Filler 101

While Botox (and similar neuromodulator) treatments have become fairly commonplace, the idea of injectable fillers may still be a bit of a mystery to some. People may be wary of filler and looking “done” with an image in their mind of an overfilled celebrity. The reality is that filler injections, when done by the right person, should deliver subtle enhancements and harmonization of facial features. 

Hyaluronic acid (HA) based fillers are most frequently used. Common brands include Juvederm, Restylane, etc. HA is a natural substance found in our skin. HA filler is a gel-like substance that can be injected into the area of concern at different depths to help soften a line or fold, lift tissues, or enhance a feature. Over time the filler will gradually be absorbed by your body. The results from filler can be seen immediately and generally last 6-18 months. There are a wide variety of HA filler options, with different thickness or viscosity, intended for different purposes. An advantage of HA fillers is that they can be dissolved with an enzyme called hyaluronidase if needed.

The range of different formulations of filler provides the injector with the ability to select the appropriate product to achieve a specific outcome. Fillers can be used to provide treatments ranging from general facial contouring to lip enhancement to filling under eye hollows to “liquid rhinoplasty.” There is even a class of fillers referred to as biostimulators, like Sculptra or Radiesse, where the injected product encourages the body to produce collagen.

Filler injections are generally quite safe but as with any procedure there are risks, and the risks with filler are greater than those with Botox. Bruising, redness and swelling may occur. Inadvertent injection of filler into a blood vessel can lead to more serious complications including loss of blood supply to the skin or eye. This is one reason why it is extremely important to see a qualified injector who understands facial anatomy as well as how to manage complications should they arise. With strategically placed filler, and when safety and natural looking outcomes are top of mind, we can have great results with filler treatments.

Lip Filler and Gradual Lip Enhancement

For those seeking lip enhancement, I’m a fan of subtle and sometimes slower progression. The patient pictured below was keen to improve balance and proportion with a little more volume in her upper lip in particular.  She had treatment over the course of a year and a half which fit with her (and my) desire for a conservative approach.

We know that lips and lip filler have been popularized in social media. Market research has shown that patients getting lip filler tend to be younger and get treatment more frequently. We have seen a potential downside of this with cases of over-enhanced, malformed lips. And now we are seeing at home hyaluron pens trending for lip injections which is a whole different and scary story . As injectors we have to balance patient wishes with our own judgment and I believe it is important to advocate for natural and safe aesthetic enhancement. Some women want, and may look good with fuller lips, particularly if it is in balance with their facial proportions. But, extremely overdone lips (think of the currently popular “pillow face” filter) and risky techniques or devices give our field a bad reputation and can make people fearful of getting filler done. 

Having said that, lips are one of my favorite areas to treat. If you’re looking at enhancing your lips, see an experienced injector who can help you safely achieve your goals!

Can Filler Treatment Be Reversed?

I am often asked if injectable treatments can be reversed. For most fillers today, which are commonly hyaluronic acid (HA) based, the answer fortunately is yes. HA fillers, including Juvederm and Restylane, can be dissolved using an enzyme called hyaluronidase. Hyaluronidase is a naturally occurring substance in the body and it works by breaking up the bonds that hold the HA filler together and then the body can reabsorb it by a natural process.    

Hyaluronidase allows injectors to adjust HA fillers if the treatment needs to be modified to ensure satisfactory results. Some patients are worried about getting filler injections and looking unnatural or “what if something doesn’t look good.” Thanks to hyaluronidase we can reassure them that filler can be adjusted if needed. In addition, it is critical for patient safety. In the rare event that an HA filler has been injected into a blood vessel, hyaluronidase can be used to dissolve the filler! If you are an injector it is absolutely important that you are up to date with management of these complications and have access to a sufficient supply of hyaluronidase!

The photo below the progression of filler being dissolved immediately, 30 and 60 minutes after hyaluronidase.  

While it is helpful to understand how hyaluronidase can be used, it is also important to remember that when you are being treated by a highly trained injector HA fillers are not only very safe but can deliver a beautiful, natural result.

What You Need to Know About Fillers

One of the topics I get asked about most often by patients who are curious about cosmetic procedures is the use of fillers. Many people don’t really understand what filler is or they may have negative association of people being “over done” with filler.

When injected by a professional filler is very safe* and can serve as a key part of an overall program to restore a more youthful appearance by replacing volume in the face that is lost through aging.

In 1981 bovine collagen became the first FDA approved substance for soft tissue augmentation. Collagen remained the only commercially available filler until 2003, when the first hyaluronic acid (HA) dermal filler was approved. This was a breakthrough because HA fillers are easier to use and demonstrate longer-lasting results than collagen.

HA is a sugar that occurs naturally in the body and the effects of HA filler can be reversed (dissolved) simply by injecting a substance called hyaluronidase. In recent years HA fillers have continued to evolve and data suggests that HA fillers can stimulate a biological response to induce production of the patient’s own collagen.

The majority of the fillers I use in my practice are HA based. Commonly I will use the newer cross-linked fillers for their volumzing properties. These products are often used to address deeper wrinkles that cannot be treated with Botox alone. They are also used to bring back contours of the face, especially in the cheeks and chin, which flatten as we age.

The use of too much filler, especially when placed incorrectly, can begin to create an unnatural look. However, when an appropriate amount is used in carefully selected areas, filler provides an essential foundation to minimize the effects of aging. In general filler treatment can last for up to 12 months, but depending on the type of filler used and location of injection the duration may vary.

If you are interested in learning more about filler or booking a consultation to discuss cosmetic options please contact my office.

*Note on safety: In May 2015 the FDA issued a warning about serious complications if filler is inadvertently injected into blood vessels. I have researched and authored two papers on complications that can arise from the use of fillers. With a solid understanding of facial anatomy and proper protocols in place the risk is very low.