“In modern esthetic world, restoration of facial volume and contour has become the first line of treatment before surgical correction is entertained.”
Dermal Fillers
Q: What are dermal fillers used for?
A: Dermal fillers are used to restore facial symmetry, volume, and recreate a smooth skin surface. As we age, our face goes through metamorphic changes. Certain features are disrupted due to loss of subcutaneous fat, facial bone loss, and dermal collagen degeneration. This will result in wider lower facial depressions and grooves and folds, therefore, any lines of facial expressions can also become pronounced with age and muscular hyperactivity. The goal of dermal fillers is to harmonize the upper, middle, and lower face.
Q: Where is it used in the upper face?
A: Dermal filler can be used for upper eyelids as a substitute for blepharoplasty. In the lower eye lids, where there is depression, restoring this area for volume and contour and be achieved, rather than removing fat. The appropriate filler can restore the demarcation between the lower eyelid and the upper cheeks as well. This will provide a more uniform smoothness in the transition between the upper and midface. Along the outside of the eyes, the sunken temporal areas can be used with filler, and also along the crow’s feet. The combinations of these treatments will give you an energized, more rested appearance.
Q: Where is it used for the midface?
A: Dermal fillers can be used to enhance cheeks. This will increase the prominence of the cheeks and enhance a youthful convex appearance. Another popular area to treat is the nasolabial folds, also known as the ‘smile’ lines. This area will cross over the transition area of midface to lower face. Although ‘smile’ lines don’t really give away an age, the lines create an abnormal demarcation in these two facial regions, thus giving an ‘unyouthful’ appearance, making you look severe and angry. Dermal fillers will soften the vertical depths of these lines, making you look younger and happier.
Q: Where is it used in the lower face?
A: Dermal filler can be used to soften the ‘drool’ lines, also known as the marionettes. Marionettes are results of expression, genetics, gravity, loss of volume and support, loss of fat, and loss of dermal elasticity. Everyone is different as to how pronounced the ‘drool’ lines are. In severe or advanced sagging, individuals might also need a combination of fillers and neuromodulators, such as Botox, in this region. Another area in the lower face for dermal filler is the contour and profile of the lips. As we age, our lips thin and vertical lines appear, giving a ‘bleeding’ lipstick appearance. Dermal fillers can be used in the lips to enhance and achieve a natural fullness.
Q: What kind of dermal fillers are there?
A: There are many dermal types of filler from different companies. These are just a few that we use:
| Maker | Brand | Key component |
| Allergan | Juvederm, Juvederm Voluma | Non-animal Hyaluronic Acid |
| Galderma | Restylane, Restylane Silk | Non-animal Hyaluronic Acid |
| Merz | Radiesse | Synthetic Calcium Hydroxylapatite |
Q: What can I expect immediately after the treatment?
A: Where there is the injection site, the skin will look slightly more swollen. Most often, there is no bruising, but each individual is different. Ice packs are given to alleviate the initial swelling, which the majority of the swelling will normalize by the next day. It will take up to 1-2 weeks for dermal fillers to settle nicely. Any “bumpiness” will usually resolve over a week or two without therapy.
Q: What is the function of the dermal filler?
A: Dermal filler stimulates collagen secretion when injected into the dermal layer of the skin. Slowly in time, as the body absorbs the dermal filler, the area of injections has new collagen.
Q: How long will dermal filler last?
A: Depending on lifestyle and type of dermal filler, treatment can last anywhere from 6 to 14 months.
Neurotoxins
Q: What are neurotoxin relaxers?
A: Neurotoxin relaxers are prescription medicine that is injected into the muscles to control and improve frown lines caused by years of facial expressions. Initially these lines only appear when the face is moving, but ultimately the facial expressions remains as wrinkles at rest. Neurotoxins will relax the muscles that create the span expression lines by blocking nerve impulses. Reduction in muscle activity will soften the lines. When skeletal muscle is repeatedly treated, some degree of muscle atrophy will occur, thus smaller units of neurotoxins are required or treatments intervals time are longer in between.
Q: Where would I need it?
A: Most common areas are frown lines in between the brows and forehead.
Q: How long will it last?
A: Treatment will normally last about 3-4 months, depending on the appropriate number of units for optimal effects of muscle relaxation to induce softening of frown lines.
Q: What kind of neurotoxin relaxers are out there?
A: We have three different kinds:
| Maker | Brand | Frequently Asked Questions |
| Allergan | Botox | www.botoxcosmetics.com |
| Medicis | Dysport | www.dysportusa.com |
