Facial Fillers - Overview
Facial fillers are what they sound like. They fill in! They replace soft tissue that has been lost as we age. If you look at a child’s lovely face, they don’t have lines or wrinkles because they have an abundance of fat in their face. As we age, we usually gain fat in the lower half of our body and lose fat in our face.
In addition, there can be loss of skin elasticity as we age. Think of our skin as the wrapping paper and the fat and muscles of our face as the package. If the package shrinks with ageing, then the skin will hang and sag. Fillers can take up much of that laxity and, in fact, people refer to the addition of several cc’s of fillers as a “liquid facelift”.
Lip Fillers - Overview
This is a very popular procedure these days. There seem to be two distinct groups of women (and occasionally men) that desire this procedure: women in their early 20’s, who have been heavily influenced by what they see on social media. And women in their 50’s and 60’s who have noticed that their lips are thinning as they age (not their imagination, it is happening!).
Facial fillers are what they sound like. They fill in! They replace soft tissue that has been lost as we age. If you look at a child’s lovely face, they don’t have lines or wrinkles because they have an abundance of fat in their face.
As we age, we usually gain fat in the lower half of our body and lose fat in our face. In addition, there can be loss of skin elasticity as we age. Think of our skin as the wrapping paper and the fat and muscles of our face as the package.
If the package shrinks with ageing, then the skin will hang and sag. Fillers can take up much of that laxity and, in fact, people refer to the addition of several cc’s of fillers as a “liquid facelift”.
Botox is a drug which is injected which causes the muscles to stop contracting. Botox is largely used in the upper face: the crow’s feet, between the eyes and the forehead.
There are a few fillers that Dr. Berman believe are better suited for use in the lips, over the plethora of fillers that are now on the market.
Dr. Berman personally prefer Volbella and occasionally, Juvaderm Ultra (not Ultra Plus). Dr. Berman prefer these because they are softer and you want a soft filler in your lips.
Generally speaking, the softer fillers last a shorter period of time, compared to the more cohesive fillers, such as Voluma, which are firmer.
Volbella, will last about one year and Voluma, which is better suited for deeper injection than the lip area (such as the nasolabial folds or over the cheek bones) will last about 2 years.
Juvaderm Ultra is somewhat firmer than Volbella and gives a somewhat elevated ridge at the top edge of the lip, which Dr. Berman personally do not like but Dr. Berman have noticed that some women in their 20s prefer (no doubt due to social media).
Dr. Berman is wary of using fat in the lips because it can be tougher to make sure it is perfectly smooth and it cannot be dissolved like the fillers above.
They are commonly and effectively injected along the infra-orbitial rim, zygomatic arch, into the cheeks themselves, into the tear trough, the nasolabial folds, the upper and lower lips and the areas above and below the lips, in the pre-jowl hallowing. into the cervical-mento line, into the temple hollowing, into a deep furrow in the glabellar line. Basically anywhere on the face where it can be helpful to add volume.
None of our patients want to look like those movie stars who look way over-injected and who resemble Daffy Duck more than they do a person. The key is not to place too much filler.
Dr. Berman always explains to his patients that it is better to ERR on the side of caution and place a bit too little and come back in a week or two and buy some more filler, than overload an area.
The injection should be almost painless. You are getting an injection but it is very manageable.We never use blocks etc. Most if not all of the fillers that we use,are already mixed with lidocaine. This will render the area numb.
It is best to avoid Aspirin, Bufferin or any type of blood thinner for the week before. It is also better to avoid drugs like Motrin, Advil, Ibuprofen etc. Tylenol is fine since it does not interfere with blood clotting.
Juvaderm, voluma, vollure, volbella, and occasionally your own fat.
It can be a bit uncomfortable during the injection. I think it is totally unnecessary to use nerve blocks. I have my patients apply an ice pack for about 30 seconds beforehand and with good injection technique are all that is required.
I have done a large number of lip fillers with no complaints of significant discomfort. In addition, the fillers already have lidocaine mixed in with them. There can be bruising, and although this is not common, it can happen.
There can be swelling. Everyone will have a little bit of swelling and I always tell my patients to give it 10-14 days to completely settle in place, before considering any changes or adjustments. I have had a very small number of patients, who have had a lot of swelling in the lips after the injection.
It was not clear why. It was not an allergic reaction. It settled down but took a few weeks to do so. This has only happened about 2 times in the very large number of patients, I have injected with fillers.
I don’t think you need to do anything. You certainly can go exercise or eat anything you want. If you have nothing else to do, then you could ice it for a few minutes to minimize any swelling. Definitely avoid taking aspirin or any blood thinners for a week before.
Different fillers last different lengths of time. Volbella lasts about a year, However, in some individuals when it is injected in the lips, it can last a shorter period of time. Voluma lasts about 2 years. Vollure lasts about 18 months.
The vast majority of patients will not bruise. However, anytime you are stuck with a needle, you can get a bruise. If you get a bruise, it can last 2-3 weeks, so be aware of this.
You do not want to do this 2-3 weeks before an important social event, in case of bruising. Of course, you can cover any bruise with make-up.
Do not overdo it. I strive for a natural look. It is much better to undercorrect than to overcorrect. It is always better to put some in now and then in a few weeks (or months) later, to add more.
If you have extremely thin lips, you can only add a small amount at a time, to stretch the red part of the lip, so that you can add more at a later date. If you try to add too much at once, it just looks like you got punched in the lips, not an attractive look!
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