are capable of different results. We use only facial fillers that are manufactured by approved United States firms to ensure the safety of these products. We spend time with out patients during their consultation, so that we can better understand their needs and their desired outcomes. We are very pleased to have these added treatments available to us, so that we can give our patients of any age a more complete restoration of facial rejuvenation.

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The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, neck and chin surgery, rhinoplasty (nose surgery), surgery after massive weight loss, and tummy tucks. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, Juvederm®, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires.