Injectable Fillers

Fillers are used to fill in wrinkles and facial depressions that may come with age. Many patients misunderstand fillers and sometime confuse them with BOTOX®. Fillers are substances that are injected under the skin or lips to plump up the tissues. Facial fillers replace skin fluid that, when lost, cause wrinkles. In youth, our skin is plump from a natural sugar called hyaluronic acid that attracts water. As we age, our skin thins by loss of collagen and fluid.

Since there are a number of available fillers for fine and deep wrinkles, both may be used in the same patient. We often layer them in the same areas in order to plump folds and fill the lines that often lie in the depths of those folds. They can be given in minutes with a tiny needle to give definition to the lips and fill other wrinkles such as laugh lines. The results are instantaneous, producing a long-lasting (6-9 months), natural enhancement, which is gentle and safe to the skin. You may return to normal activities within hours.

Before and After Injectable Filler Photographs

Select a patient below to view more detailed pictures and information about the injectable filler procedures performed by Dr. Joseph.

Restylane®, Perlane®, Juvederm® & Ultra Plus®

These are all crystal-clear biodegradable synthetic injectable gels. These products use no animal-derived materials, so there is no need for a spot test before treatment. This filler material (hyaluronic acid) is naturally occurring in our bodies and it attracts water, hydrating your skin.

Reslylane Products

Superficial Fillers (Fine lines and wrinkles)

Restylane® and Juvederm® are smooth consistency gels made of hyaluronic acid. These injectable gels are placed under the skin to reduce fine lines and wrinkles providing a smooth, natural look and feel.

Medium Depth Fillers (Medium wrinkles and folds)

Juvederm Injectable Gel

Perlane® and Juvederm Ultra Plus® are clear medium volume injectable fillers with a larger molecular size to augment the lip and fill larger areas by lifting and adding volume. Medium depth fillers are used for folds in the skin and deeper crevices. Medium depth fillers are very effective for naso-labial folds, which run from the corner of the nose to the corner of the mouth. They may also be effective for melo-labial folds (“marionette” lines) that run down from the corners of the mouth to the jaw. They may also be used for lip augmentation providing plumping and volume. These fillers are also longer lasting than the thin, superficial fillers.

Deep Fillers

The thickest fillers are better for volume enhancement, and are used to treat the areas of the face that need to be “plumped up.”  One option for large volume replacement are using one’s own fat.  The fat is re-injected immediately after removing from elsewhere in the body.  There is more swelling than with other fillers, but the results are smooth, natural and often long lasting.

Where are Fillers Used?

For the lips, fillers can increase lip size as well as enhance the definition. They can also plump out “lipstick lines. In the lips, the filler is used to enhance the natural lip outline and definition that is lost with aging. It is also used to plump the lips to actually make them bigger and to show more of the lip. For many patients, one syringe may be enough to plump both lips.

For skin wrinkling, fillers are usually used for nasolabial folds (laugh lines) or bigger, deeper wrinkles. Fillers can also be used to augment facial anatomy as in making bigger cheeks, chin or filling in defects and scars. For nasolabial folds (laugh lines) the filler is injected to soften the fold. Patients must understand that the fold will not be totally eliminated (actually adults would look unnatural without any smile lines). For most patients with moderate to deep nasolabial folds (smile lines) a syringe of filler for each side is needed.

The newest application for fillers is the “tear trough” area under the eyes. Fillers can also be used to fill in the lines that are underneath the lower eyelids called the tear troughs. This area makes patients look hollow and by injecting fillers, it plumps out the depression and improves the “dark circle” look.

How are Fillers Administered?

Fillers are injected through small needles. Dr. Joseph goes to great lengths to make this procedure painless. All patients are first treated with numbing cream on the areas to be injected. If the lips are to be injected, a numbing cream is first placed, and then several small dental anesthetic injections are given to totally numb the lips and related areas for a truly painless procedure.

The filler is then injected in the lips, wrinkles or folds and takes only minutes. Ice is placed on the lips immediately after the injections. The lips generally swell somewhat but most patients are able to return to work the next day. Rarely, some patients experience more significant swelling. It is also a good idea to refrain from aspirin or drugs that delay clotting for 1 week before treatment to decrease bruising when injecting fillers.

Dr. Joseph recommends having the patient return in two weeks to check the result. Occasionally a touch up may be performed at the follow up appointment. It is important to view filler injection as a sculpting process and in some cases multiple appointments are required to provide optimal results.

How Long Does the Filler Last?

There is no correct answer to this question as each patient metabolizes fillers differently. Research has shown fillers such as Restylane® and Juvederm® to last up to eight months. Fillers may not last as long in areas of increased movement such as around the mouth. Different fillers will last different periods of time in different patients. One thing for sure is that the newer fillers last considerably longer than the first generation of fillers.