Hyaluronic acid (HA) dermal fillers, such as Restylane® and JUVÉDERM®, have replaced collagen as the “go to” option for facial fillers at Dr. John Burroughs’ practice in Colorado Springs. Hyaluronic acid is a naturally occurring substance in the body and is essential for the appearance of plump and youthful looking skin. Because the body produces HA naturally, it hardly ever causes an allergic reaction, and it gives a smoother, more natural appearance than collagen. In addition to looking and feeling more natural, hyaluronic acid fillers also last longer than collagen fillers of the past. HA fillers have been shown to last anywhere from 6 to 12 months (possibly longer, depending on the metabolism of the patient). Another advantage of HA fillers is the fact that they are reversible. Though rarely needed, there is an enzyme called hyaluronidase that can be injected to reverse any unwanted cosmetic results within 24 hours.
This video is to inform how Juvederm or other fillers may be used. This video was not created by Dr. Burroughs.
Fillers are synthetic materials that are injected into the face to increase lip, cheek, or chin volume. Fillers can also be used to reduce the nasolabial fold and to fill skin creases. In some cases, filler can be used to treat the hollows beneath the eyes as shown in the picture to the left. The top photos show prominent fatty bags on top of (above) deep hollows. This patient underwent a “filler blepharoplasty” with an hyaluronic acid and has been thrilled with the results even several years later. Filler treatments are no-recovery treatments that can be performed over the lunch hour.
Frequently asked questions concerning dermal filler injections
1. What is a dermal filler?
A dermal filler is a material injected into or beneath the skin to add volume to the face.
2. Why are dermal filler injections popular?
Dermal filler injections typically cause a consistent subtle improvement in facial appearances that can be seen immediately after the injection yet with little or no recovery.
3. Why do dermal fillers make people look younger?
With the passage of time, we lose volume in the face. Loss of volume results in deflation of the face. Our face is much like a round, inflatable ball. If the ball is fully inflated, there are no wrinkles on the surface. If we let some air out of the ball, wrinkles form on the surface. If more air is let out of the ball, it no longer maintains a round shape. Dermal filler essentially re-inflates the face.
4. Who gives the dermal filler injections at Dr. Burroughs’ office?
Dr. Burroughs and Melissa inject dermal fillers.
5. How experienced is Dr. Burroughs in the use of dermal fillers?
Dr. Burroughs is very experienced, and has published and taught both cosmetic and reconstructive uses for dermal fillers.
6. What areas of the face are fillers used in the most?
Dermal fillers are used most frequently in the nasolabial folds (the fold between the cheek and mouth) and the lips. More and more fillers are being used to accomplish changes that formerly required face lift surgery or surgery to place cheek or chin implants. In these cases filler is injected beneath in the cheeks or chin to replace lost facial volume changes as shown in the photos to the left. This patient had dermal filler placement to fill in the hollows shown at the black arrows.
7. Do dermal filler injections and Wrinkle Blocker injections do the same thing?
They both can make one look younger and more rested, but do so in different ways and in different parts of the face. Wrinkle Blocker reduces wrinkles caused by contraction of muscles by relaxing those muscles. It works best in the forehead, between the eyebrows, and in the area just lateral to the eyelids (crow’s feet wrinkles). Filler adds volume to the face and works best in the areas of the face below the eyes.
8. Can one receive Wrinkle Blocker and dermal filler injections at the same time?
Yes. Dermal filler and Wrinkle Blocker are often used simultaneously to treat different areas of the face, resulting in a synergistic effect. Rarely, people will have very deep wrinkles in the area between the brows, crow’s feet, and forehead that do not resolve completely even when the muscle is relaxed with Wrinkle Blocker. In these situations, filler can be used in combination with Wrinkle Blocker to improve the deep wrinkle appearances. This patient had Wrinkle Blocker and perioral dermal filler placement to reduce the deep vertical links around her mouth and at the sides.
9. Can one receive dermal filler injections and have cosmetic surgery at the same time?
Yes. In some cases, dermal filler injections can delay or even alleviate the problems formerly treated with cosmetic surgery. However, some issues, such as excess skin in the upper eyelids and sagging skin in the neck, cannot be improved with dermal filler. Dr. Burroughs often uses dermal filler at the time of cosmetic surgery to enhance the results of surgery.
10. How do filler injections in the lips work?
Some young people simply like having full lips. Adding filler can give one fuller lips. In middle age, there are some aging changes that alter the appearance of the lips. The upper lip gets longer which allows some of the red part of the lip to roll under, resulting in the appearance of less redness in the upper lip relative to the lower lip. There is also a loss of elasticity and volume in the skin. This allows vertical wrinkles to form in the upper and lower lips. Injecting filler into the lip can roll out the upper lip, exposing more of the red portion of the lip. Injecting filler on the edge of the red part of the lip and into the vertical wrinkles can reduce these wrinkles. These changes can be accomplished without markedly increasing the size of the lips or giving one an unnatural appearance. Restylane is the most commonly used filler in the lips. These injections are typically repeated once every 6-9 months.
11. How do filler injections work in the lower eyelids?
Some of the aging changes in the lower eyelid are caused by separation of the cheek fat from the lower eyelid fat. This leaves a depression or valley at the intersection of the lower eyelid with the cheek. Many people refer to this as a dark circle. Adding filler to this valley or depression can cause the dark circle to resolve. Many different fillers, such as Belotero and Restylane, are commonly used to fill in the lower eyelids. These injections can last up to 2 years.
12. Do filler injections in the lower eyelid work equally well in all patients?
No. It works better if the skin is pigmented or thicker. In lightly pigmented female patients, the skin tends to be translucent, allowing the filler to be visualized beneath the skin. This technique works better in patients of pigment and in male patients as men tend to have thicker skin in the lower eyelid. This is mainly a concern for the lower eyelids because this skin is so thinner than the skin on rest of the face.
13. What is Belotero?
Belotero is a cross-linked hyaluronic acid. Hyaluronic acid occurs naturally in the skin, and it attracts water, increasing the fullness or plumpness of the skin. As we age, we lose hyaluronic acid from the skin, resulting in loss of fullness and deflation. Injecting Belotero can increase the fullness and inflate the skin. An advantage of Belotero to all other hyaluronic acid fillers is that is specially formulated to avoid appearing blue under the skin. Many hyaluronic acid fillers that are placed too superficially can appear blue like how our veins appear blue. The fact that hyaluronic acid occurs naturally in the skin accounts for the low incidence of allergic reaction to Belotero.
14. What is Radiesse?
Radiesse is a calcium-based microsphere suspended in a gel. It is a long acting filler that is best used for injections deep in the skin. It is used most commonly to add volume beneath the nasolabial folds. It should not be injected superficially in the skin, and it should not be used in the lips. It can be used very effectively in those who have generalized loss of volume in the face to add volume over the cheeks and even along the jaw line. Radiesse injections can last between 1-2 years, but some patients find benefit with more frequent injections for re-volumizing their faces. This patient had the dermal filler placement to reduce the deep nasolabial folds and the wrinkling at the outer corner of the lips.
15. Is it necessary to perform skin testing prior to Restylane or Radiesse injections?
No. Allergic reaction to Restylane, Belotero, and Radiesse is so rare that skin testing is not recommended by the manufacturers.
16. What filler is best for me?
It depends on the patient and the problem that is being treated. If you are not sure about the use of filler but would like to try it out, you may want to use Restylane because, if you do not like the appearance, it can reversed with an injection of a second medication. The answer to this question is best answered by consultation with Dr. Burroughs.
17. What needs to be done to prepare for filler injections?
Very little needs to done. Some medications such as NSAIDS (e.g., Motrin), omega oils (e.g., fish oil, flax), aspirin, vitamin E, gingko, and glucosamine thin the blood and promote bruising with filler injections. If these have been prescribed by a doctor or to treat a specific medical problem such as cardiac disease, you should continue to take the medication. Otherwise, temporary discontinuation of these medications and supplements may reduce potential bruising.
18. Do filler injections hurt?
Most patients experience only a temporary and minor discomfort. Dr. Burroughs is interested in making filler injections as comfortable as possible. The smallest effective needle possible is used, and some patients benefit with numbing cream to reduce the sensation of the skin. Radiesse is now mixed with a small amount of numbing medication.
19. What is recovery like for filler injections?
One of the great things about filler injections is that it requires little or no recovery. Most patients treated with filler get little or no bruising. The exception to this is the lower eyelids where patients will often get some bruising. The face does develop some small bumps from swelling adjacent to the injection sites. These are typically resolved in about an hour. Patients often apply a cold compress over the treated portions of the face to reduce the swelling. There may be some areas that feel but do not look lumpy. This typically resolves in a week or less.
20. Does Dr. Burroughs uses only FDA-approved dermal fillers?
Yes. The United States has one of the safest drug selections of any country in the world because of safeguards put in place by the FDA. Dr. Burroughs only uses genuine FDA-approved dermal fillers procured from legal sources.
21. Does Dr. Burroughs use fillers and other drugs on an off-label basis?
Yes. When a drug is approved by the FDA, it is typically approved for a narrow indication. It is common in the practice of medicine to use medications for indications other than the one it is approved for. For instance, Procardia was approved by the FDA for the treatment of chest pain but at one time was prescribed by doctors mostly for the treatment of high blood pressure. Wrinkle Blocker was initially only approved to treat wrinkles between the eyebrows. Dr. Burroughs also uses it on the forehead and in the crow’s feet area. He only uses fillers that are approved by the FDA but often uses fillers and other medications on a calculably safe but off-label basis.