Fill ‘er up

January 23, 2018 by Shari J. Twigg, MD
Fill ‘er up

What are dermal fillers?  A dermal filler “fills” the skin, restoring volume, contouring, and softening lines and wrinkles.  The first filler used was fat in 1893.  Then came bovine collagen (cow collagen) in 1981.  Silicone has been used as well and is still used off-label in micro-droplet form by some for acne scars and other reasons.  The most widely used filler at this time are a group call hyaluronic acid dermal fillers.  They have revolutionized fillers due to the duration of effect that is seen with these with relatively few complications.  These fillers were first introduced in the US in 2003.

Skin loses hyaluronic acid as it ages, leading to decreased movement and elasticity.  Hyaluronic acid acts as a scaffold for collagen and elastin to bind to.  It also binds water, augmenting and hydrating the skin.

Generally as we age, facial bone changes, soft tissues (muscles, fat-pads) fall due to gravity, and the skin begins to sag and droop downward.  The fat-pads of the face can shift, while fat-pads beneath the chin can increase in prominence causing the “double-chin” appearance.  Genetics play a role in how you will age, but other factors such as sun exposure and diet can also affect when aging begins and how fat it may progress.  The goal of therapy is to temporarily restore facial volume and correct age-related shadow patterns.  In others, it may be adding fullness to the lips for those that want additional lip volume.

There are many types of hyaluronic acid fillers on the market, but we will focus on the ones I use in my practice:  Juvederm.  Juvederm has a collection of fillers that offers a wide range of treatment options that can be customized to individual needs.  Often, more than one type of filler is used for optimal treatment of any given face.

  • Juvederm Voluma XC:  This filler is used solely for adding volume to the cheek area.  It is the first and only filler FDA approved for this use.  It can help restore a more youthful contour of the cheek area, lasting up to 2 years with optimal correction.  The goal is to create a natural-looking more youthful contour to the cheek.  As the skin is more highly suspended on the cheek, the nasolabial fold may also improve and become less pronounced.    It is infused with lidocaine for increased comfort during treatment.
    • Lines and wrinkles aren’t the only sign of aging.  As we age, the cheek flattens, and the skin may begin to sag.  This is called mid-face volume loss.  This is the first area that needs attention and possible correction prior to addressing other areas of the face.
  • Juvederm Vollure XC:  This is the first and only filler proven to last up to 18 months in moderate to severe facial wrinkles and folds with optimal treatment.  This filler can be used to temporarily soften moderate to severe parentheses lines and wrinkles (nasolabial folds) that produces a subtle but dramatic result.  This can be used in other areas for treatment of moderate to severe wrinkles as well.  It is infused with lidocaine for increased comfort during treatment.
  • Juvederm Ultra XC:  This was the first and only filler proven to last up to 1 year in the lips with optimal treatment.  Some may have naturally thin lips or may just want the lips restored to a more youthful volume (we start to lose lip volume in our 30s).  In addition, this filler can be used in the parenthesis lines, corners of the mouth, marionette lines, and other areas.  It is infused with lidocaine for increased comfort during treatment.
  • Juvederm Volbella XC:  This is the first and only filler proven to increase lip fullness and soften the appearance of vertical lip lines for up to 1 year with optimal treatment.  For women that may wish to add a more subtle volume to the lips and/or soften the appearance of their vertical lip lines.  These unwanted lines often develop over time from repeated muscle movement as well as sun exposure.  This is infused with lidocaine for increased comfort during treatment.

Dermal fillers are an excellent addition to promoting a more youthful appearance.  Please go to the Juvederm website for excellent before and after photos.  Your physician may recommend other treatments as well to work synergistically with the filler for an even better result.