Have you ever looked in the mirror, put your fingertips on your cheekbones, pulled your skin up and back and thought “What can’t it just stay like that?”?
Of course, you have – we all have. As we age we lose the subcutaneous “scaffolding” along our cheekbones and under our eyes that normally supports the skin of our lower faces. As we lose these structures our skin “slumps”, leaving hollows under our eyes and creating folds around our nose and mouth.
In the picture on the left, you can see the face of a woman in her 20s. The structures along her cheekbones are full and high – which makes her look young. Now, look at the picture on the right. You can see her structural tissue sliding off her cheekbone and getting thinner, leaving hollows under her eyes and creating lines around her nose and mouth, and sagging along her jawline.
So how can this be fixed? While the loss of volume and structure across the cheekbone is inevitable, you can combat it by replacing the lost structures with Dermal Fillers, and lifting the skin back into place – very much like you do with your fingers in the mirror!
Fillers can be used to create contours such as a more defined cheekbone, fill in hollows under the eyes (also called the “tear trough”), or lift the skin up and back to reduce the folds around the nose and mouth.
Fillers across the cheekbone in action! This patient was 39 years old in the first picture, and 45 in the second.
Frequently Asked Questions
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®, 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. There are fillers which are made from other substances (Radiesse®, Sculptra®, and Belafil® are examples of this type of filler) but since they cannot be adjusted after they are injected, we do not use them at RESTOR.
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.
Fillers act by “filling in” or supporting 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.
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, more cohesive fillers such as Voluma® and Lyft® are best used to sculpt a cheekbone or a chin.
Medium fillers – such as Juvederm® or Versa® – work better under the skin for lines around the mouth.
Softer fillers such as Restylane® and Volbella® are best for the lip and the tear trough: areas where there is a lot of movement and the filler must act in a very fluid way.
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
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 – this goes away on its own and normal after injections.
If you have your lips injected expect swelling. Lips are very delicate tissue, and you will experience marked swelling for 24-48 hours. This is normal, and will go away naturally with time – but we recommend that people getting their lips done do not schedule any major social events for about 72 hours just in case.
Side effects of Filler 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 or damage to nearby blood vessels or nerves – but this is exceptionally rare.
Avoid taking aspirin or ibuprofen before your appointment – as these are both blood thinners which can increase bleeding or bruising at the injection site.
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.
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.
The injection process takes only about 15 to 30 minutes. If you choose to do topical numbing we recommend allotting an additional 30 to 60 minutes for the numbing medications to take effect.
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 about a 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.
You may like how your filler looks, but your face itself cannot physically get addicted to filler. Hyaluronic acid fillers are intentionally made to be temporary (lasting between six months and two years depending on what’s used and where it’s injected) and are gradually dissolved by the body, 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.
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 difficult because of the sheer amount of material it takes to get that look.
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 look 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 is that it can be continually adjusted to meet the changing needs of your face.
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