Face
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Fillers in Lips
I use Restylane to improve and augment the lips. I find this to be the best because Restylane stays where you place it. This allows me to shape the lips better. I don’t like the sausage look that I notice in so many people who have obviously had lip augmentation. Shaping seems simple, but it is a very artistic procedure. Traditionally, it is believed that the height of the upper lip should be half of the lower lip. But I have found that in many beautiful and sensual faces, the height of the upper lip is equal to the lower lip. Again, we come to the notion of beauty and proportion. The golden proportion indicated a ratio of 1/1.618 between the upper and lower lip. The shape of a lip can have a profound effect on the aesthetics of the face. Just like the eyes or the nose, the lips are an important element of the facial identity, and their shaping requires a keen artistic sensibility which is not easy to teach.
Fillers in the Nasolabial Folds
These are the creases that extend from the corner of the mouth to the side of the nostrils. The Juvéderm advertisement calls them parentheses and says that no one should have them. I agree that they are one of the early signs of aging that can be helped with fillers. There are patients however who show very deep folds that detract from their appearance. In these locations, the skin is attached to the deep layers, and as the cheek relaxes, the creases appear deeper. In most cases, fillers like Restylane, Juvéderm Ultra Plus, or Radiesse injections can improve the situation, but if the creases are deep, one needs to release the dermal attachments first and fill at the same time. For the deep nasolabial folds, I prefer to release and use a small fat graft to prevent reattachment. These deep folds also need a mid facelift to redistribute the excess skin.
Fillers in Eyelids
This is the most delicate area in the face. Fillers are usually used in the crease between the lower lid and the cheek (tear trough) to improve a tired and gaunt look. An intravascular injection with a sharp needle can have disastrous consequences. I do this procedure very carefully with a special needle that is designed to minimize this complication. This is not the kind of procedure that you let anyone with an MD behind their name do. You should always ask yourself the question: Is this doctor offering to do this procedure on me because he wants to supplement his income? Or does this kind of procedure constitute his main line of work?
Fillers in Cheeks
As we age, we lose the subcutaneous fat. This is most noticeable in the cheeks, as this area is mainly made of soft tissue. I find that the best filler for this area is Radiesse. It is made of a suspension of hydroxyapatite, which is a constituent of our bones. Radiesse stimulates collagen formation as it gets absorbed, therefore the results last longer. Fat grafting is another alternative.
The other product which is effective in this area is Sculptra. This is injectable poly-l-lactic acid. After the injection, the results gradually build up over time. There are patients who suffer from abnormal lipoatrophy, which gives them a skeletonized look. In these patients, Radiesse, Sculptra and fat are very effective.
Fillers in Temples
There are patients who present with hollowness of their temple, which makes their orbits stand out too much. In these cases, fillers could be very helpful. Fat can be used as well, but because small asymmetries could be very noticeable in these areas, I would favor fillers, which are more predictable in results.
