“Keep this in mind when seeking a practitioner for fillers: “Of all the artists using paint on canvas, not everyone deserves to be hung on your wall.”
-Dr. Andrew Kornstein
Actual patient photos that have not been altered or retouched in any way.
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What patients should know about fillers…
- A quick history of dermal fillers. [More…]
- The greatest downside of Hyaluronic Acid fillers (e.g. Restylane® and Juvederm®) lies with the injector. [More…]
- There is a difference between dermal fillers. [More…]
- Some fillers are reversible. [More…]
- Fillers give you the opportunity to “try on” a practice with little commitment or risk. [More…]
A quick history of dermal fillers: As recently as a decade ago, collagen based products were the standard of care for fillers in the United States. They were, however of limited use and duration. Their mechanism of action was through swelling, primarily triggered by the body’s reaction against a foreign protein. The only other options at the time were fat, which cannot be placed into the skin, only under it; and silicone, which is permanent and cannot be reversed, often of uncertain purity, and can accelerate the aging process as gravity pulls on the silicone/scar tissue complex. With the addition of the more powerful Hyaluronic Acid fillers (e.g. Restylane®, Juvederm®,) the facial aesthetic options were expanded and were biologically correct replacements.
The greatest downside of Hyaluronic Acid fillers (e.g. Restylane® and Juvederm®) lies with the injector. Hyaluronic Acid fillers enjoy well deserved popularity. The downside however is when used by an inexperienced injector with either poor technique or more commonly a skewed aesthetic eye, they are powerful enough to be able to create the dreaded “over-operated look” that we see almost everywhere these days.
There is a difference between dermal fillers. Hyaluronic acid fillers work effectively as filling and shaping agents for the forehead, temple, brow, lower lid, nasolabial fold, lips and commissures, marionette lines and nose. Restylane® tends to be a bit more concentrated and is used to influence shape. Juvederm® is softer and better for lips and as a filler for delicate skin types. Radiesse® is another excellent, safe and frequently used filler. Typically it is used for volumizing regions of the face and can also fill body defects. It is a powerful agent for replenishing facial regions such as temples, cheeks, deep nasolabial folds, (enlarging) weak chins, and (enhancing) jaw lines.
Some fillers are reversible. Hyaluronic Acid fillers have long durations depending on location of treatment and the patient’s own biology—lasting anywhere from 6 months to two years, or more. They are also reversible with an enzyme injection and therefore offer another aspect to their “safety profile.” This is especially important as more and more patients are reacting to what they perceive as the unnatural and compromised looks they see throughout society these days. Because Radiesse is not readily reversible, but not irreversible, it is best used by experienced injectors with trustworthy aesthetics. Silicone is permanent and cannot be reversed,
Fillers give you the opportunity to “try on” a practice with little commitment or risk. Fillers are an excellent way to “test drive” a doctor’s aesthetic sense and bedside manner. After seeing how you get along and if trust builds, more permanent and/or biologically active (adipose derived stem cells— which can enhance skin quality and slow the aging process) surgical options can be entertained with more comfort from the patient’s point of view. This has become more important because of the growing number of practitioners who are excellent marketeering tactics may not be commensurate with their skills leading to a confused and disappointed patient population.
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