We educated you on proper dosing for Botox last month so now let’s discuss dermal filler. First, a quick history about filler. The concept of using dermal fillers to help patients restore lost volume started back in the 1890’s with the first reports of fat grafting procedures being done. Fast forward to the 1970’s and the advent of Bovine Collagen. Several factors made this type of dermal filler obsolete by the 2000’s. Collagen didn’t last very long (maybe 2-3 months), caused significant tissue swelling, and could stimulate a sensitivity reaction in patients. In 2003 the FDA approved Restylane, an injectable hyaluronic acid used to correct volume loss in the nasolabial folds. Injectors across the country thought this was the best invention since sliced bread. Not only does hyaluronic acid last longer than Collagen, it also doesn’t have the same swelling profile or sensitivity reactions associated with it. Boy have we come a long way since the 1890’s! Today, not only do we have many different types of Hyaluronic Acid fillers available here in the US, but we also have several other types of fillers used to stimulate collagen production.
Just like any evolving field of medicine and science, how and why we inject dermal fillers continues to change. The original mantra of injectors was “fill the lines.” Directly filling in the nasolabial folds and marionettes were the go-to techniques of most aesthetic injectors. We have since learned that simply filling areas that have lines is often not the best approach for optimal aesthetic outcomes. In fact, that’s how some people end up looking puffy or bloated in the face and often times women can begin to get such heaviness in the lower third of the face that they look masculine. The goal is to maintain the “Triangle of Youth” which is an inverted (upside down) triangle. Repeatedly filling the nasolabial folds and marionette lines on many women does exactly the opposite and flips that triangle right side up. So how do we address the problem without making a distorted or puffy face? We look to restore volume to key structural areas, keeping the face beautifully and appropriately balanced.
Filler dosing really depends on a host of factors including genetics, environmental damage, skin quality, and age. While age is a consideration, it’s not uncommon for younger patients who lack certain structural support to need higher amounts of filler than an older counterpart that doesn’t have those issues. I’m going to use myself in this example; I started working in this industry 9 years ago when I was almost 27 years old. I thought that filler was primarily for older patients and that I might get my lips done one day, but that was it. I was probably in the second filler training of my life when the trainer says, “Honey, you have the flattest little face I’ve ever seen! We need to get some filler in those cheeks.” I kept my composure but was mildly horrified and thinking I was too young. Turns out, she was absolutely right! She put 1 syringe in each cheek and another 2 under my eyes. I had just gotten 4 whole syringes in my face and still looked like myself, just better. After the swelling dissipated and everything settled, we reassessed my “flatness” and determined that I would benefit from 2-3 more syringes in my cheeks and 1-2 syringes in each temple. This whole process occurred over a 1-2 year period but ultimately, I had a grand total of 12 syringes… and I looked absolutely natural. Even my mom said so! Since then, I’ve had little top-offs in each area, but have been surprised at how my face has not returned to it’s original flat state.
With the advent of new and improved filler technology we can customize a treatment plan to maximize the result. When I first had my cheeks filled, we didn’t have Juvederm Voluma. I think we used either Juvederm Ultra Plus or Perlane (now called Restylane Lyft) and got a decent improvement but something was still slightly lacking. Voluma had just come out before my second round of cheek filler and that’s what we layered over the previous filler. I attribute several factors to the longevity of my results. First, layering product in treatment areas before the previous product dissipates seems to allow for a longer lasting result. Getting the correct amount of filler also improves longevity and obviously the result. Finally, choosing the right product that’s suited to the treatment area seals the deal. For instance, choosing a really thin and delicate product for the cheeks will not only produce a sub-optimal result but whatever result you may see will also likely fade away sooner than the product’s indicated duration.
Now that we have several different tools in our toolbox, we as injectors should look to specifically address structural issues as well as volume loss for a balanced, beautiful face. Below are the personal experiences of all of our staff to show some different examples of facial structures. So next time you’re with your aesthetic injector, be sure to talk about the long-term value of properly dosing your filler.
Corinne Case, PA
I recently had Juvederm Vollure added under my eyes and was blown away at how it instantly made me look more rested and gave my eyes a more youthful appearance. I found the treatment itself to be painless and oddly relaxing! The filler compliments the effects of my Botox beautifully and I look forward to doing both injections again. Next on my list is trying Juvederm Volbella in my lips for a softer more hydrated look. Until I stepped into this position, I had no idea of the vast array of uses filler has and the areas in which it can be used. When dosed properly, filler can leave you looking like you… just a more youthful and rested you!
The thought of dermal fillers never has really scared me as I have seen great results that helped rebuild lost volume and enhance natural features. Being confident in your provider’s skills and their knowledge of products and anatomy is key to getting natural results. I love to have a full face evaluation by my practitioner every year to ensure I am keeping up with minimizing the signs of aging. I was really excited when I treated my jawline for the first time. Naturally, I do not have a very defined jawline but with the help of Voluma in my cheeks to create a lifting effect and Radiesse along my jawbone I now have a stronger, more defined look which really helped boost my confidence.
Kim Bickly, LE
Since working a beyond|AESTHETICS I have sat in on injector trainings and been the guinea pig for new techniques/products. I’ve realized that the purpose of filler is to enhance our natural beauty and perhaps fill areas that have lost volume over time. I think filler can sometimes get a bad rap but the proper product, correct amount, and the knowledge behind the needle should ease your mind. With the right provider, you can be confident in knowing that you will receive the best outcome for the look you’re trying to achieve. Over the years I have had multiple areas treated, from my lips to tear troughs to cheeks, and I absolutely love the results!
Megan Reider, NP
Before working in Aesthetics, when I heard of the word ‘filler’ I would automatically think of a person I’ve seen on reality TV that looked unnatural or fake. I’m sure many people have that exact same thought. Little did I know, fillers placed appropriately can look natural and create general facial harmony. We are all born unique and some of our features we love, while others we may dislike. Mild asymmetries, under eye circles, dehydrated oral region/lips, gummy smile, weak jawline, and receding chin are all hereditary/genetic traits that can be treated with filler. I have had a number of areas treated including my lips which really boosted my self confidence. I have also treated my cheeks and under eyes, which is by far my favorite combo. It resulted in a well rested and refreshed appearance. It even softened my nasolabial folds. Almost every patient would benefit from this combination whether they know it or not!
Heather Hatch, RN
I didn’t know that I wanted filler before being assessed and treated by a skilled and educated practitioner. She saw what I needed and explained why it was needed and how beneficial it would be. Although I was looking at my lips and under eyes, my cheeks are what needed attention first. It’s all about the structure of the face. The bone and fat loss in one area can affect the other areas of the face that you notice more. Once structure and foundation was explained to me I knew cheek filler is what I needed to get the youthful, rested look I wanted. I love my cheeks and not even my husband noticed I had anything done. It was subtle but enough to make a big difference in my facial structure and in turn the overall aesthetics of my face.