Diving Into the World Of Beauty Fillers — What Injectables Are Good For and When Fat Graphs Are a Better Answer

In the words of sardonic author Fran Lebowitz: “There are three ways to look: young, old, and surgical.” In an attempt to preserve the former and avoid the latter, many of us turn to non-surgical alternatives, such as dermal fillers, to achieve immediate results and restore facial volume lost over time, smooth wrinkles, plump lips, enhance facial contours and even treat deep atrophic acne scars.

With the popularity of those GLP-1 weight loss drugs, more men and women who’ve experienced rapid weight loss are turning to fillers to restore volume loss, not to mention those in their forties who are beginning to see the subtle and not-so-subtle signs of aging. You might have even heard the brand names Juvederm and Restylane, made with hyaluronic acid (HA), the mineral-based Radiesse, filled with Calcium Hydroxyapatite (CaHA), and Sculptra, a poly-L-lactic acid (PLLA, a substance that stimulates collagen production.

For nearly a decade, I’ve turned to Yoav Kaufman, MD, a board-certified plastic and hand surgeon at Kelsey-Seybold Clinics. Needing a refresher, I recently booked an appointment with Dr. Kaufman, where he injected a round of Restylane Eyelight ($750 a vial) and, instead of an HA filler as I’ve had in the past, he suggested I undergo two sessions of Sculptra, injected six weeks apart ($900 a vial).

Be warned, not all practitioners are alike. If you go this route, I would implore you to trust only the skills of a board-certified plastic surgeon or a dermatologist with a deep understanding of facial anatomy.

Now, let’s dive into our discussion with the doctor:

Dr. Yoav Kaufman: For you, we’ve been very conservative. I’m not seeing that level of depressed volume in the cheeks that we observed when we first started. I think some of the fullness of your cheeks has decreased slightly. Rather than go back add more filler material, which leaves residue, I’ve started adding Sculptra.

Sculptra has the benefit of bio-stimulating the tissue to increase collagen production, but it doesn’t leave behind the same kind of residue as filler.

PaperCity: What is “residue”?

YK: It’s a material like scar tissue. Old filler material can harden into residual filler, but in most cases, I don’t mind leaving that filler in place because it’s not visible. Also, it acts as a kind of scaffolding for the soft tissue. Superficially, I don’t want to add any fillers that might migrate or leave residue. That’s not ideal.

What I like about Sculptra is that I’m able to fan it and leave a nice layer on top in a subcutaneous plane, to stimulate the tissue’s fibroblasts to produce collagen which tightens up the skin, giving you a nice layer of volume without leaving filler residue.

PC: Are you partial to any derma filler manufacturer?

YK: I don’t have a preference. I use them interchangeably for different purposes. I’ve found none last longer than another. They all last about the same, anywhere from a year to a year and a half.

PC: Unlike gel-like derma fillers such as Juvederm and Restylane, which are hyaluronic acid fillers that can fill in fine lines, wrinkles and folds, Sculptra is different. How so?

YK: It’s an FDA-approved poly-L-lactic acid (PLLA-SCA) collagen stimulator that can improve skin’s glow, tightness and jawline contour for up to two years. It stimulates the fibroblast cells that produce collagen, creating a framework that supports and maintains the skin’s structure.

Initially, your face may look slightly more swollen because of the water content that carries the Sculptra, which will eventually dissipate and promote the bio-stimulation of your own tissue.

LC: Would you apply Sculptra only to the cheek area?

YK: I prefer to apply it along the cheeks and mandible to provide a subtle fanning effect, creating a more defined jawline and overall better facial shape. For the eyes, we can use a lighter filler just in the troughs. I’m using Restylane Eyelight, a hyaluronic acid (HA) product. It’s a very thin, modified filler used in the tear trough, which I can place just beneath the skin to create a barrier between the skin and the muscle.

The skin under your eyes is so thin that it allows the hue of the dark muscle to appear, creating that impression of the dark circles. If you inject filler beneath the skin and attempt to separate the skin from the muscle, you can reduce the appearance of dark circles under the eyes.

LC: Who are the candidates for filler, and who are not?

YK: Pretty much anybody can be a candidate for fillers, unless you’re on any kind of blood thinners or you have had an allergic reaction in the past. The latter is very rare.

LC: What are the risks of injectables?

YK: In regard to Botox, I think that a lot of places inject more than necessary. You can get away with using the minimum units (30 to 40) and still get a good result that lasts for three to four months. Also, it’s important to understand the vectors of your animation muscles and the consequences of paralyzing them.

It’s very easy to inject the brow and forehead area, and next thing you know, it causes the eyelid and brows to look droopy. In patients with deep forehead furrows and/or excess upper eyelid skin, this will result in a very angry or tired look. Fillers are much more dangerous because they can be injected inappropriately into a critical vessel.

They can cause skin necrosis and occlude a vessel, which may make the vessel visible or result in segmental skin loss. In such cases, treatment is required. God forbid, the worst of it is that you can blind someone if the filler travels to the eye.

LC: When is it appropriate to undergo fat grafts in lieu of dermal fillers?

YK: When you like the results of fillers but want something more permanent, fat grafts are appropriate.  It’s a surgical procedure we can do it in the office if we need to add just a little bit of volume. However, for larger-volume areas, monitored anesthesia may be necessary for the patient’s comfort. It can complement a face lift or neck lift to refine and smooth residual volume. We usually take fat from the lower belly.

Finally, many find that the process of filler injections is more comfortable when numbing cream is applied prior. While it’s quite common to experience bruising, to reduce the severity avoid any blood thinners like aspirin, naproxen (Aleve) or ibuprofen (Advil/Motrin), as well as fish oil and vitamin E, for about a week before your appointment, and start a regimen of Arnica Montana pellets dissolved under the tongue and topical Vitamin K and Arnica cream, which can help strengthen capillary walls and speed up the breakdown of trapped, pooled blood.

Eating pineapple before and after your treatments (a natural source of bromelain) is reputed to have anti-inflammatory properties. Avoid alcohol and ice the area immediately after injections.