Question : I had Juvederm injections under my eyes, but I did not like the results because my eyes now look uneven. Would fat injections under my eye solve this problem?
Answer : I would have to evaluate your particular anatomy and problem area to determine whether or not fat grafting would be appropriate but, in essence, you are just trading one filler for another since both Juvederm and fat would be considered volumetric enhancements of the face. So, in other words, if fat grafting would be useful to improve your uneven look then more Juvederm would also be good at creating the same effect.
Question : Will I experience more wrinkle reduction from a true facelift or from Botox injections?
Answer : It really depends on what area of the face you are describing as to whether or not a facelift will be better than Botox for wrinkle reduction. When I personally think of a facelift, I really think of a treatment that is improving upon laxity of the face, such as areas of jowling and laxity under the chin. In the case of Botox, I am treating hyperdynamic muscles, or muscles that are overly active, creating deep wrinkles. So, in essence, these two treatments can actually complement one another since one can be used for the treatment of facial laxity while the other is used for hyperdynamic muscles.
Question : Does ultherapy remove fat or just tighten the skin? Are the results permanent?
Answer : In reality, Ultherapy neither removes fat nor tightens the skin but, in fact, targets the deeper layer of the face in the area of the SMAS where there is a significant amount of collagen. The ultrasound waves heat the collagen to the point where they denature and this creates a healing response where new collagen is deposited, which in turn then tightens. When we treat an entire face with the Ultherapy device, we will do upwards of 8000 small thermal injury zones where new collagen is going to be deposited and each zone will create a small amount of tightening. When these are all added together, we get brow lifting and cheek lifting and improvement in jowls and laxity under the chin. In my opinion, the results are similar to other devices such as laser resurfacing or even surgical results in that the tissue heals and now we start the aging process from a new reference point so, in effect, the patient that undergoes an Ultherapy treatment will always look better than if they had never undergone a treatment, but they will eventually age out of the improvement that was obtained.
Question: People seem to use injectable fillers more than fat transfer but I don’t understand why. Doesn’t fat transfer last longer? Isn’t it possibly permanent?
Answer: I think the main reason that fillers are so popular is two-fold. One is that they are right off the shelf, so there is no need to harvest fat and, therefore, individuals who are not trained in aesthetic medicine and, therefore, would not feel comfortable harvesting fat can just grab a filler off the shelf and use this product in place of fat grafting. The second issue is that it does involve liposuction from another area and the collection and purification of the fat prior to reinjecting it and is, therefore, much more costly than fillers and requires expertise in this technique. Ultimately, if someone requires a large volume of facial augmentation, I certainly will discuss fat grafting with them since the fat grafting becomes very economical in that circumstance since multiple syringes of filler can get quite pricey. If a patient just needs a small amount of volumetric enhancement then most likely it would just be easier to use filler since the higher cost of fat transfer for just a small amount of fat would most likely outweigh its benefit.
Question: How does Juvederm compare to Restylane for lip augmentation?
Answer: I think both Juvederm and Restylane are excellent choices for lip augmentation and I really do not have a strong preference for one over the other although I will say that the Juvederm seems to be slightly smoother and tends to be more natural feeling faster than the Restylane does; however, both are great alternatives, so I would not necessarily sway you away for Restylane.
Question: It’s been a full day since I had Restylane injected into my lips and I now have duck lips and severe bruising. What can I do?
Answer: Since it has only been one full day, I would not get too concerned as this occasionally happens with lip injections. The bruising is going to add more swelling and the swelling is going to give you more of a duck lip type look and you, therefore, just need to be patient and allow the swelling and bruising to subside. You can accelerate the process by keeping your head elevated, staying active, and intermittently icing the lips, but it may take about a week for all the swelling and bruising to go away and at that point, your lips should look like they did immediately after the injection. Hopefully, this will give you the look that you desire but, if it does not, Restylane is reversible with the injection of hyaluronidase.
Question: I’m interested in getting injectable fillers in my cheeks. It seems like this is mostly done for aging reasons, but I’m 24 and just want more pronounced cheekbones without getting surgery. Would fillers be good for me?
Answer: Fillers are an excellent way to enhance the cheek area and there are multiple different filler agents that are good at this, but overall I tend to stick to the hyaluronic acid fillers due to their extreme safety and tolerance by the patient. I have found that fillers are a nice way to enhance a young cheekbone and if the patient appreciates this then we can discuss the possibility of future malar or cheek implants as a more permanent way of enhancing this area.
Question: I am interested in having Juvederm injections into my lips soon. I would like to know how much of the product is in each syringe, and if I do not use it all, could it be used for another session?
Answer: Juvederm comes in 0.8 mL syringes though now they just recently came out with 1 mL syringes replacing these. Most of my patients who desire lip augmentation can use the entire 1 mL syringe in their lips and get a very nice, natural volumetric enhancement of their lips without giving them the look of over-augmented lips. If we do not use the full amount, I usually just find other areas of the face that require volumetric enhancement and go ahead and use the remainder of the syringe since the open syringe will not last long enough to be used in another session in the future.
Question: How big are the needles used for injectable fillers?
Answer: The needles used for most injectable fillers range in size from a 27-gauge to a 30-gauge needle depending on the thickness of the filler material being injected. The far majority of injectable fillers that I personally use, I can perform using a 30-gauge needle, which is an extremely small needle, so that it causes very little discomfort. Furthermore, the injectable fillers have numbing medication in them and once the treatment starts the area begins to lose its sensation and, therefore, further injections are virtually painless. We can even do lips without having to perform any sort of a dental block.
Question: Do injectable fillers work on very deep wrinkles?
Answer: Injectable fillers can definitely work on very deep wrinkles but it really depends on what part of the face has the very deep wrinkle as to how effective they will be. Overall, they can at the very least greatly improve the appearance of the wrinkle and in many circumstances we can virtually eliminate the wrinkle with injectable fillers.