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November 9, 2011
I am interested in getting longer lasting injectable fillers to decrease my nasolabial folds
Filed under: Injectable Fillers,Sculptra — Dr. Andrew Campbell @ 4:14 pm

Question: I am interested in getting longer lasting injectable fillers to decrease my nasolabial folds. What type of longer lasting fillers would work in this area and do you have experience with this filler?

Answer: Well, at the time of this blog, the theoretically longest lasting available filler in the United States would be Sculptra since it can last several years. I have limited amount of experience with Sculptra since in the far majority of my patients they are better served by a hyaluronic acid filler but, certainly, if you are very interested in a longer lasting injectable, Sculptra would definitely be something to consider. I would, however, strongly encourage you to avoid permanent fillers in this area simply because we have no idea what you are going to look like 20 or even 30 years from now or even longer and, if it truly is a permanent filler, that filler will still be in the soft tissue of the face and I am concerned that down the road many patients will look rather unusual if they have had a permanent filler placed in the past.

September 1, 2011
Do any fillers provide permanent results?
Filed under: Injectable Fillers,Radiesse,Sculptra — Dr. Andrew Campbell @ 3:41 pm

Question: Do any fillers provide permanent results? Which provide the longest lasting results, and what can they be used for?

Answer: There have been and are currently materials available that could be used as a permanent filler.  One of which is medical-grade silicone, which is not FDA approved to be used as a facial cosmetic filler, but many physicians still use it for this.  Another is a product that is composed of methyl methacrylate, which currently, I believe, is not available but historically has been a filler that was approved for facial use and is considered permanent.  I personally am not interested in permanent fillers for folds and wrinkles since I do not know what this patient will look like in 20 or even 40 years when this filler will still be in their face.  In patients that want volumetric improvement of their face and want a permanent result, I typically would discuss implants with those patients.  Other long lasting fillers are Sculptra and Radiesse; Sculptra lasting typically at least two years and many times much longer, Radiesse typically lasting one to two years; however, I have seen many patients where it did not last a year.  I, therefore, typically recommend the hyaluronic acid fillers as these fillers routinely last nine to twelve months in most areas of the face.  They are extremely safe and reliable, and if the need occurs, they can be reversed with injection of an enzyme.  Essentially, the hyaluronic acid fillers are nearly a perfect filler material, and that is why I prefer these over the aforementioned other options.

August 12, 2011
Is there something that could be injected into my cheeks to fill it out?
Filed under: Injectable Fillers,Juvederm,Radiesse,Restylane,Sculptra,Wrinkle Fillers,Wrinkles & Dermal Fillers — Dr. Andrew Campbell @ 4:27 pm

Question: Over the years that fold that runs from the edge of my nose down to my mouth on both sides looks like it is sagging. I wonder if I can get this repaired without surgery. Is there something that could be injected into my cheeks to fill it out? Is anything like that permanent?

Answer: Yes you can definitely get something injected into the cheeks to fill them out and these would simply be filler injections. The most popular filler injection is a hyaluronic acid filler such as Restylane or Juvederm but you could also use Radiesse which is calcium based or even Sculptra. If desired you could also consider fat grafting since we can use a rather significant amount of volume from fat grafting and a portion of this can be considered a permanent filler. There have been permanent fillers on the market and most likely there will continue to be these options and for cheek augmentation I certainly can consider using these products to add volume to the cheeks. Another option would be cheek implants if your anatomy would benefit from such a procedure. Ultimately as you can see there are many options for your problem and that is why I feel a consultation with an experienced board certified facial plastic surgeon would allow you to select the best option for you.

August 11, 2011
Is this the only filler that lasts this long?
Filed under: Injectable Fillers,Juvederm,Radiesse,Restylane,Sculptra,Wrinkle Fillers — Dr. Andrew Campbell @ 9:58 am

Question: I heard that the injectable filler, Sculptra, can last 2 years. Is this true? Is this the only filler that lasts this long, and what can it improve?

Answer: Sculptra can definitely last two years or even longer, and in my personal opinion, I feel that it is best used as an overall volumetric enhancement of the midface, but I certainly know of others who use it in other areas of the face as well, including the smile lines. Other fillers that can last this long are Radiesse, which is calcium-based, though I do not think that it is nearly as reliable in its longevity as Sculptra is. Realize also, that the hyaluronic acid fillers, Restylane and Juvederm, can also last 2 to 3 years in certain individuals, but that is a relatively small percentage of the overall patient population that we see, and we cannot predict which patients will get this increased longevity of these filler products. Ultimately, I think fillers need to be highly customized for each individual’s desires, needs, and anatomic features, but overall I think that the hyaluronic acid fillers are the most reliable fillers on the market today.

August 1, 2011
I recently read an article on Sculptra.
Filed under: Sculptra — Dr. Andrew Campbell @ 10:25 am

Question: I recently read an article on Sculptra that said it was made from poly-L lactic acid and not hyaluronic acid. What is that and how does it differ from ingredients in other injectable fillers?

Answer: Poly-L lactic acid is another polymer, which means its molecules link together to form a chain, only hyaluronic acid is sugar molecules which are naturally found in our body and the poly-L lactic acid has different molecules that are not a naturally occurring substance.  It is interesting that poly-L lactic acid is similar to the substance that makes up Vicryl sutures, which are very commonly used in plastic surgery.  These sutures slowly dissolve, as does the Sculptra, though strangely Sculptra lasts much longer that the actual suture material does since this injectable Sculptra material can be present for 2 to 3 years and sometimes even longer, which is a great advantage for Sculptra over the hyaluronic acid products.

July 27, 2011
Are there any fillers that provide permanent or longer lasting results and what can they be used for?
Filed under: Sculptra,Wrinkles & Dermal Fillers — Dr. Andrew Campbell @ 10:49 am

Question: Are there any fillers that provide permanent or longer lasting results and what can they be used for?

Answer: Historically, there were permanent fillers available in the United States under the name of ArteFill and I believe these are coming back out once again at the time of this blog. These are made of methylmethacrylate, which is a similar chemical to superglue and it is an extremely small bead-like spheres that are in gel matrix that can be injected into lines and folds. Other possible permanent fillers are injectable silicone, which is not FDA approved for injection in the face, but can be used off label for this purpose. My personal philosophy with permanent fillers is that I try to avoid them at virtually all costs due to the fact that they are truly, literally permanent. What I mean is that they do not just last 10 or 20 years, these products last for the rest of the patient’s life. I certainly do not know what some of my patients are going to look 40 years or 50 years from now and I therefore do not want to place a filler that will still be present that many years from now. It would be great is the filler was available that could last for around 5 years and there certainly is one, called Sculptra, that can do this, though the only drawback I see with Sculptra is that you rely on the patient’s inflammatory response to give the volumetric enhancement and you therefore cannot use it like the other fillers where you see what you get immediately. I think Sculptra is great for overall volumetric enhancement of the cheeks, but I personally would use it cautiously in other areas of the face. Otherwise, for the cost, ease of use, safety, and efficacy, I feel that the hyaluronic acid fillers are by far and away the best fillers at this time.

February 9, 2011
Can you explain what Sculptra is?
Filed under: Sculptra — Dr. Andrew Campbell @ 3:21 pm

Question: Can you explain what Sculptra is? What it is used to treat and how long the results last?

Answer: Sculptra is a product that is composed of poly-L-lactic acid which is a compound that is used in certain forms of dissolvable sutures.  It is essentially very fine particles of the same substance that is mixed with an injectable numbing solution and then placed in the areas where volume is desired.  It was initially developed and used for HIV lipodystrophy, but now has a cosmetic application and FDA approval as well.  Once injected the product creates as response by the body which then develops the volume that is desired through the body’s reaction.  That is why it is not a "what you see is what you get" filler like Restylane and Juvederm or Radiesse is.  In essence we have to wait 6 to 8 weeks for the effect and then usually a second injection session is performed in order to create the desired volume.  The biggest advantage that Sculptra has is that it is does have a very long-lasting effect of 2 to 3 years in most patients. 

April 8, 2010
How soon after Sculptra can I have fat injections?
Filed under: Sculptra,Wrinkles & Dermal Fillers — Tags: , , , , — Dr. Andrew Campbell @ 10:16 pm

Well, that depends if you want the fat injected in the same area that the Sculptra has been injected. If that is the case, then I ask whether the Sculptra injection was inadequate in its treatment of the area that you desire volume. Ultimately, fat injections can be applied to anybody that has had Sculptra injections even in the area where Sculptra has already been placed; however, I am uncertain as to the affects that the Sculptra will have on the viability of the transferred fat. This is due to the fact that Sculptra gets its volumetric enhancement through the inflammatory response that the patient has to the actual Sculptra product. With this additional inflammation in the tissue, it is unclear as to whether this negatively or even positively will affect the viability of transferred fat. I have personally performed fat injections in areas of prior Sculptra and I have found that it is not only more difficult to perform due to some significant fibrous side effects of the Sculptra injection, but I do have significant concern over the long term viability of this fat due to the inflammation that must be present in that area. With that said, I have no problem whatsoever performing fat transfer injections into other areas of the face where Sculptra has not been placed. This should in no way affect the result of the fat and can give the patient the desired result that they expect

February 9, 2010
If fat or Sculptra a better option for replacing large volume loss?
Filed under: Botox / Dysport,Juvederm,Sculptra,Wrinkles & Dermal Fillers — Tags: , , , — Dr. Andrew Campbell @ 1:52 pm

Depending on where the volume loss is on the face, there are advantages and disadvantages to each of these possibilities. The big advantage of Sculptra is that it is a product that is available literally off the shelf. You just reconstitute it a few hours before the patient arrives and you can then inject it into the area that requires additional volume. The downside is that we are relying on the patient’s inflammatory response to this product to create the volume, which in my opinion can be somewhat unreliable and therefore this product should only be used in the cheek area. The second downside is that it is a temporary solution to the problem in that the Sculptra will last approximately three years. Now, the upside is that three years is quite a long time for an injectable product to last and it is easily administered and relatively cost effective. The advantage of fat grafting is that the outcome can potentially be a permanent solution to the volume loss and the other advantage is that there is a nearly inexhaustible supply of this product on the patient’s body. The downside is that a portion of the fat will resorb over time and I expect approximately one-half to two-thirds of the fat to disappear in the first six to twelve months. With that being said, approximately one-third to up to one-half of the fat volume can persist long term and is theoretically permanent. I suggest that the patient make a consultation at Quintessa Medial Spa or with myself to consider the options.

February 8, 2010
How can I get a Cupid’s bow in the lip?
Filed under: Juvederm,Lips & lip Augmentation,Radiesse,Restylane,Sculptra,Wrinkles & Dermal Fillers — Tags: , , , , , , , , , , , , — Dr. Andrew Campbell @ 1:54 pm

The most reliable and safest method of improving the appearance and shape of the lip is through the use of injectable fillers.  I prefer the use of Juvéderm and/or Restylane and would consider virtually any other type of filler material contraindicated in the lip.  Specifically, I would highly recommend avoiding the use of Radiesse, Sculptra, or NewFill as well as ArteFill and silicone in the lips.  I feel that these products are fraught with complications and though patients frequently would desire a longer lasting result, the benefit of the increased longevity is outweighed by the extremely high risk of irregularities, granulomas, asymmetries, and potentially more significant complications.  With that being said, the hyaluronic acid type fillers can do a wonderful job of recreating a Cupid’s bow in the lip and I typically place a small amount if the ridges or the small vertical ridges from the nose down to the Cupid’s bow portion of the upper lip to enhance this area as well.  This gives patients an extremely youthful lip appearance without creating the look of an overdone or sausage-type lip.  I would recommend that any patient that is interested in lip injection seek someone with a significant amount of experience injecting the lips as this is an area that requires significant precision and an artistic eye so that the patient will get a very natural appearing voluptuous lip without the telltale signs of an overdone treatment.

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