What is a dermal filler?
Dermal fillers, otherwise known as facial fillers, have become one of the most popular anti-aging treatments in the last two decades. As a result, while facelift surgery continues to be the ultimate procedure in turning back the clock, fillers have taken over as a minimally invasive method for restoring a youthful look to the face as dermal fillers plump up areas of the face that lose volume naturally with age. Some of the most common areas to ‘fill’ are the lips, cheeks, and under-eyes and providers commonly use hyaluronic acid for this procedure. A naturally occurring substance in the body that plays a major role in wound healing and skin regeneration, hyaluronic acid is thought to be why babies are capable of nearly scarless healing. The FDA approved the first hyaluronic acid dermal filler, Restylane, in 2003. numerous brands and versions of hyaluronic dermal fillers have hit the market, commonly known as Juvederm and Belotero.
Hyaluronic acid has several properties that make it an excellent choice as an injectable treatment. It is non immunogenic, meaning the body does not mount an allergic reaction to it. This is in contrast to some other types of fillers like, Bellafill or bovine collagen filler that require allergy testing prior to injection to reduce the risk of adverse reactions following injection. It is quick to inject, the injection takes just a few minutes to complete. It is dissolvable. Hyaluronic acid can be melted away with an enzyme called hyaluronidase, which every provider who injects hyaluronic acid should have on hand.
How do you know which filler is best for you?
Not all hyaluronic acid fillers are the same. The particle size, concentration of hyaluronic acid, the degree of molecular cross-linking, the degree of osmotic action (how much water is pulled in by each filler type), and the elastic modulus or G prime number of the filler are different in each formulation of hyaluronic acid filler. These properties dictate how the filler behaves and how long it will last when injected. This is where it is critical to pick an injector who has extensive training and understands these concepts.
How do you get the most natural looking results?
Achieving natural results requires selecting an injector who is experienced and highly trained. There are many crash courses training masses of individuals how to inject dermal fillers for cosmetics. Be aware that the best-looking results require in depth understanding of the filler being used and the anatomy being injected.
Common Pitfalls to Avoid
Over-injecting
If your goals are plump lips and high cheekbones, be patient! The most natural results can be achieved by “stacking” filler. This means injecting smaller amounts over more visits. This does not drive up the cost because you typically are charged per syringe of filler. Start with one and go up from there. This makes the change less obvious and allows you to see when you are reaching a reasonable endpoint without overfilling. It’s much easier to add more than try to reduce over-filling.
Choosing the wrong filler for the wrong location
It is your injector’s responsibility to know which fillers are best for each patient and their goals. Pick your provider wisely, it’s okay to get a second or even third opinion. Go to someone who really knows their stuff.
Injecting to deep or too superficially
Different types of filler are intended to be injected at different levels in the skin and soft tissue of this face. This goes back a bit to selecting the correct filler for the correct location and goal.
Starting too young or too late
Some patients who come in asking for filler may be too young or better served by botox or other procedures like microneedling with or without platelet right plasma Anti-Aging Tips & Tricks in the ‘Zoom Era’. Other patients may be older and may be far better served by a surgical procedure like a mini-facelift or deep plane facelift. The best way to find out is to seek a consultation with a trained and experienced provider.
How to succeed
Do your homework, pick someone well-trained and experienced that you trust. Go slow, you can always add more. Focus on your overall health and well being. Looking as young as you feel starts with the basics like healthy eating, exercise, sleeping well, skin care, and managing stress. Final thought – aging is beautiful, it’s less about anti-aging and more about aging well.
Roxana Moayer, MD is a facial plastic and microvascular reconstructive surgeon. Her clinical specialties include treatment of facial nerve disorders and synkinesis, facelift and neck lift, rhinoplasty, blepharoplasty, brow lift, cosmetic facial skin treatments including microneedling and PRP, facial reconstruction (following trauma and cancer), hair restoration, facial feminization, and otoplasty. She is dedicated to helping patients look like the best version of themselves, driven by a strong belief that such work is inextricably linked to their self-confidence and overall health. Her attention to detail and aesthetic eye, paired with advanced training in cutting-edge techniques, allows her to deliver reliable, safe and natural-looking results.
After completing her medical doctorate at the Keck School of Medicine of USC, Dr. Moayer continued to the University of California, Los Angeles to complete her internship and residency. From there, she moved to Philadelphia for an additional year of training at one of the highest volume, AAFPRS-accredited fellowship training programs in the country, Jefferson Facial Plastics. She is currently an assistant professor on faculty at the Keck School of Medicine in the Department of Otolaryngology Head & Neck Surgery.
Dr. Moayer is also involved in the Face-To-Face program, an organization affiliated with The Break the Silence Foundation against domestic violence that provides plastic surgery treatment for survivors of domestic abuse.