Periorbital Dermal Fillers
Do the appearance of your “smile lines” make you frown? Do the bags under your eyes make you look tired and older than you are? Is your lipstick bleeding through the border of your lips? If so, you may be a good candidate for facial fillers. If your cheeks appear to be deflating and look flat, you may truly appreciate the ability of facial fillers to restore a more youthful and rounder contour to your face. Dermal and subdermal fillers, “facial fillers”, are one of the most exciting areas of minimally invasive, non-surgical, facial rejuvenation available today. Fullness or roundness of facial features is associated with a youthful appearance. As we age, we gradually lose the round contour of our facial features. While fat tends to accumulate in areas where we don’t want it, like our bellies and thighs, we tend to lose fat volume in our faces. Performed in an office-based setting, facial fillers are simple, quick, comfortable and convenient. The results can be amazing and quite gratifying. The advent of readily available, biocompatible and diverse dermal fillers has transformed the facial rejuvenation experience. In an attempt to restore facial symmetry and volume, dermal fillers have become a first line treatment in correcting or restoring aging facial characteristics. In some cases dermal fillers can be used quite successfully as an alternative to invasive surgical procedures. In other cases, dermal fillers are used as adjunctive treatment with surgical procedures.
Please note. For simplification purposes, I will occasionally refer to both dermal and subdermal fillers as “Facial Fillers”. Facial volume replacement many times includes placing the filling substance in more than one layer of the facial tissues. Please refer to my skin anatomy diagram to better understand the dermal and subdermal anatomy.
This is an example of mid facial volume replacement. 4cc of Artefill was used. Notice the rejuvenating effect that this patient demonstrates in his cheeck and nasolabial fold. Additional photos can be found in the gallery.
1. What are dermal and subdermal fillers?
Dermal and subdermal fillers are substances of various compositions that are placed into the dermal layer of the skin or subdermal (fat or muscle) layers. All fillers, no matter the location of placement are used for aesthetic volume rejuvenation. Because of the relative ease of use and impressive aesthetic outcomes, fillers are exceedingly popular. Due to the high demand for facial fillers, a wide variety of FDA approved injectable substances have been introduced into the cosmetic treatment arena.
2. How do fillers work?
The three D’s of facial aging include Decent, Deflation and Deterioration. As we age, we lose fullness in our face. As we age, hollowness becomes more common than full, round facial features and contours. Dermal fillers (volume addition) are used to treat the deflation (volume loss) portion of facial aging. In addition, dermal fillers are used in people who want to enhance their natural facial features such as the lips. Facial fillers can be injected into areas with fine lines or deeper wrinkles, folds and depressions. Facial fillers can mask lower eyelid bags and facial jowls. Any facial area can be treated with dermal fillers.
3. Are fillers safe?
While any medical treatment or procedure has inherent risks and potential complications, facial fillers are typically quite safe and predictable. The earliest FDA approved fillers consisted of bovine (cattle) collagen. Today, animal based fillers are still on the market and used successfully. Animal based fillers require pre-treatment skin testing in order to identify patients who may display allergic reactions to the foreign substance. The majority of dermal fillers used today are not animal-based and are typically quite biocompatible (of being compatible with living tissue or a living system by not being toxic or injurious and not causing immunological rejection). Other potential complications arising from the use of facial fillers can be largely avoided by working with a Physician well versed in facial anatomy, physiology and knowledge regarding the nuances about different fillers and their best facial applications.
4. What are the most commonly used types of dermal fillers?
Young, healthy-looking skin contains an abundance of a naturally hydrating substance called hyaluronic acid (HA). But as you age, sunlight and other factors can reduce the amount of HA in your skin. The lack of HA causes your skin to lose structure and volume, creating unwanted facial wrinkles and folds – like those parentheses lines around your nose and mouth. HA is involved with tissue repair, joint lubrication and cartilage resilience.
Juvederm XC is a smooth gel filler used to instantly smooth or soften wrinkles around your mouth and nose. Juvederm is a non-animal product. The risk of allergy is remote. Juvederm can be used under the eyes to mask lower eyelid bags or in the cheeks to achieve a more youthful appearance. Juvederm XC is infused with lidocaine, an anesthetic, to improve comfort during treatment. Juvederm also works well in the lips. Juvederm is relatively long lasting. The amount of time that Juvederm lasts depends on variables including the amount used and location of placement. Juvederm in the lips or facial folds will last about six months, while Juvederm under the eyes typically lasts well over a year.
Restylane is also a HA smooth gel filler that is designed to smooth wrinkles, plump lips and shape facial contours. It is used anywhere on the face for volume enhancement. It lasts at least 6 months. Perlane is identical to Restylane except the gel particles are larger. It works as a very good subdermal filling substance to correct nasolabial folds or for cheek enhancement. Perlane will last 9-12 months. Restylane and Perlane are also available with lidocaine infused into the gel in order to diminish discomfort during the treatment.
With Radiesse subdermal wrinkle filler, you welcome back your own natural collagen to smooth out the signs of aging. Radiesse wrinkle filler’s formulation stimulates collagenesis – the production of new collagen – which results in increased volume for natural looking wrinkle correction that may last a year or more in many patients.
Radiesse wrinkle filler consists of smooth calcium hydroxylapatite (CaHA) microspheres that are suspended in a water-based gel carrier. Over time, as the patient’s own soft tissue replaces the gel carrier, the newly formed collagen provides the desired long-term effect. Radiesse has proven to be an excellent choice for correcting nasolabial folds or other midface deficiencies. In Dr. Mitchell’s practice, Radiesse is never used around the eyes or in the lips. Radiesse is best used in areas of the face with thicker overlying skin.
Artefill was FDA approved for use in the United States in 2007. This dermal filler is considered permanent. It is composed of nonresorbable polymethylmethacrylate (PMMA) microspheres, suspended in a water-based carrier gel. Artefill also contains bovine collagen and lidocaine. Because of the bovine collagen, skin testing must be performed prior to treatment. Artefill works well in the nasolabial folds or cheek region. Because of its permanence, Artefill is typically injected in a series of treatments until the desired outcome is achieved.
5. How much filler do you need?
Fillers typically come in approximate 1cc syringes. Smaller amounts are available for either very small correction areas or for touch-ups. The amount of filler needed for the proper correction varies between the proposed site of injection, the amount of volume loss, depth of lines and wrinkles and patient preference. 1cc is typically good for lower eye bag camouflage or for lip plumping. Nasolabial folds typically require 1cc per side. Some patients opt for a “liquid-facelift” and may require 6cc for a refreshed and rejuvenated appearance. Discounts are given for multiple syringe purchases.
6. How long does the treatment take to complete?
I never rush my work. Your treatment is my art and the session time is truly unlimited. Treatment time varies and depends on factors including the amount of filler being used during the appointment, your individual needs and anatomy. If you are well known to my practice then the treatment time is typically less. If you are a new patient, then it is important that we communicate about desires and expectations. Most treatments involve the use of topical anesthetic. Topical anesthetic takes effect within 15-20 minutes and the application of the filler takes an additional 10 – 20 minutes. Occasionally multiple treatment sessions are booked in order to get the desired look just right.
7. How long do the fillers last?
Dermal fillers last variable amounts of time. Hyaluronic acid fillers such as Juvederm and Restylane lasts 6-9 months or longer depending on the location and depth it is injected. The lips do not last as long as the nasolabial folds or around the eyes. We have found that Hyaluronic acid fillers last more than a year when placed under the eyes to camouflage bags.
8. What are the side effects of facial fillers?
Treatment side effects are usually mild to moderate, lasting 7 days or less, and include temporary injection-site reactions such as redness, pain, firmness, swelling, and bumps. Bruising occurs on occasion. Bruising is more apt to occur in patients taking blood thinning medications such as aspirin or Non-Steroidal Anti-Inflammatory drugs (NSAIDS). Certain herbs and vitamins may also thin the blood and increase the chance of post-treatment bruising. While not an absolute necessity, it is recommended that all blood-thinning medications be discontinued for 7-10 days prior to dermal filler treatment. Do not stop any prescription medications without the approval from your Physician.
9. What are post-injection activity limitations?
There is minimal recovery and downtime following dermal filler treatments. Many patients may resume normal activity immediately following the treatment. Cold compresses will be applied immediately following the treatment and may be applied throughout the day to help minimize swelling and/or bruising. For 24 hours after treatment avoid strenuous exercise, consumption of alcoholic beverages and extended exposure to sun and heat. These activities may increase the temporary redness, swelling and/or itching at the injection sites.
10. Why Choose Dr. Mitchell to perform your Facial Filler?
Dr. Mitchell is a Board-Certified Facial Plastic and Reconstructive Surgeon. Dr. Mitchell has successfully treated hundreds of patients with Facial Fillers since 2003. His artistic ability and thorough knowledge of facial anatomy provides for reliable and consistent success using Facial Fillers of all types. Dr. Mitchell recognizes that there exist many different fillers on the market today. Dr. Mitchell will help you choose the best filler to achieve your goals and expectations.