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Soft tissue dermal filler injections can be used in many ways to address your individual concerns. Areas of possible augmentation include:
- Lateral eyebrows to provide adequate brow support, “brow lift” and shaping
- Periorbital volumizing diminishes appearance of infraorbital hallows, “under eye” dark circles
- Nose – shape and structural irregularities can be address by non-surgical filler rhinoplasty
- Periorbital wrinkles, “smile lines”, the furrows that develops around the eyes
- Restoring malar cheek projection, volumetric reconstruction of the lateral cheek and “cheek bones” and lateral cheek with filler material has double benefit. First it restores more youthful cheek appearance and second by replacing volume decreases sagging and soft tissue loss in the mid face. As a result the prominence of nasolabial and melolabial folds in reduced.
- Nasolabial fold – facial “parenthesis”, the lines that run from the nose to the corner of the mouth
- Chin – shape and structural irregularities can be address by non-surgical filler chin implant
- Lips – soft tissue fillers are used to fill in and augment thin lips
- “Marionette lines” – sad, downward expression that appears at the corners of the mouth with advanced age
- Lips border and volume
- Lift up jowls or plump up volume along the jaw line where definition has been lost.
- Acne and depressed scars
- Static wrinkles; wrinkles at rest, caused by aging, overexposure to the sun, environmental exposures and/or cigarette smoking
While it is not a soft tissue filler, botulinum derivatives Botox, Dysport, Xeomin, Jeuveau are a very popular injectable treatment that works synergistically with fillers for wrinkle treatment and overall facial rejuvenation. BOTOX® and Dysport® are meant for “dynamic” wrinkles that are caused by repeated muscle movements and potentiate effects of fillers that actually plump up wrinkles and facial depressions. Soft tissue filler and BOTOX®/Dysport® injections can be performed on the same during a single session.
Temporary Fillers
- Restylane
- Restylane Lyft
- Restylane Kysse
- Juvederm Ultra and Ultra Plus
- Juvederm Voluma XC
- Juvederm Volbella
- Juvederm Vollure
Semi-Permanent
- Radiesse
- Autologous Fat Transfer
Collagen Stimulators
- Sculptra
Hyaluronic Acid Fillers
Hyaluronic acid is a naturally-occurring, biodegradable complex sugar found in the human body and in all mammals. It is used to restore volume to the aging skin giving a smoother, more youthful appearance. Results are instantaneous.
Hyaluronic acid is hydrophilic (“water loving”) and constantly draws water into its matrix. This process hydrates the skin and creates volume, contributing to the improved overall appearance. This ability of hyaluronic acid to bind to water is what helps the filler to provide lasting results.
Hyaluronic acids produce superb, reproducible results that last six to twelve months. They can be injected in a 15 to 30 minute session.
Restylane® and Restylane Lyft®
Restylane® and Restylane Lyft® are cosmetic dermal filler made of hyaluronic acid. The hyaluronic acid in both is a crystal-clear gel called NASHA™ or Non-Animal Stabilized Hyaluronic Acid. NASHA is completely biocompatible with human hyaluronic acid.
Restylane® and Restylane Lyft® are safe and natural cosmetic dermal fillers that restore volume and fullness to the skin to correct facial wrinkles and folds, such as “smile lines”, “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jaw line, depressed scars and marionette lines. Restylane ® is also an excellent lip enhancer..
The difference between Restylane® and Restylane Lyft® is in the particle size and hyaluronic acid cross-linking. The hyaluronic acid in Perlane® is chemically cross-linked (the long chemical strands are tied together) to delay breakdown by skin’s enzymes. Therefore, Restylane Lyft® works well for filling deep lines while Restylane® is better suited for fine tuning and correction of fine lines and wrinkles.
How long the effects of Restylane® and Restylane Lyft® treatments last is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient. The majority of scientific literature reports 50 to 80% retention after 6 months for Restylane® and 6-12 months for Lyft®. When used around eyes, Restylane® tends to last 12 months.
JUVÉDERM , JUVÉDERM® Ultra and JUVÉDERM® Ultra Plus, Juvederm Voluma XC
JUVÉDERM® injectable gel is a hyaluronic acid approved by the FDA for treatment of facial lines and wrinkles.
The smooth consistency gel helps to instantly restore your skin’s volume and smooth away facial wrinkles and folds, like your “smile lines”, nasolabial folds (the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jaw line, depressed scars and marionette lines. Juvéderm™ is also excellent lip filler.
How long the effects of JUVÉDERM™treatment last is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient. The majority of scientific literature reports 50 to 70% retention after 6 months for Juvéderm™.
JUVÉDERM™ Ultra is a highly cross-linked (the long chemical strands are tied together) formulation for more versatility in contouring and volumizing of moderate to deep facial wrinkles and folds. JUVÉDERM® Ultra Plus, a more highly cross-linked robust formulation for facial volumizing and correction of deep folds and wrinkles.
The major difference between JUVÉDERM and other hyaluronic acid fillers is the consistency. JUVÉDERM, JUVÉDERM® Ultra and JUVÉDERM® Ultra Plus, JUVEDERM Voluma XC can be administered in a smooth-flowing injection, providing physicians with a high level of control for individualized, tailored wrinkle treatment and for achieving a smooth and natural look.
Dr. Reszko can provide advice on which material is right for your particular procedure.
Comparisons Among Selected Commercially Available HA Fillers
| HA Fillers | Restylane®
Restylane Lyft |
Juvéderm™ Ultra (24 HV)
Juvéderm™ Ultra Plus (30 HV) |
| Source | Bacterial fermentation | Bacterial fermentation |
| Gel sizing process; product consistency | Sieving; granular consistency | Homogenization; smooth consistency |
| Cross-linking agent | BDDE | BDDE |
| HA concentration | 20 mg/mL | 24 mg/mL |
| Duration of effect (FDA label) | ~6 -12 mo | ~6-12 mo |
Collagen Stimulators
Collagen stimulators contain particles that signal the skin to produce more collagen. Instead of just filling in select lines and wrinkles, these are used on larger areas like the cheeks. The results (which are not instant but improve over time) are longer-lasting; you may need a series of treatments for maximum results.
Sculptra
Sculptra® is an FDA-approved injectable product that restores and corrects the signs of facial fat loss by replacing lost volume. Also known as “poly-L-lactic acid,” it is synthetic, and biocompatible (does not harm the body) and biodegradable (able to be broken down by the body).
Sculptra aesthetic is targeted for use in:
- Deep folds such as nasolabial folds (between the nose and the mouth),” smile lines”
- Lines framing your mouth (marionette lines)
- Chin wrinkles
- Augmenting cheek bones
- Age associated temporal wasting
The mechanism of action of Sculptra is to stimulate new collagen synthesis, restoring the structure under the skin — for smoother skin and fuller volume. Typically, several treatments (on average 3-6 treatments) are needed and results develop progressively over several months. Results seen with Sculptra are long lasting (two or more years). Gradual resorption is thought to occur over a 2 to 4 year period with eventual breakdown of the material to lactic acid that is found naturally in the body. No skin test is required prior to use.
Sculptra results are not immediate. At your first treatment visit, it may appear that Sculptra worked immediately because of swelling from the injections and the water used to dilute Sculptra. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra takes time to gradually correct depressions in your skin. On average, patients may require 3 to 6 treatment sessions.
Treatment results will differ for each person. In a clinical study, the treatment results lasted for up to 2 years after the first treatment session or more. Touch-up treatments may be needed to maintain the desired effect.
Immediately following a treatment session with Sculptra, redness, swelling, pain or bruisingmay occur in the treatment area. These signs usually go away in a few hours to a few days. You will be given specific post-treatment care instructions, which will include massaging the area a few times each day for several days after the treatment session.
SEMI-PERMANENT FILLERS
RADIESSE
Radiesse®, calcium hydroxyapatite, is safe, new generation cosmetic dermal filler. It is used for the correction of facial lines and wrinkles, restoring a natural, youthful look in an easy, convenient treatment. Numerous medical studies have shown that Radiesse is a long-lasting treatment to fill and correct smile lines, nasolabial folds jowls and jawline contours, as well as augmenting the mid cheek, chin and facial hollows.
Calcium-based microspheres provide a scaffold that promotes soft tissue in-growth. Fibroblasts (collagen producing cells) lay down a collagenous matrix. As matrix is deposited, calcium hydroxyapatite implant becomes integrated into the surrounding tissue, providing long-lasting, natural results. Calcium hydroxyapatite spheres are biodegradable and break down slowly over months to years. Because calcium hydroxyapatite is a normal constituent of bone, it does not elicit a chronic inflammatory or immune response lowering the risk of potential side effects.
Radiesse is long lasting, but not permanent filler with none of the risks associated with permanent implants. It does not require any allergy testing. Radiesse longevity ranges between 12 and 18 months, Radiesse is a great treatment option for patients who seek a longer lasting correction.
Autologous Fat Transplantation
For patients who desire a longer lasting, natural appearing result, autologous fat transplantation is a superb treatment option. Autologous fat transplantation offers two advantages over other methods for erasing wrinkles. First, the fat we use is your own tissue, eliminating the risk of allergic reactions. Second, most of the fat that is transplanted will remain semi-permanently, resulting in fewer repeat treatments.
Fat transplants are used to fill in contour defects, such as the groove that runs from the nose to the corner of the mouth (nasolabial folds), cheeks, temples, jaw line and to improve the appearance around the corners of the mouth, which often begins to sag with age.
Before the Procedure
To obtain fat for transplantation, a small liposuction procedure is performed in which cells are harvested from the abdomen, buttocks, outer thighs or hips. Virtually painless, this procedure takes less than 30 minutes. Afterwards, the fat tissue is processed for implantation. A small portion of the harvested fat is used for immediate transplantation, and the remainder is processed and stored in a specially designed facility for future use.
The Procedure
After a small amount of local anesthesia is administered, the patient’s own tissue is inserted using special small instruments. Careful attention is paid to the fat insertion technique, ensuring that the results are both smooth and symmetrical. Extreme care is exercised to preserve and enhance natural aesthetic contours, and use precisely controlled movements to create a wrinkle-free appearance.
Recovery
Post-operative care is minimal after this procedure and recovery is quick. Results can be seen within 24 to 48 hours after the swelling recedes and the newly transplanted tissue settles in place.
Bruising is uncommon, and is usually covered easily with makeup. If additional wrinkle correction is desired by the patient, a small touch-up procedure can be performed 3 to 6 months after the initial procedure.
Natural aging process can be divided into photoaging and structural aging. Structural aging has two components gravitational and volumetric. As a result of structural aging shape and facial proportions change.
Age associated structural changes include:
- Dermal thinning and loss of elasticity
- Photoaging and exposure to environmental pollutants are associated with reduction in collagen and elastin leading to clinically visible fine lines and wrinkles.
Therapy Options: sun protection, topical retinoids, chemical peel, microdermabrasion, intense pulsed light (IPL), photodynamic therapy (PDT), non-ablative and ablative lasers
- Gravitational aging
- Leads to drooping of the skin
- Common manifestations include rhytids, grooves, wrinkles, and jowls (“sags and bags”)
Therapy Options: BOTOX®, Dysport®, fillers, neck and jowl liposuction, contour thread life, S-lift, blepharoplasty, facial implants, brow-lift, CO2 and erbium: YAG laser resurfacing, Thermage®
- Volumetric aging
- Leads to development of deep hollows and furrows and thinning of the face
- Loss and redistribution of fat
- Loss of temporal fat resulting in loss of natural convexity
- Loss of lateral cheek (malar, zygomatic) fat leading to sagging and soft tissue loss in the mid face
- Skeletal and bone remodeling
- Decreased brow support leading to sagging eyebrows
- Increased orbit size
- Sunken maxilla
Therapy Options: fillers, autologous fat transfer, facial implants
Soft tissue injections can be used in many ways to address your individual concerns. Areas of possible augmentation include:
- Lateral eyebrows to provide adequate brow support, “brow lift” and shaping
- Periorbital volumizing diminishes appearance of infraorbital hollows, under-eye dark circles
- Nose – shape and structural irregularities can be addressed by non-surgical filler rhinoplasty
- Periorbital wrinkles – “smile lines”, the furrows that develop around the eyes
- Restoring malar cheek projection, volumetric reconstruction of the lateral cheek and “cheek bones” and lateral cheek with filler material has double benefit. First it restores more youthful cheek appearance and second, by replacing volume, decreases sagging and soft tissue loss in the mid face. As a result the prominence of nasolabial and melolabial folds is reduced.
- Nasolabial fold – facial “parenthesis,” the lines that run from the nose to the corner of the mouth
- Chin – shape and structural irregularities can be address by non-surgical filler chin implant
- Lips – soft tissue fillers are used to fill in and augment thin lips. Improve border and volume.
- “Marionette lines” – sad, downward expression that appears at the corners of the mouth with advanced age.
- Lift up jowls or plump up volume along the jawline where definition has been lost.
- Acne and depressed scars
- Static wrinkles – wrinkles at rest, caused by aging, overexposure to the sun, environmental exposures and/or cigarette smoking
While they are not a soft tissue filler, botulinum derivatives BOTOX® and Dysport® are a very popular injectable treatment that works synergistically with fillers for wrinkle treatment and overall facial rejuvenation. BOTOX® and Dysport® are meant for “dynamic” wrinkles that are caused by repeated muscle movements and potentiate effects of fillers that actually plump up wrinkles and facial depressions. Soft tissue filler and BOTOX®/Dysport® injections can be performed on the same day during a single session.
Temporary Fillers
Hyaluronic Acid Fillers
- Restylane®
- Perlane®
- Juvederm Ultra® and Ultra Plus®
- Juvederm Voluma® XC
Semi-Permanent
- Radiesse®
- Autologous Fat Transfer
Collagen Stimulators
- Sculptra®
Hyaluronic Acid Fillers
Hyaluronic acid is a naturally occurring, biodegradable complex sugar found in the human body and in all mammals. It is used to restore volume to the aging skin giving a smoother, more youthful appearance. Results are instant.
Hyaluronic acid is hydrophilic (“water loving”) and constantly draws water into its matrix. This process hydrates the skin and creates volume, contributing to the improved overall appearance. This ability of hyaluronic acid to bind to water is what helps the filler to provide lasting results.
Hyaluronic acids produce superb results that last 6 to 12 months. They can be injected in a single session.
Restylane® and Perlane®
Restylane® and Perlane® are cosmetic dermal fillers made of hyaluronic acid. They are safe and natural cosmetic dermal fillers that restore volume and fullness to the skin to correct facial wrinkles and folds, such as “smile lines,” “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jawline, depressed scars and marionette lines.
Restylane® is also an excellent lip enhancer.
What’s the difference between Restylane® and Perlane®?
The difference between Restylane® and Perlane® is in the particle size and hyaluronic acid cross-linking. Perlane® works well for filling deep lines while Restylane® is better suited for fine tuning and correction of fine lines and wrinkles.
The length of the effects of Restylane® and Perlane® treatments is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient. The majority of scientific literature reports 50 to 80% retention after 6 months for Restylane® and 6 to 12 months for Perlane®. When used around eyes, Restylane® tends to last 12 months.