PSC Roundtable

Facial Fillers 101

Facial Fillers 101

Injectable facial fillers, along with their allies, the neuromodulators, compose what many would say is the vanguard of non-surgical facial rejuvenation. The products aim to ease faces back towards youthfulness by filling wrinkles, lines, and the deeper structures of the face that cause an aged appearance.

The array of fillers committed to this pursuit continue to grow, causing confusion in those would-be patients who think the menu is small, and perhaps most naive, works for all. Board certified plastic surgeons Dr. Robert Whitfield, Dr. Charles Messa, and Dr. Jason Cooper breakdown what it is fillers actually do, and how patients can get the best results from these modern wonders.

Fillers Act Like Paints on a Palette

Facial fillers continue to become more refined and specific as the products split from general to pointed use. With this growing array of products, practitioners are able to better select which ones may do better here and there, and with others may compliment the former, or introduce rejuvenation on their own. Many of the best who wield fillers seem the procedures as analogous to a painter with a palette of paints; a little of this here and maybe some of that blended with this over there is how truly rejuvenative results are crafted.

Facial fillers for static wrinkles.

The first step in this process is realizing everyone’s facial structure and aging journeys are different, which means a deep consultation with an expert is critical to the true benefits of these products. “I like to really look at the patient, look at their anatomy, understand what’s really bothering them, and then understand what their thresholds are for what they want to do,” explains Dr. Cooper, a board certified plastic surgeon in Jupiter, Florida. Only with a proper consultation can a practitioner decide upon the right course of treatment. It’s never a one-size-fits all proposition in the office of filler veterans.

The First Time Filler Experience

Even with a critical assessment of a patient’s unique issues, great filler practitioners do have a general sense of where to begin for those who have never received the products. Dr. Cooper, for example, has certain areas he thinks are best to begin with. “I think the areas at the lid-cheek junction and the lips are typically areas I put on the back-burner initially,” he explains. “I really look to the nasolabial folds and the cheeks with a medium-sized particle like Voluma or Vollure.”

Nasolabial folds.

Even so, patients beginning their journey with fillers may be coming in at different places in the aging timeline and thus have different issues. Dr. Whitfield, a board certified plastic surgeon in Austin, notes that he has a growing number of younger patients coming in looking for a different need – lip plumping.

“I get a lot of patients in the earlier 20’s through 30’s wanting lip augmentation,” he explains. “I typically use a hylaruonic acid filler, and one that, if there’s any issue, we can reverse easily.”

In addition to utilizing different fillers to fill the lips – more of an augmentation injection rather than a procedure to impart youthfulness – Dr. Whitfield utilizes a differing technique. “I use cannulas, not direct injection. They want to have an improved look but no bruising and very little swelling.”

Fillers with lips.

Even beyond the variety of facial fillers, there also exists a variety in technique and the tools used. For the younger patient looking to utilize fillers to plump the lips, they prefer a quick, recovery-free surgery where bruising is non-existent. The use of a cannula over a needle is thus the calculated tool to be used, rather than utilizing needles for all filler applications.

Botox vs. Fillers

One of the biggest points of confusion is the difference between Botox and fillers. Botox and Dysport are not fillers; they are neuromodulators. Instead of being used to fill areas, neuromodulators are used to cancel or lessen the ability of muscles to animate.

Botox patient.

For example, the lines on the forehead and crow’s feet are generally products of using our facial muscles over decades. The faces we make when we laugh, cry, smile, yell, and frown all combine to etch in lines over time. When patients come in to have a filler injected into these areas, what they’re really looking for is a neuromodulator to inhibit their muscles from continuing to deeper those lines. “I explain to them that they’re lines of animation from muscular activity,” explains Whitfield. “Those are not things we can fill or obliterate with a filler.”

Combining Botox with Fillers

While it is true that neuromodulators like Botox are completely different than fillers and serve a different purpose, there are certainly possibilities of a combination of the two. Dr. Cooper describes how this is a technique he uses on the smooth part of the forehead above and between the eyes, known as the glabella. “Someone will ask, ‘I’ve got a deep, dominant crease as a result of a fine line in here. Do I fill that?’ You want to avoid having them look like a unicorn with an over-injected volume in that area,” he shares. “But at the same time, it may result in an opportunity to inject both a neuromodulator as well as a filler. The filler to soften the line, and the neuromodulator to decrease the animation.

Such situations explain how facial fillers are much more than just a one-stop shop where someone injects one product into any area and the patient is good to go. The truth – especially for great results – is a mix of multiple products, some fillers and perhaps even Botox, to achieve a designed result for individual patients. So long as patients don’t go cheap with facial fillers and see an expert, a personalized therapy plan will be developed that will maximize the incredible power of fillers.

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