Question: How often do fillers need to be replaced?
Answer: Fillers essentially just need to be replaced when the filler has been resorbed by the body. Depending on what filler is used and what part of the face has been treated will determine how long the filler lasts and this can vary anywhere from six months to several years.
Question: My lips have a lot of fine wrinkles on them. If I plump them up with a filler, will this also smooth out the lines?
Answer: Yes, if you plump up the lips with a filler, the fine wrinkles that are on the lip itself or along the lip line will be stretched out just like the concept of a raisin as opposed to a grape. I have not found that the enlargement of the lips creates worsening of the wrinkling over time.
Question: After you get lip augmentation, is there a period of time we’re you’re extra aware of your lips? Does it take a while to get used to them?
Answer: I think most people feel as if their lips are overly large after a lip augmentation and this is mainly due to the swelling that occurs after the injection but also is due to having larger lips from the filler. It really does not take long to get used to this and for most people it is just a matter of a few days and their lips feel as if they are completely normal.
Question: Can Restylane contour the face for more of an oval shape?
Answer: Restylane can definitely contour the face to create any sort of shape that is desired, but if you really have an issue with significant volume need, you may want to consider either facial implants or fat grafting since it would become quite expensive to use multiple syringes of Restylane to overall change the shape of one’s face. Most of the time we are using syringes of Restylane to improve upon slight depressions and folds and we can use anywhere from one to six syringes of Restylane to improve upon these areas and in effect change the contour of the face, but remember that 1 teaspoon is 5 cc, so this is just a little over 5 cc of product, whereas when we do fat grafting we may use anywhere from 10 up to 60 cc of fat doing full face rejuvenation. That is 10 times more volume of which a third to a half of this volume will be retained long term. So, as you can see Restylane is going to have a limited effectiveness to truly change one’s facial shape, but it is an excellent option for those that just need a little bit of tweaking in areas that are concerning.
Question: I’m African American and wondering if there are any special considerations when it comes to injectable fillers for ethnic patients.
Answer: There really is not any special considerations regarding injectable fillers for African-Americans versus other ethnicities since all we are doing with injectable fillers is improving the contour of facial folds and wrinkles and whether it is light skin or dark skin the contour is still the same and we would treat ethnic patients identical to lighter skinned patients.
Question: I’ve had different injectable fillers over the past few years and I’m wondering if fat transfer can be used as an alternative and if the results will last longer.
Answer: It really depends on where the injectable filler has been placed over the past few years as to whether or not I would recommend fat transfer as an alternative for longer lasting results. If you are getting injectable fillers in the cheeks then fat transfer can be an excellent option since portions of the fat will be permanent; however, if you are getting fillers in the lips, I recommend to most patients that they consider continuing the filler since it is highly customizable, extremely safe, and very unlikely to give you any sort of side effects, whereas fat transfer in the lips does have risks of creating lumpiness and irregularities and frequently will require more than one treatment. Ultimately, I think you need to sit down and have a consultation so that the risks and benefits of the fat transfer and the expectations from this can be discussed.
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 : 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: I have fine lines above my lip. What’s a good filler for this area?
Answer: I think the hyaluronic acid fillers Juvederm ULTRA and Restylane are the best options for fine lines of the upper lip. They can be used to fill small lines. They are very well tolerated and last a relatively long time and are overall a good value. They are also extremely safe and should any sort of an unexpected bumpiness or fullness occur, they can be reversible.
Question: Does Radiesse provide permanent or temporary relief of facial wrinkles?
Answer: Radiesse provides a temporary solution to facial wrinkles and folds and can last one to two years though in multiple patients I have seen them return within six months needing more volumetric enhancement. Due to this fact, we typically use the hyaluronic acid fillers Restylane and Juvederm over Radiesse, but occasionally someone will desire a significant amount of cheek enhancement and I will oftentimes discuss cheek implants, fat grafting, and Radiesse to those particular patients.