Hyaluronic Acid Fillers

Q: What are dermal fillers, and how do they work to reduce wrinkles or restore volume?

Our skin consists of a few basic layers: the epidermis, which is where the layers of cells known as keratinocytes and melanocytes live; the dermis, which is the layer of collagen, elastin, and connective tissue right under the epidermis; and the adipose layer, where the metabolically-active adipocytes, or fat cells, live. Dermal fillers are sterile injectable materials created to be placed into the dermal layer to enhance volume and shape there, which may also help to smooth surface wrinkles.

Q: How does filler treatment differ from Botox or Dysport injections?

Botox, Dysport, Xeomin and other similar injectables are known as neuromodulators. These are a completely different category of injectable material. Neuromodulators do not actually take up any space or themselves remain under the skin after a few hours to days. Instead of taking up physical space, they disrupt the signal between nerve and muscle, reducing the muscle’s ability to contract. After a few months, the muscle regenerates the receptors that respond to the nerve’s signal and full movement is restored. Dermal fillers are inert materials that are not biologically active and just take up physical space.

Q: What is the difference between hyaluronic acid fillers and other types of fillers?

Hyaluronic acid molecules are a type of sugar molecule that naturally resides in the dermal layer, floating and cushioning our strands of collagen and elastin. As we age, our production of HA decreases (along with our production of collagen and elastin) and skin becomes less juicy and plump. HA fillers aim to refill and reshape our dermis with as natural a molecule as possible, but this means HA fillers also break down and are re-absorbed more easily than other dermal filler materials, which last longer, for better or worse.

Q: How long do results from hyaluronic acid fillers typically last?

Hyaluronic acid fillers can last from about 6 months to several years, depending on which exact filler is used, where it is placed, and the body’s own biology.

Q: Is there any downtime or recovery period after receiving dermal fillers?

Technically, there is no real downtime after receiving dermal fillers but some board-certified dermatologists may ask you to refrain from vigorous exercise for a day or two to allow the minor injuries from needle marks to heal or to ensure no unusual swelling or problems will occur from your treatment. It may take a week or two for swelling to settle and for small bruises to fully fade. If there is any pain or visual disturbance after your treatment, this may be an indication of a blocked artery, which can be an emergency.

Q: Can dermal fillers be used to enhance lips, cheeks, or under-eye areas?

Dermal fillers can be used to enhance lips, cheeks, and under-eye areas, even if just a bit, to restore a more youthful plumpness without having to look “done” or “filled”. Speak with your board-certified dermatologist about what your real goals are. There are many “good” filler results out there that look so natural no one can tell treatment was done.

Q: How soon will I see results after my filler treatment?

Unlike Botox and other neuromodulator treatments, which can take a few days to kick in and a few months to optimize, dermal filler results start to show immediately the day of treatment. Results may settle, smooth, and shape-correct over a week or two after injections, and sometimes a second or third visit for small amounts of additional filler are desirable to achieve full results, but even after a few minutes, a small amount of filler placement can correct something that has been bothering you.

Q: Can dermal fillers be reversed or dissolved if I am unhappy with the results?

Hyaluronic acid (HA) fillers can generally be dissolved but the more modern HA fillers that last longer can be tricker to dissolve. Other non-HA fillers may be more permanent and not dissolvable at all. Discuss this with your board-certified dermatologist injector before you begin treatment, so you understand what to expect. Generally speaking, it’s not a bad idea to start filler treatment with dissolvable HA fillers until you know what you like and whether you trust your injector to deliver results that make you happy.

Q: Are follow-up visits required, or can fillers be touched up over time?

After dermal filler treatment, follow up visits are not required at all if you are happy with your result. If you would like to ask questions about results or possibly get small amounts of additional filler to continue shaping the areas, follow up visits are never a bad idea. Fillers can definitely be touched up over time, whether this is in 3 months or 2 years. Dermal filler does not need to be constantly replenished on a set schedule. In fact, this could lead to many people looking overdone or over-filled.

Q: What should I do to prepare for my dermal filler appointment?

To prepare for your dermal filler appointment, write down all of your questions and make a consultation appointment with your board-certified dermatologist to make sure you hear everything she wants to tell you in person, and that you are able to ask all of your questions in person even before the day you first try filler. Each physician has her own set of rules and requests for filler treatments, so it’s best to speak with your own doctor to prepare.

Hyaluronic acid fillers are a great option for those looking to replace lost volume by plumping your wrinkles, folds, and sagging skin. The process for injectable dermal fillers is minimally invasive and results are instant, lasting anywhere from six to eighteen months.

The risks of FDA-approved dermal fillers are low, but can include very rare instances of allergic reaction to a specific formula and possible injection site problems that are more likely with an inexperienced injector. Read on for more information on hyaluronic acid dermal fillers.

What Are Injectable Fillers?

A dermal filler is a gel used to physically add volume to folds and hollow areas, improving creases on your face and around your mouth. HA fillers are also very good at hydrating lips, supporting their natural shape, or adding volume as desired. There are many types of dermal filler procedures, mostly including wrinkle reduction or temporary facial fillers to adjust the physical contours of certain facial regions like the cheeks and under-eye areas.

Unlike Botox and Dysport, dermal fillers are not neuromodulators, which means they will not affect nerves or muscles underneath your skin. Basically, the name says it all: Dermal filler injections affect the deeper layers of the skin to support sagging areas created by age-related volume loss.

How Do Soft Tissue Fillers Work?

The most popular and safe dermal fillers are made of hyaluronic acid (HA). This is a molecule that’s produced naturally inside our bodies that creates the cushioning and moisturizing environment for our collagen and elastin in the dermal layer of the skin. Over time, with age, our bodies produce less hyaluronic acid, leading to sagging skin, less firm skin, hollow areas, and aging signs like folds and wrinkles.

Dermal filler treatment integrates into your facial tissue to attract and bind surrounding water molecules for added volume in the specific area. The consistencies and particle sizes of each filler differ among products and brands, making each one more or less suitable for certain uses. This is why it’s important to have a consultation with a board-certified dermatologist like Dr. Krant to know exactly which dermal filler procedure might be right for your facial anatomy, aging signs, and goals from treatment.

What Are The Different Hyaluronic Acid Fillers?

The original Restylane® is a versatile filler of medium viscosity that has a smaller particle size than other fillers, making it an appropriate option for lip augmentation in patients over 21 years of age. It is also easily manageable in the under eye area, cheeks, temples, and jawline. Restylane can also be used easily in other areas of the face since it is not as dense or rigid as some of the other HA fillers. Restylane has since spawned a number of related fillers with different specialties.

Restylane products are formulated to add volume to the skin by acting like the body’s naturally occurring hyaluronic acid. The line of products was created with two patented innovative technologies: NASHA™ and XpresHAn Technology™.

With NASHA Technology, the gel particles that make up the product are given unique sizes to better tailor them to specific treatments. Small particles are used for fine lines and detailed shaping. Mid-sized particles are used for more moderate to severe folds and wrinkles. Large particles are used for greater desired volume and severe wrinkles. The NASHA gel is also firmer than XpresHAn gel, which makes it a great option for reducing the appearance of wrinkles and a more pronounced enhancement of the jawline and cheeks.

XpresHAn Technology, also known as Optimal Balance Technology™ (OBT™), causes the gel particles to be softer and more flexible, which allows for a greater range of natural expressions and more natural-looking results. The more malleable gel can be an effective option to add volume to the mid-face areas or for patients with thinner tissue coverage. It also can be used for more dynamic areas of the face, such as lips or wrinkles in cheeks.

Restylane Family of Fillers

Restylane’s fillers are formulated for specific purposes and each has FDA approval for its unique use. Formulas in the Restylane family include:

Restylane Kysse – for lip augmentation and smoothing lip wrinkles
Restylane Silk – for lip augmentation and smoothing lines around the mouth
Restylane Lyft – for volume enhancement in the cheeks and hands
Restylane and Restylane-L – the original formula for wrinkles and folds throughout the face, or for lip enhancement
Restylane Refyne – for softening laugh lines and nasolabial folds
Restylane Defyne – for softening laugh lines and enhancing chin projection
Restylane Contour – for enhancing volume in the cheeks

Juvéderm® products are made by a different company that also makes Juvederm Ultra Plus and Juvederm Voluma. Juvederm marketing claims that it differs from Restylane in that its formula uses Hylacross™ technology to purportedly achieve a smoother consistency than Restylane, though this difference hasn’t been clinically proven to be of any significance at the present time. This also implies that Juvederm absorbs more moisture, so it can be trickier to handle, as it will swell more than Restylane. This may be of benefit if increased volume is the primary desired effect.

Juvéderm® Ultra Plus and Juvéderm® Voluma also use the Hylacross technology, but for different purposes. Juvederm Ultra Plus is denser than regular Juvederm, so it is used for deeper wrinkles. Juvederm Voluma, however, is the first dermal hyaluronic acid filler to be FDA-approved to specifically replace lost volume in your cheeks. The Juvederm family of products comes pre-mixed with lidocaine in their “XC” line.

Juvederm products that begin with the letter V have a similar distinction, as the company creates these formulas with Vycross technology. According to the manufacturer, Vycross utilizes two molecular weights in particular proportions that makes a natural-looking result easier to obtain and “mold” during an injection treatment. Some patients report that Vycross formulas also last longer than traditional Juvederm hyaluronic acid formulas.

The type of filler used is entirely dependent upon the patient’s situation, so as always, see a board-certified dermatologist to discuss what’s best for you.

Juvederm Family of Fillers

Juvederm also offers many iterations of their well-known dermal filler, including:

Juvederm Ultra XC – for filling in laugh lines and nasolabial folds as well as lip augmentation or enhancement
Juvederm Ultra Plus XC – for filling in facial lines, folds, and wrinkles
Juvederm Voluma – for cheek and chin enhancement
Juvederm Vollure – for smoothing out facial folds and wrinkles
Juvederm Volbella – for lip augmentation and smoothing lip wrinkles

There are many options available for hyaluronic acid fillers in New York City, which means the filler that’s right for you is best chosen by a qualified, experienced dermatologist like Dr. Krant. If you’re interested in any of the enhancements these fillers can provide, it’s important to first schedule a consultation so Dr. Krant can examine your areas of concern and discuss which products and treatments best fit your needs.

Dermal Fillers in NYC

Trust your dermal filler injections to a board-certified dermatologist like Dr. Jessica Krant for the safest procedure and most consistent results. To learn more about which type of hyaluronic acid filler might be right for your goals and skin concerns, don’t hesitate to schedule a consultation in Manhattan by calling or contacting us online today.