Injectable Fillers

What happens with aging?

As we age, years of movement catches up to us and etches lines and wrinkles.  Sun damage and our genetics contribute to the breakdown of skin collagen which leads to wrinkles.  Sun and free radicals in the environment cause brown spots, poor skin texture and loss of elasticity.  We also lose fat and bone in the mid face which and this loss of structural support leads to wrinkles, jowls, and sagging/loose skin. 

Whereas the neuromodulators, botox and dysport are for wrinkles that occur with facial motion, injectable fillers are generally for wrinkles that you see at rest.  They can be used to lift and restore cheek volume, improve jowls and jaw contour, fill superficial wrinkles or acne scars, and add volume to lips.

There are many different types of fillers.  Many of them utilize the substance hyaluronic acid.  This is a naturally occurring substance in the skin that binds water to cells.  When injected into the skin and lips, it can restore lost tissue volume.  There are several different hyaluronic acid fillers and they differ based on the thickness, G prime (how a filler retains its shape with force) and viscosity (how it flows or how spreadable it is) of the hyaluronic acid being used.  Which filler is right for you depends on the location and the depth of the wrinkles being treated.  Our physicians are skilled injectors and will meet with you to discuss your goals and determine which injectable filler is right for you.

Juvederm: FDA approved Juvederm contains hyaluronic acid and when injected supports the skin surface leading to a firmer, smoother, more youthful face.  It is particularly effective for nasolabial creases (AKA ‘smile lines’) and marionette lines (creases that appear at the corners of the mouth that result in a sad expression).   It can also minimize the appearance of scars and enhance your lips. 

Restylane: Restylane is one of the oldest and most widely used hyaluronic acid fillers.  It is exceptionally effective for treating nasolabial folds and marionette lines (creases that appear at the corners of the mouth that result in a sad expression).  It can also be used under the eyes to correct a sunken look, and to minimize scars.  One quick treatment with no downtime can yield dramatic results.   Restylane and Juvederm are similar but there are subtle differences which our physicians can discuss with you depending on your goals.    

Voluma: Juvederm Voluma is a newer hyaluronic acid filler with a higher G prime and viscosity.  These new properties enable injectors to correct volume loss in areas that have lost the structural support of fat and bone during the aging process.  It is particularly effective to add volume and restore contour to the cheeks and temples.  When injected in these areas it can also lift the sagging skin of the jowls creating a more contoured jawline.  It lasts up to 2 years which is nearly twice as long as other fillers.   

Restylane Lyft: Restylane Lyft (formerally Perlane) is another hyaluronic acid filler with the highest G prime and viscosity designed to lift and contour cheeks and treat deep facial folds. 

Silk: The mouth and lips also show signs of aging.  As we age, lips thin, lose shape, and vertical lines appear above the mouth. Restylane Silk is a filler with a lower G prime and smooth properties designed to precisely shape lips and fill perioral lines resulting in silkier, smoother, and natural looking lips.   

Volbella: The newest FDA-approved filler for plumping lips and smoothing lines around the mouth (perioral rhytides).  Specifically designed as a smooth gel, it gives a soft, natural feel, and results last up to one year.

Sculptra: Sculptra is a dermal filler made from a material called Poly-L-Lactic acid.  This substance has been used in medicine for many years (specifically in dissolvable sutures) and has been used in Europe for decades.  Sculptra gradually adds fullness to areas of the face that have lost volume and encourages the body to form collagen.  Over time, volume is replenished and facial contours appear smoother, softer, and more youthful.  It is particularly helpful for hollowed cheeks and temples or areas of atrophy/fat loss.  Usually patients undergo a series of 3 or more treatments over a period of 3-4 months.  The changes last up to 2 years. 

What should I expect during my filler procedure?

Before your treatment you will generally sit with a topical anesthetic on your skin to make the procedure more comfortable.  Then the skin is cleansed.  Typically the injections take 15-30 minutes.  Many of the fillers are mixed with lidocaine which also enhances comfort.  You will feel several needle pricks but they are generally easily tolerated.

How long do fillers last?

Depending on the product used, the results last from 6 months-2 years.  Because they all stimulate new collagen formation to some extent, by having regular treatments, it is possible that in time you will need filler less often.

What are the side effects?

Most patients experience minimal side effects.  Some patients have swelling which typically resolves in 1-2 days.  Some patients will have bruising.  The chance of bruising can be minimized by avoiding blood thinners (aspirin, NSAIDS, vitamin E, fish oil, garlic supplements, and alcohol) for 1 week prior to treatment.  Some patients benefit from eating fresh pineapple the day before treatment due to the Bromelain enzyme in pineapple that has been reported to minimize swelling and bruising.

Can you combine filler with other treatments?

Yes! Our physicians can combine filler with the neuromodulators (Botox & Dysport) as well as a variety of skin tightening, laser treatments, and skin care products to achieve a complete plan for facial rejuvenation based on your cosmetic goals. 

Before and After Filler Photos


Restylane Before and After


Voluma Before and After

Resylane Silk

Restylane Silk