Dermal Fillers
(Teosyal, Evolence, Radiesse)
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Questions and Answers:
What are dermal fillers?
Dermal fillers are substances that are injected to "fill" any area of skin that needs it. They are used to fill wrinkles, lines, folds, and scars (eg. acne scars). They are also commonly used to give a fuller appearance to the lips.
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What kinds of fillers are used?
The first fillers were all made of collagen derived from cows. Collagen is the substance that fills the spaces between the cells of the body. Cow collagen is not commonly used these days because of its allergic potential. Test doses are required prior to treatment.
Today, there are many different fillers to chose from. We offer three kinds: hyaluronic acid (Teosyal and others), pig collagen (Evolence), and calcium-based fillers (Radiesse).
Hyaluronic acid: (Teosyal, Restylane, Perlane, Juvederm, Juvederm Plus, Revanesse) The most common fillers in use today are made of synthetic hyaluronic acid. You may see the term NASHA, which stands for Non-Animal Stabilized Hyaluronic Acid. Early hyaluronic acid products were extracted from rooster combs. The hyaluronic acid products we use are genetic copies of human hyaluronic acid. The only difference between this manufactured hyaluronic acid and your own is in its stability. Human hyaluronic acid is very unstable. In unmodified form, it wouldn't last anywhere near long enough to be used as a filler. So synthetic hyaluronic acid undergoes a process known as cross-linking to thicken and stabilize it. The more links, the thicker it gets.
Porcine (pig) Collagen: (Evolence) This filler is made of porcine (pig) collagen. Porcine tissue closely resembles human tissue. This is why pig heart valves can be used to replace human heart valves. Allergic reactions have not been reported.
The cross-linking (thickening and stabilizing) process is unique in that it is sugar-based. This is far less toxic than all other cross-linking processes (that use substances like gluteraldehyde) . Besides being well tolerated, the nice thing about Evolence is that it lasts about 12 months.
Calcium Hydroxylapatite: (Radiesse) this product contains calcium hyroxylapatite (CaHA) microspheres. Calcium hydroxylapatite is one of the primary mineral substances of bone. No allergy testing is required. Over a period of weeks following injection your body encapsulates the microspheres with collagen, giving a filling effect. Because the calcium hydroxylapatite microspheres persist for 2-3 years, collagen production is continuous. This product provides the longest duration of all the temporary fillers, averaging about 18 months.
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What areas can be treated?
Any skin can be treated, but the most common areas treated are nasolabial folds (from the nose to the corners of the mouth), labiomental folds (from the corners of the mouth down to the chin), upper lip (smoker's) lines, the glabellum (between the eyebrows), and crowsfeet.
It is also used for lip augmentation and to fill depressed scars.
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Who is a good candidate for dermal fillers?
Almost everyone from 20 to 80 could benefit from dermal fillers. However, advanced age, smoking, and excessive sun exposure can leave skin severely damaged, and dermal fillers are less effective in these cases.
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How are treatments done?
Injections are given into the area using a small needle. The amount used depends on the area being treated. In most cases, this is 0.5 to 2.0 milliliters. Up to 8ml can be used in one session, but this is extreme.
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Do dermal filler treatments hurt?
There is no simple answer to this question, because pain response and tolerance is different from person to person.
The degree of discomfort also varies from area to area. Filling folds is less painful than filling wrinkles. Wrinkle treatments are much less painful than lip augmentation.
In most cases, we recommend the use of topical anesthetic creams. Local anesthetic injections cannot be used (except for lips) because they will "fill" the area and obscure what we want to fill with the product.
We perform dental blocks when we do lip augmentation and upper lip lines. This freezes the nerves that feed the entire area and eliminates pain.
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How long do treatments take?
Most procedures take about half an hour.
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When are the results seen, and how long do dermal fillers last?
Beneficial effects of dermal fillers can be seen immediately following the first treatment.
Dermal fillers do not provide permanent improvement. The duration of benefit depends on the substance used, the area injected, and the person injected. See the question above: "What kinds of fillers are used?"
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What are the side effects of dermal fillers?
There are very few side effects to dermal fillers.
Bruising can occur.
Mild swelling and redness often occur. It usually resolves in a few hours, but it can persist for up to two weeks.
On rare occasions redness, tenderness, and swelling develops a few weeks after treatment.
Granulomas can form. These are inflammatory lumps under the skin that can last for months. They are rare.
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What are the alternatives to dermal fillers?
There are several treatment options that can improve your skin, depending on the nature of the problem, including peels of varying strengths, laser skin resurfacing, and surgical facelifts. You should also stop smoking, start using cosmeceuticals regularly, and wear sunscreen!
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What is your cancellation policy?
We require 48 hours notice for cancellation of your consultation or treatment, in order to fill the appointment time. If sufficient notice is not given, the full value of the treatment to be done may be charged.
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Photos
 
Before and after filler in upper and lower lips
Before and After fillers for pout lines
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