Have you noticed lines forming around your nose and mouth, along your jawline, and under your eyes? Think there is nothing that you can do? The reality is that there is a way to slow down and even reverse these effects of aging!
When we look at young faces we see that most are in shape of a V, with the upper face having more volume than the lower face. As we age, we lose subcutaneous tissue and collage, leading to the skin wrinkling and sagging – especially around the eyes, mouth, and lower face. We lose volume in the upper face, leading to hollows in our temples and under our eyes, and since the upper face now has no support, the skin “sags” downward, leading to folding around the nose and mouth and sagging along the jawline. Overall – the face changes from a V shape to more of a square shape.
Fillers, usually comprised of hyaluronic acid, do exactly what the name suggests— they fill in deep wrinkles and restore volume to areas where it is lost. Overall, the goal is to look like yourself; albeit a slightly refreshed, softer version. Think of it like that Instagram filter that always makes you look fabulous – but in real life!
To put it another way, dermal fillers are like the springs inside a mattress. Placed under the skin where things are starting to sag, they provide support you have lost – lifting your skin back up to where it belongs.
So how can you tell if a line or a wrinkle is a good candidate for fillers? You can think of lines and wrinkles in three categories:
Fine Lines
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• Barely visible in the skin or creating a ‘crepey’ appearance
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• Due to a loss of collagen in the skin itself
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• Respond best to microneedling, regenerative treatments and lasers to rebuild collagen in the skin itself.
Deeper Lines and Folds
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• Deep Lines in the upper face lines (on the forehead and around eyes) are caused by muscle movement and are fixed by muscle relaxation (Botox/Dysport)
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• Deep lines in the lower face (from the cheekbone to the jawline) are caused by loss of volume and supporting structures under the skin, and can be fixed by replacing the loss structure with fillers
Hollows
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• Hollow area in the temples, and under the cheekbones lead to sagging along the jawline and mouth – again – because the skin has lost support. Hollow areas are best treat with a bioregenerative like Scuptra – which helps your body build its own structure back naturally.
To summarize: Lines and wrinkles in the upper face are usually caused by muscle, and corrected by muscle relaxers such as Botox and Dyport. Folds, lines, and hollows of the lower face are usually caused by loss of support under the skin which leads to sagging along the jawline, folding along the side of the nose and mouth, and hollowing under the eyes or in the temples.
Some lines and folds are treated best the Hyaluronic Acid Fillers such as Juvederm, Voluma, Volbella, the RHA line, Lyft, and many others. Hyaluronic acid (HA) is a natural substance in your skin that assists in adding hydration and volume. You can think of HA fillers like the springs inside a mattress. It is placed under the skin where the skin is sagging, and it stays there providing support until it dissolves – which usually takes between about 12 months.
HA fillers like Juvederm, Restylane, RHA and Lyft work best on lines around the mouth and nose, marionette lines, or hollows unxder your eyes. . It can also be used to enhance your cheekbones or chin and give you fuller lips. The downtime is minimal and you can get back to your normal routine right away.
Biostimulators like Sculptra are best used to fill in the hollows in the temples and cheeks that we see as we are aging – which is harder to exaplin but shown perfectly in the picture below!
Since most of us have lines, folds, AND hollows – balancing the use of HA fillers and Sculptra is the best approach.
What are fillers?
Most dermal filler made from hyaluronic acid. Hyaluronic acid is a naturally occurring substance in your skin that helps to hydrate and add volume. At Restor we only use Hyaluronic acid fillers – such as Juvederm, Restylane, Lyft, Voluma, and Vobella – because there is a medication that dissolves hyaluronic acid fillers. Therefore, in the rare instances that a patient has lumpiness, asymmetry, or any other outcome that they are not totally happy with, the filler can be dissolved.
What are Biostimulators?
Where fillers replace your lost volume – biostimulators like Sculptra direct your body rebuild its lost structures – leading to a result which looks amazingly natural because….well….because it is your own tissue. At RESTOR we prefer to use biostimulators when we can – because we believe that rebuilding is better than replacing. However – there are some areas of the face where fillers work better – primarily along the bone structre of the cheeks and chin and in the lips – so in those areas we prefer to use HA fillers.
What do fillers and biostimulators do?
Fillers can be used to lift wrinkles, furrows and depressions around the nose and mouth. Fillers can also be used to plump the lips and decrease those smokers’ lines that you can get even without smoking. It can reduce the appearance of undereye bags, and lift the cheekbone, making you look younger and refreshed instantly.
How do fillers and biostimulators differ from Botox?
Fillers act by “filling in” wrinkles or creases in your face. It works best in the lower face where lines tend to be caused by loss of volume under the surface of your skin – especially the lines around your mouth and nose. In contrast, Botox works by relaxing muscles in your face that pull your skin into creases or furrows. It works best on the upper face where the muscles of your forehead cause lines between your brows and across your forehead. For best results, both are used together.
What is the difference between Juvederm, Restylane, Voluma, Lyft, RHA and all the other Fillers I have heard about?
All of these products are hyaluronic acid fillers – which means that they are made from the same naturally occurring protein.
There are two considerations when choosing a hyaluronic acid dermal filler. The more “cross-linked” (this is a medical term that is used to describe how tightly the filler sticks together) a filler is, the longer it lasts and the more support it can give your skin. However – the more rigid a filler is, the more it will be visible under the skin.
Therefore, a stronger filler is desired when it will be placed deeper under the skin, and when more structure is desired. Strongillers such as Voluma and Lyft are best used to sculpt a cheekbone, or a chin.
A medium strength fillers – such as Juvederm, RHA , or Restylane are best for lifting corners of the mouth, or deep lines around the corners of the mouth, or smoothing a tear trough.
Very soft fillers are best for very superficial lines, or plumping the lip: areas where there is a lot of movement and the filler must act in a very fluid way. Vobella, Kysse and Redensity are examples of soft fillers.
How soon will I see results from my dermal filler treatment?
Results are immediate and natural. Most patients need one treatment to achieve optimal wrinkle smoothing, and the results last up between 9 months and 18 months depending on what filler you use (Generally the more “cross-linked” a filler is, the longer it lasts. Stronger fillers such as Voluma or Lyft last over a year on average. Softer fillers such as Kysse in the lips last about 6-9 months.).
Patients will typically be slightly red in the injected areas for 24-48 hours. About 1/3 of patients will have a small bruise at the injection site as well. Filler can typically be felt under the skin for a couple of weeks after the injections are performed.
How soon will I see results from my Biostimulator treatment?
We love HA fillers because we get that immediate gratification – but that immediate gratification comes because we are replacing your lost tissue. Biostimulators like Sculptra are rebuilding structre – not replacing it – so they take longer to see results. Think of it like going to the gym – we don’t expect the body to rebuild itself in a day – no matter how hard you work out! Sculptra will typically take 3 treatments spaced a month apart – and you will see your full results in about 6 months. It is slow – and it can be hard to be patient – but the results are natural and totally worth it!!
Are there any potential side effects?
Side effects of Filler and biostimulator injections may include slight bruising, redness or swelling. Most side effects are mild and last only a few days. The most common side effects include temporary injections site reactions such as redness, pain/tenderness, swelling, lumps/bumps, and bruising. As with any injection there is a very small risk of infection.
What should be done before a Filler or biostimulator treatment?
It is recommended to arrive for your appointment with a clean face without make up. Avoid taking aspirin or ibuprofen before your appointment – as these are both blood thinners which can increase bleeding or bruising at the injection site.
What should I do immediately after Filler treatments?
Refrain from vigorous exercise until the following day. Other than that you can return to your normal activities. Avoid pressure to the injected areas for about two weeks. Fillers remain moldable for 1-2 weeks, and pressure can deform your filler. The most common culprits? The face cradle on massage tables, tight ski goggles and swim goggles. Normal activities like washing your face or putting on make-up do not have enough force to mold your filler.
Are Filler and biostimulator injections painful?
Injections may cause some discomfort during and after the injection. Most Fillers have lidocaine (a painkiller) mixed in with the gel which reduces the discomfort soon after it is injected. You may choose to numb the treatment area with topical numbing cream or ice to reduce discomfort – especially around the lips which are very sensitive. You will be a little sore the day you get your injections, but that resolves in 24 hours or so.
How long does a treatment usually take?
The injection process takes only about 30 minutes per area of the face we are treating.
Will I be able to feel bumps under my skin?
You will be able to feel the filler under your skin for a couple of weeks, and these bumps can sometimes be seen as well. However, they are not permanent.
As with the springs inside a mattress – the thicker and harder the support system is – the more you can feel the springs when you lie down on it. This is also true of Fillers. When Filler is placed under the skin – especially if it is placed in an area where the skin is very thin, or if it is placed very close to the surface, you will be able to feel it when you press on the area with your fingers. If it is placed well – it should feel like a smooth, rubbery “pad” under the skin – giving support to the skin that was beginning to wrinkle.
These bumps will even out over time as the filler dissolves. Fillers remain moldable for abouta week after they are placed – so if there is a bump that does not go away on its own, it can be “massaged” out with fingers or a Q-tip in a 15-minutes follow-up appointment.
Once you get fillers or biostimulators, do you have to get them forever?
You may like how your filler looks, but your face itself cannot physically get addicted to fillers or biostimulators. Hyaluronic acid fillers are intentionally made to be temporary and are gradually dissolved by the body, leaving nothing behind. Biostumulators are slightly different – they send a message to your bodfy to rebuild, and then they are removed naturally – leaving nothing behind but new, healthy collagen growth.
However – as with most things which make us look years younger, most patients do make regular appointments to keep looking their best.
When you get injected with fillers, will it be totally obvious?
The only fillers that you notice are those that are overdone or misplaced – trust me when I say that you have seen a lot more people with filler than you think you have! Many of the people you think overdid a filler actually have surgical implants. Getting an ‘overblown’ look with fillers is actually quite difficult because of the sheer amount of material it takes to get that look.
I heard there are permanent fillers? Why isn’t everyone using them?
The most important thing to understand with fillers of any kind is that despite having injections, your face will still continue to age. Aging is a dynamic process that involves a gradual loss of bone and soft tissue across several areas of the face. As the tissue that supports our skin becomes thinner, and slides down our faces under the influence of gravity, fillers placed in the cheeks and lips that looks good when we are 50 will not look appropriate when we are 60. Permanent filler in the face leads to a face with unnatural proportions that are too big and in the wrong position as the aging process continues. One of the biggest benefits of the Hyaluronic acid fillers like Juvederm, Restylane and Lyft is that it can be continually adjusted to meet the changing needs of your face.
Can every line and wrinkle be treated with filler?
There’s still a common misconception that filler and Botox are similar. Botox works to relax the facial muscles that cause lines and wrinkles, giving a more relaxed and smooth look to skin. Fillers are mainly for lifting up and smoothing hollow areas of the face as well as fine, superficial lines that are etched into the surface skin.
Can fillers and biostimulators prevent or pause the aging process like Botox does?
Just because you opt for fillers in your 30s, doesn’t mean you’ll stop the aging process entirely, but you may delay certain parts of it. In terms of volume, which we all lose as we get older, restoring minimal amounts along the way may help to offset a more dramatic deflated look that can appear with time. In patients who are just starting to see hollowness under their eyes, or fine lines around their lips, filler can correct the flatness and loss of definition due to aging.
Biostimulators like Sculptra, however, stimulate the body to rebuild – and so using them on a regular basis does prevent age-related volume loss – in the same way that going to the gym can prevent age-related loss of strength and endurance.
