The Science Behind Dermal Fillers

Soft tissue fillers provide correction by two general mechanisms: the filler occupies a space, or the filler material stimulates collagen production. Adjustment of variables such as viscosity, elasticity, and plasticity determines how the filler behaves during and after injection. Different HA concentrations, particle size, hydrophilicity, and percentage of cross-linking are additional factors that contribute to diverse clinical outcomes and allow for selection that is best suited for a specific goal.  The science-based selection of filler products and injection techniques allows a safe and efficacious approach.

Types of Dermal Fillers

Dermal fillers can be divided into ‘passive fillers’ that are made from hyaluronic acid (Juvederm® and Restylane®) and restore volume without stimulating collagen production, and ‘active fillers,’ such as Radiesse®, Sculptra®. Active fillers replace lost volume and stimulate the patient’s collagen production. The longevity of each facial filler depends on its composition and properties and area of placement.

Different fillers have specific qualities that make them ideal for different areas of the face. In the delicate eye area, dermal fillers can be a powerful rejuvenation tool to improve the appearance of eyelid bags and dark circles, drooping eyebrows, or asymmetric appearance. Extensive experience with dermal fillers in the eye area is required to achieve the best results and avoid complications.

Dr. Levin's Philosophy with Dermal Fillers

To achieve meaningful and natural results, I take on a comprehensive approach that treats the aging face from the “inside out”.  Products and treatment techniques are tailored to the individual needs of the patient. As our knowledge and understanding of the physiology of aging has evolved, so has our use of dermal fillers, shifting from an early focus on the treatment of superficial lines to the current focus of facial areas in a three-dimensional manner. The aging process of the face is a complex interplay of numerous factors. These include the redistribution, atrophy, and hypertrophy of the facial fat, dermal thinning, bone resorption, the loss of elasticity and collagen in the skin, loss of muscle tone, and finally, gravity. 

Before & After

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Considering Chronological Age

Chronological age is one factor that I consider heavily when selecting a soft tissue filler. Because the face continues to age following procedures, temporary effects are preferred, especially in younger patients, so the face can be periodically reassessed and treated to accommodate the ongoing changes. Although there is no age beyond which patients no longer benefit from volume restoration with fillers, declining tissue quality and skin laxity are limiting factors that may require combination treatments with other modalities such as lasers or surgery.  Older patients are more likely to require treatments with products that correct the results of more significant fat atrophy and replace volume, addressing the loss of the foundation and underlying structure of the face.

In younger patients, age-related disharmonies are not yet prominent and emphasis is typically on modification and improvement of congenital features. Younger patients are better candidates for dermal fillers in certain areas, such as the lower eyelids, due to adequate skin tone and tissue support to keep the filler in place. Once herniation of orbital fat (bags) becomes more pronounced, and/or significant skin laxity is seen, surgical procedures are more successful. In younger patients, the typical goal of lip augmentation is to make the lips appear fuller, whereas, in older patients, the goal is to restore structure and volume.

Overvolumization is best avoided with a conservative approach and careful assessment with each treatment, especially with newer, longer-lasting fillers. I often counsel patients about the philosophy of more frequent visits to achieve and maintain consistent results, rather than be unnatural and overdone.

The use of one filler is not exclusive to the use of another filler. The best outcomes are often achieved with combination treatments, taking advantage of the attributes of each product.

What Takes Place During Dermal Filler Injections?

During the consultation, Dr. Levin will listen to your concerns, discuss your individual goals and design a treatment plan based on your needs and her examination. In most cases, treatment can be done on the same day as the consultation. The face is cleaned with an antiseptic (anti-bacterial) solution. The areas to be injected may be marked with a skin marker.

For sensitive areas such as the lips, a short-lasting injection can be done to anesthetize the area completely. Alternatively, a topical anesthetic can be applied. Dr. Levin uses a micro-cannula for most injections. This technique minimizes pain and bruising and can provide added safety.

The injections can be completed in a matter of minutes. After the procedure, the markings are cleaned off, and ice may be placed on the treated areas. You can resume normal activities right away and will receive post-procedure instructions on your specific treatment.

What are the Different Types of Dermal Fillers?

Juvederm®

Juvederm Voluma, Juvederm Volbella, Juvederm Vollure XC

These are a new family of hyaluronic acid (HA) fillers made by Allergan, the makers of the original Juvederm. These are temporary dermal fillers that last 12-24 months, depending on the specific type and site of injection.

  • Juvederm Voluma is best suited for deeper placement in the cheek, temple, and jaw area for volume restoration or augmentation.
  • Juvederm Vollure is used in the nasolabial folds (smile lines) and marionette lines around the chin.
  • Juvederm Volbella is an idea for the lips, vertical lines around the mouth, and the eye area.

Restylane®

Restylane Lyft, Restylane Refine, and Restylane Define

These products are members of the Restylane line of fillers by Galderma. These are temporary hyaluronic acid (HA) fillers that last 12-18 months.

  • Restylane Lyft is designed for use in the midface and lower facial areas, restoring volume loss associated with facial aging.
  • We love Restylane Refine for the lips and fine lines around the mouth. It produces minimal if any swelling and is long-lasting
  • Restylane Define is used for deeper lines around the mouth and jaw to alleviate marionettes and improve the appearance of the jowls.

Sculptra® Aesthetic

Sculptra® Aesthetic Sculptra is an active filler used to restore facial volume gradually and naturally by promoting the body to produce collagen in response to the filler.

  • Sculptra can be used on the face to treat wrinkles and folds. It is commonly used around the chin, mouth, and nose.
  • Sculptra can also be used on the body to correct cellulite, wrinkles or add volume. 
  • You will begin to see gradual results after your treatment, with long-lasting results that can last for up to two years.

Your Consultation With Dr. Levin

Dr. Flora Levin provides dermal fillers to her patients in Fairfield, Westport, and the surrounding areas. Contact her office today to schedule a consultation. We look forward to seeing you!

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