Lip Fillers and Dermal Fillers

Fillers such as Juvederm® Restylane® Belotero® Revanesse® or Radiesse®  are used for much more than just plumping lips and giving you a sexy pout. As you age, your skin loses elasticity and moisture. 

This normal aging process, plus environmental factors like sun exposure, cause different facial lines to form, including moderate to severe wrinkles and folds.  Fillers can erase evidence of aging and worry lines by replacing lost volume and filling in deep wrinkles.

Dermal fillers are substances injected beneath the skin or deeper soft tissue layer to help smooth fine lines and boost volume. Also known as dermal fillers, these injections are in-office procedures that are minimally invasive alternatives to cosmetic surgery. Patients often undergo dermal filler injections to achieve a more youthful appearance with as little down time as possible. Fillers are available to target nearly any area of the face, including crow’s feet, laugh lines, and thin lips.

The results from filler injections can be subtle or dramatic. Add volume during your next lunch break; you could come in for a quick lip filler, or get an entire facelift without having to go under the knife. Our signature liquid facelift will give you noticeably beautiful results without the recovery time or cost of a surgical facelift.  

To get a good filler treatment, you need to find someone who is a good sculptor. 

In essence people think they are just paying for a syringe or two of product. Consider that you are not only paying for the product, but for the expertise and artistic eye . Good injectors have mastery level knowledge of facial anatomy, skin, muscles, bone, and have keen visio-spatial insight on strategic filler placement. 

A good sculptor knows where they can add value to what is there; adding to your natural beauty, accentuating your bone structure, and filling in volume where your own natural fat pads have shrunken. 

Not all doctors and nurse injectors are good at knowing where and how much to inject.  A title is just an indication of basic standards being met for the job. A title does not show you someone’s passion or artistic skill.  

Find someone who has not just the training and capacity to consistently do a good job, but also look for someone who is committed to giving you a great result. If you go to someone who has only done a couple face injections, no matter what that person’s title is you may not get the result you wanted. Not all doctors or nurses are super obsessed about mastering the art of creating beautiful facial harmony.

Also, sometimes I turn people down for fillers. It is better not to do the filler at all for someone who has not set aside enough funds for the treatment. 

It is like asking a painter to paint your whole house with a gallon of paint. No matter how good the painter or paint is, a gallon won’t cover a whole house. 1 syringe may be enough for just the lips for a little fullness replacement. 

In reality, for full face rejuvenation, I often use 10 syringes of filler to replace fat loss in the fat pads of the both cheeks, both eyebrows, the chin, both jawlines and lips. 1-1.5 ml per area, along with suspension sutures to shape the face , cheeks, nasal ridge, philtrum, lips, and angle of the jaw.  

Then, I also use RF to tighten the skin, the MaxG IPL for sun damage /dark spot removal, and the 1540 fractional laser to increase collagen elastin in the skin. I top this off with botox wrinkle smoothing. My goal is to deliver a ‘wow’ transformation. 

As far as fillers go there are two main types Biostimulatory fillers and HA ( sugar) fillers. The biostimulatory ones, you cannot break down with an antidote enzyme in case you did not like it whereas you can break down HA filler. 

Biostimulatory fillers 

There is sculptra and radiesse for biostimulatory fillers. These stimulate your body to build more tissue. These are particles suspended in a gel. The provider has less control over this type of filler as the end result is due to 2 things: 

  1. The initial volume of the gel placement.
  2. How your body responds to it, creating even more collagen around the round product particles/ beads. 

Hyaluronic Acid fillers

HA fillers are more controllable in terms of end result, you get what you see on initial placement of the filler. The injector has more control on your end look with HA fillers, and doesn’t have to guess your body’s future collagen upregulatory response, and has to put in less product, so that in the end, the area doesn't look too full later (when the biostimulatory response kicks in and plumps up the area more).  Within the HA filler class there are multiple types of fillers. Fine fillers for fine wrinkles, intra-dermal fillers, and sub-skin deep fillers. All look like clear hair gels, of different consistencies.  There are different types of HA fillers.  Some are watery and thin,  like Belotero, and are good for use under the eye. However, since they are thin, they often do not last long; typically 6 months. Squirting out Belotero from a syringe results in a watery puddle.

The more crosslinked the HA filler, the more HA is in the gel, the more fill power it has, in terms of holding its shape in or under the skin. Some fillers like Voluma are highly crosslinked so they maintain their shape better, and maintain their skin lift as well.  The cross linking of the HA filler determines how long it lasts after injection into the skin, and how much lift it provides under the skin. Squirting out Voluma from a syringe results in a pyramid type of gel pile that looks like a Hershey’s kiss. 

Improper choice of filler for someone, insufficient quantity, or improper placement, can lead to disappointment. 

Injecting fillers well requires solid knowledge about various fillers, their individual concentrations of HA, knowing how much cross linking each product has, and knowing where exactly to put it for the most strategic benefit. 

Knowing all the gels and what  they are good for based on the concentration of the filler and the amount of cross linking, the covalent bond that gives the fillers its lift or form, is key. There are different thicknesses of these HA (sugar) filler gels. They all look like clear gels in the syringe but they are made by different companies and the concentration and cross linking are what differentiate these fillers and give the individual fillers their specific use profiles.  

The different types of HA crosslinking are proprietary and give individual companies a way to promote and market their filler products.  

Revanesse versa for example has a lot of cross linking. The company that makes it shows that their unique method of cross linking gives it an average 3 months longer in staying power, allowing it to last 12 mo vs 9 mo for the average HA filler. 

In addition to knowing individual filler differences, and use cases, a good filler injector needs to know the muscles, bones, blood vessels, nerves, as well as the danger zones of the face. Knowing how to avoid complications that injections into the danger zones can cause is very important.  So there is a lot to consider when choosing a skin filler injector. 

Filler can be placed in front of and behind the jowl to minimize its appearance and to straighten out the jawline.  This typically requires 1-1.5 ml of product for each side of the jawline. 

Loss of collagen under the eye is well treated by superficial RF with continuous mode twice a week for a month or 3-4 laser 1540 treatments or RF microneedling like the secret RF microneedling or genius RF microneedling. 

The resting frown and down turning lips can be reduced by placing filler in the corners of the mouth and knocking out some of the DAO fibers with botox. Injection of the depressor anguli oris muscle with Botox into the depressor anguli oris muscle which is pulling down on the corners of the mouth, allows the elevator muscle of the lip to dominate, and allows for the lip to lift up. The DAO is the lip corner depressor muscle, responsible for down turning the lip at each corner of the mouth.  Botox needs reinjection into the DAO every 3-4 months to maintain lifting the corners of the lip up. 

Also injection of botox at the upper outer lip in the outer thirds can also create a slight upward lip flip. 

A more definitive procedure to turn the lip corners up again is to remove a tiny triangle of skin  at the lip corners. This needs to be done with meticulous reapproximation of the vermilion border of the lips.  This is all educational information and not medical advice.

Using fillers, Dr. Patel can modify the size and shape of your features or simply accentuate your natural beauty. She specializes in using fillers to create internal highlighting and natural color contouring. She plays with light and shadows, by masterfully placing filler in areas that define and highlight your bone structure.

Depending on your desired results, several different types of fillers can be used at the same visit. The customization begins at your consult.  The fillers we use at Iconic Medical Skin & Laser Center are all FDA approved and are based on naturally occurring substances in your body like Hyaluronic Acid and Calcium Hydroxylapatite.  

Schedule your consult with Dr. Patel and she’ll customize a product and treatment plan to help you achieve your desired results.  

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