Due to changes from aging and sun damage, our skin loses its elasticity and natural support structures. The fat compartments that once led to full youthful cheeks sag to create deep smile lines, marionette lines, and jowls. We begin to see shallow vertical lines around our mouths and find that our lips seem smaller. Facial fillers are a class of injectables, which are formulated to address these areas, adding volume where it is missing, and filling in the lines and wrinkles that visibly reveal our age.

The fillers commonly used are formulated from hyaluronic acid, a material which is a natural building block in the skin, or from other slowly absorbable substances. No pre-testing is necessary. Fillers are a non-surgical option to look younger and may be used in combination with surgical procedures. I often use them to enhance cheeks and lips, to smooth deep wrinkles and furrows, to conceal a tear trough in the lower eyelid/cheek junction, to build the bridge of the nose, to correct marionette lines and fine lines around the mouth, and to restore volume to aged hands. The use of fillers may delay your need for surgery or improve your surgical outcome.

A Changing Foundation

A youthful face is defined by high cheekbones, full cheeks, and a defined jawline. As the face ages, cheek skin and fat start to sag creating deeper nasolabial folds and flattened cheeks, the jawline is no longer clearly delineated and a fullness develops between the neck and chin (a double chin). The aging face tends to look less like a heart and more like an egg. Many of these changes are due to loosing skin ligaments, loss of facial fat, decrease in facial glands leading to less moisture, collagen and elastin loss, and changes in the facial bones. When considering placement of fillers, it is paramount to understand anatomical changes in order to naturally enhance your face.

The Players

Hyaluronic Acid

Dermal fillers (Juvederm, Restylane, and Belotero) are injectable fillers made from hyaluronic acid, which quickly integrate into your skin, naturally filling in facial wrinkles and smoothing out your skin. With these fillers, you can replace lost hyaluronic acid caused by the natural aging process. Once injected, the fillers attract water molecules to the site of injection to enhance their effectiveness. Choosing a hyaluronic filler depends on the placement of the filler. Some fillers are made from larger particles and are better for deeper injections. Others are formed from small particles so that they can be injected into fine lines or areas of thinner skin. Softer fillers may be best in more dynamic areas like the lips. The key to hyaluronic acid is that it is naturally occurring so you will not mount an allergic reaction and they are reversible by injecting hyaluronidase.

Radiesse

Radiesse Volumizing Filler is a synthetic injectable filler used to replenish volume to your cheeks to help wrinkles and folds disappear immediately. Radiesse contains calcium-based microspheres, which upon injection act as a scaffold under the skin to provide lift. Over time these microspheres begin to stimulate your own natural collagen to grow so results are both immediate and long-lasting. Because Radiesse is made from the same minerals found in bones, it carries little risk of allergic reaction. In many patients, results last a year or more.

The Details

The treatment, which consists of injections with a fine needle, is complete in just 30 minutes. To minimize your discomfort, I mix the filler with lidocaine, a local anesthetic or use pre-mixed fillers. I often use numbing cream in more sensitive areas. After injection into the skin, the filler instantly plumps the skin and smooths facial wrinkles to achieve a fuller, younger appearance while still maintaining the natural features that define you. The results are expected to last for six to twelve months, but in many cases last up to two years. With little or no downtime needed, you will likely leave our office and go right back to your regular routine.

The Next Generation of Make-Up

I often joke with my patients that fillers are becoming the next generation of make-up.  Similar to make-up, fillers can be used to create definition and contour. They are reversible. Most importantly, they are used to boost our self-image and confidence. Unlike make-up, you do not need to apply them daily. Whether it is to line your lips, add cheek contour, soften dark under eye lines, or highlight your nose, I think that you will find fillers to be a very useful tool in your beauty armamentarium.

The Lip Liner: Defining Lips

As we age, the lip becomes less and less defined. Many patients complain of a flattened upper lip and small vertical lines that encircle their lips. Although much is discussed about adding volume to small lips to establish the classic 1:1.6 proportion between the upper and lower lips, little is written about re-establishing the defining landmarks of the lips. When I look at the lips of my children, I am always struck by the well-defined white line that encircles them and the perfectly elevated Cupid’s bow which defines the upper lip. The lip of youths is not only fuller and plumper but much more defined. As the lips age, vertical lines develop along the edges, volume is loss, and the Cupid’s bow becomes attenuated. Some of my patients have confided in me that they have not worn lipstick in years as it often bleeds and exaggerates the vertical lines.

The greatest concern when patients come into the office is that they do not want to look like a duck. They do not want to look like someone on the television show “Botched!” And they really do not want to look different, they just want to look better.  The first question most patients ask is how? The key to natural lip injections is injecting small aliquots, injecting slowly, using the right material, knowing which planes to inject and how much in each and understanding lip anatomy. The results of lip injections are immediate…and they are reversible. I often inject half of the lips so that you can see the difference between the two sides. You can always inject more, but I think it is better to be conservative, especially the first time. More

The Liquid Rhinoplasty

A liquid rhinoplasty refers to a non-surgical rhinoplasty in which dermal fillers are injected into your nose to help balance nasal proportions. Fillers are ideal for correcting a small hump or slight asymmetries. They can be added to the bridge of a flat or wide nose to create a higher pyramid, giving the illusion of a narrower nose. They can also be useful in correctly slight imperfections after a surgical rhinoplasty.

A liquid rhinoplasty cannot make a very crooked nose perfectly straight as this non-surgical rhinoplasty is only camouflaging the features of your nose that make it appear crooked. It cannot lift the tip of your nose. By adding filler to the tip of your nose, you will be adding volume to an already droopy or sagging tip and thus exaggerating what you wish to hide. It cannot fix a breathing problem. Breathing problems are related to deviated septums or internal anatomic problems, not contour irregularities. Surgery is the only option to improve structural problems leading to breathing difficulties. More

Cheek to Cheek

As the face ages, the cheek fat starts to sag creating deeper nasolabial lines and flattened cheeks; drawing attention to your mouth instead of your eyes. By adding volume through fillers or fat grafting, nasolabial lines will soften and your cheek bones will become highlighted, encouraging people to refocus on your upper face and eyes.

An exciting new category of fillers has evolved to treat the mid-face, adding volume where it has been loss, camouflaging the signs of age. I place deep injections into the upper cheek area to help lift the nasolabial folds and build upon the bony foundation, so that the fillers are hidden from the surface. I have always believed that the placement of fillers is more important than the volume, using less material but injecting it at key points will change how the light reflects off your face, alleviating aging shadows. The newest fillers on the market for mid-face rejuvenation are Restylift and Juvaderm Voluma XC. Both are made from hyaluronic acid but cross-linked differently from their sister products Restylane and Juvaderm, resulting in more volume and lasting longer.  More

Hidden Temples

The temples of your forehead can appear hollow due to age or your anatomy. Thin patients with long faces often have concave temples. Hollow temples are not only associated with aging but also with sickness and malnutrition. Adding small amounts of filler to this area can soften concavities, creating a healthier, youthful appearance. As an added benefit, often your brow will appear lifted.

Keep your chin up

Many patients complain that their neck is undefined or their nose is too large. Sometimes this is in part due to a small or under-projected chin. Adding filler to the chin can rebalance your profile, help define your jawline and make your nose appear less prominent. Fillers can also help to soften a pointy chin. A strong chin has been associated with being smarter and more confident. There is no coincidence that superheroes like Batman and Superman as well as many supermodels have defined chins.

A Little Bling: Earlobe Rejuvenation

As women age, they not only loose elasticity and volume in their faces and breasts, but also in their earlobes, causing them to become thinner, creased and wrinkled. This loss of volume reduces the foundation upon which an earring sits, usually causing the earring to droop forward in an awkward position. I have found that injecting a small amount of dermal filler will plump up the deflated earlobe, helping to prop up your earring into its correct position, and leading to an overall more youthful appearance. The procedure is done in the office, only takes a few minutes and has no downtime. Women walk out feeling much more comfortable about how their earrings fit. As an extra bonus, these hyaluronic dermal fillers last much longer in the earlobe than in other areas of the face, likely due to a lack of wear and tear from muscle movement. More

Extra Baggage: Treating the Tear Trough

The junction between your lower eyelid and cheek is referred to as the tear trough. For many patients, the skin strongly adheres to the underlying bone, creating a dark shadow under your eye. It is possible to inject microdroplets of filler to this area to slightly raise the skin, thereby decreasing to concavity and lightening the shadow. It is essential to use small particles of hyaluronic acid to avoid a Tyndal effect (blue discoloration) and to inject in the correct plane. The overall effect is a less tired appearance. The correction will last for up to twelve months. A permanent change is possible though surgery. More (link to blepharoplasty page)

Peaked My Interest

If you are considering having a filler treatment, please call our office at (212) 600-4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in for surgery as well as those who are local to Manhattan.