Wrinkle Fillers: Restylane, Juvederm and Radiesse

Dermal Fillers for Wrinkles and Lost Volume

If you're looking for a plastic surgeon who actually loves using wrinkle filler to help you look more beautiful, you've come to the right place! I have personally treated many thousands of women with filler and have developed a unique technique that is designed to give you natural results and restore the appearance of your face, neck, chest and hands. I'm not going to give you duck lips and I'm not going to overfill or distort your face. If you actually want those things (and I can't imagine why you would...), you'll have to find another surgeon. I inject fillers at my Park Avenue office in Manhattan and at my office in Franklin Park, New Jersey.

Back in the old days (before 2003), only collagen and fat were used to fill wrinkles. Other than Botox, the hyaluronic acid wrinkle fillers have had the biggest impact on facial rejuvenation.

We have so many new fillers - it's hard for you to keep up. But I do the homework for you. I use a variety of fillers - Restylane Refyne and Defyne, Juvederm Volbella and Voluma, Radiesse and many others.

Which Filler I Use and Why

There are different families of fillers - hyaluronic acid, calcium hydroxylapatite, and others. I usually use the hyaluronic acid products because they have the best safety record and perform so well. Hyaluronic acid wrinkles fillers are available in a variety of viscosities. They can be thin and watery like maple syrup or thick and gooey like honey. I typically use a variety of thickness and types of fillers when rejuvenating your face. Hyaluronic acid is a chemical that is already part of normal skin, but declines as you age. This  is one of the reasons your skin loses moisture as it ages.

The Microdroplet Technique

My technique for injection is very different than most other doctors. I teach my technique to the plastic surgery trainees at Columbia and Cornell Universities and have written a paper for the plastic surgery journal that will soon be published. Here's what I do:

First, I numb you up like a dentist does. I use lidocaine and numb up the four nerves in your mouth. You'll supplement this with EMLA anesthetic cream. Then I clean your skin with antiseptic and I use sterile gloves and a surgical mask. I treat this like a surgical procedure to minimize the chance of infection.

And then I go to town. I use what I call the "microdroplet technique", injecting teeny tiny drops of filler into each and every wrinkle. I inject the wrinkles that cause lipstick bleed, I buttress the edges of your lips, recreating your Cupid's Bow and that all-important philtrum. That's the spot in the center of your upper lip that women crushed flowers to disguise their breath a few hundred years ago. I typically inject 300-500 micro droplets. Don't faint - you shouldn't feel anything because I've numbed you up. To keep the procedure as safe as possible and minimize the chance of injecting into blood vessels, I use blunt tipped microcannulae. Everyone should.

I use thicker fillers, like Restylane Defyne or Lyft, or Radiesse to plump out the deeper folds, such as the nasolabial folds, the marionette lines, and to smooth out the borders of the jowls.

I use even thicker fillers, like Juvederm Voluma or Radiesse, to enhance the cheek bones or fill out hollows in the cheeks. I can even use this to make your chin larger and smooth your jawline.

How Long Fillers Last

The new generation of wrinkle fillers last longer than the old ones. They begin to go away at about 9 months and are gone by a year and a half. Voluma lasts even longer.

I use filler mostly in the face, but I also use it to hide the veins and tendons on the back of your hands. If I've rejuvenated your 60 year old face, we don't want your hands to give away your real age! The best filler for the hands is called Radiesse. It's the best material because it's thick and opaque. It  lasts over a year..

I also inject filler into shriveled up earlobes, horizontal neck lines, vertical lines on the top of the chest...chicken pox and acne scars....and the list goes on...

Fat Grafting as a Filler

Fat is the only material that has a chance of permanence. Most people are only too happy to give up a little fat, which is usually taken from the belly or hip area under local anesthesia. A space is then made for the fat, and the fat is placed under the skin. Fat is used to fill areas such as the nasolabial folds, the marionette lines, the lips, and other areas that are depressed. Since fat is harvested in a true surgical procedure, there are more risks to its use than with the commercially available fillers. My fat grafting technique has evolved since I started doing it in 1987 (!). I now treat the fat until it is of the consistency of maple syrup...and inject it like the commercial fillers.

Fillers are an incredibly versatile product and have revolutionized the way I treat a variety of conditions. And those permanent fillers like Bellafill or silicone? Sounds like a great concept, doesn’t it? But if there is a problem then the problem is also permanent. Or if an infection occurs, it can be a disaster. The only solution might be to cut out the area of skin! I strongly advise against permanent fillers.

Risks of Dermal Fillers

Ok, here's the risks of fillers:  other than bruising, they are rare. Infections can occur, but they are also rare. Nodules may occur, some even many months after the procedure, but they are very rare with the hyaluronic acid fillers. There is even a drug that can remove the filler (hyaluronidase) if too much is placed. If filler is inadvertently injected into a blood vessel, a blister can occur or a whole patch of skin can die and be replaced with scar. And yes, there have been cases of blindness and strokes with fillers. These are one in a million risks...and the risk of driving to your appointment is actually much higher. But it's my legal and ethical obligation to tell you these things....