By: Megan Couvillion, MD
Injectable fillers are a great way to restore youth to the face and/or enhance facial features. There are many different fillers available on the market, and in this information age it is easy to learn about all of the options. But, how do you know if fillers are right for you, and which ones?
First, what are fillers?
The most popular types of fillers are injectable gels made of hyaluronic acid (HA) that provide long-lasting but not permanent results. For the purpose of this post, I will focus on HA fillers, but there are also other types of fillers, including those composed of poly-L-lactic acid, polymethylmethacrylate, and calcium hydroxylapatite.
Hyaluronic acid is naturally found in our skin and is part of what makes our skin buoyant. When it is created in the lab, the HA molecule can be manipulated to have different properties. The “softness” or “stiffness” of each filler is determined by the size and arrangement of the HA molecules, which is why there are so many options available to your dermatologist. Stiffer fillers are used for volumizing or lifting and are optimal in areas like the cheeks, while softer fillers are used for areas like the lips and fine lines. Then, there are fillers “in between” that can be used in a variety of areas. Even with all of these filler options, it is often the expertise of the injector, and not the type of filler alone, that will achieve an optimal result. Which is why it’s important to choose your doctor wisely!
Where can fillers be used?
Fillers are used in multiple areas of the face. As we age, we lose support underneath the skin that can accelerate the appearance of lines and folds. Common areas affected by this are the cheeks, temples, “parentheses” around the mouth (nasolabial folds), under the eyes, and in the lips. Fillers can also be injected to enhance facial features such as the lips and cheeks, or to correct facial asymmetry. These areas can all be treated safely by an experienced injector.
What is the treatment like?
A topical anesthetic (numbing) gel is applied to the face before the procedure to make it as comfortable as possible. After the skin is numbed and cleaned, the HA filler is injected into the treatment area using a variety of specialized techniques, using either a small needle or a blunt-tipped cannula to achieve the results desired. Improvement is seen immediately, though there may be some swelling or bruising that resolves in the next 1-2 weeks.
How long do fillers last, and how does our body get rid of them?
HA fillers can last anywhere from 6-18 months, depending on the area treated and the type of filler used. There are certain fillers that have been proven in medical studies to last longer, and you can prolong your results by requesting one of these fillers.
Because our bodies naturally make hyaluronic acid, we also have an enzyme called hyaluronidase that slowly breaks down both natural HA and HA filler over time. While some may feel disappointed to know that HA fillers are not permanent, I think this is a great advantage of these products. As we age, our aesthetic goals may change – it is important to be able to continue to customize each treatment over time. Additionally, this improves safety – we can use the hyaluronidase enzyme to dissolve HA filler, in the rare case that a complication arises.
How do I know what is right for me?
This is probably the hardest question to answer broadly. There is no “cookie cutter” approach that works for everyone – we all have different factors that contribute to how we age, and different facial features. In a one-on-one consultation, you and your dermatologist can create an individualized treatment plan to address each of your concerns. It is important to ask questions and feel that your concerns are properly addressed. It can also be helpful to see before and after photographs of other patients who you doctor has treated.
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Megan Couvillion, M.D.
Dr. Couvillion has been practicing dermatology since 2017. A graduate of Louisiana State University School of Medicine, she completed her internship in internal medicine and her dermatology residency training in at Tulane University where she served as Chief Resident. Prior to starting medical school she also received a Masters of Science in Cell and Molecular Biology from Tulane University. She is certified by the American Board of Dermatology and a Fellow of the American Academy of Dermatology. She is a member of the American Society of Dermatologic Surgery, the Houston Dermatological Society and the Women’s Dermatologic Society.
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