Fillers General Information & FAQ
There have been so many advances made in the field of facial fillers that they are now one of the most popular cosmetic procedures performed.
Types of Fillers
Fillers
General Information Fillers
Upperface Fillers
Midface Fillers-Lip
& Perioral Fillers
Lowerface
Who does the injections?
Dr. Niamtu is in the top 10 percent of injectors nationwide. He also teaches other doctors in filler and neuromodulator techniques for all the major filler companies. Fillers and neurotoxins are injected by Dr. Niamtu and his two registered nurses Jenny and Breeden. For a bit of trivia, when Dr. Niamtu gets filler he has his nurses do the injections on him.
New Injectable Fillers
A virtual revolution is going on with the development of fillers. Many different products have been used safely and effectively for many years in Europe, Canada, and Australia. These fillers have been passing FDA scrutiny and many have been cleared for use in the USA. Each coming year will bring the introduction of new fillers.
What Filler is the Best?
There is no easy answer for this question as each filler has different advantages and disadvantages. Contemporary cosmetic surgeons use multiple fillers to assist the various problems associated with facial aging. It is rare that any contemporary surgeon uses only a single filler. In reality it is important to separate the marketing and media hype from the true clinical science of injectable facial fillers. It seems that each time a new filler is FDA approved, it is hyped as “the best and longest lasting filler in history”, that is until the next month when the next filler comes out. In reality, they are all good for specific indications. Sometimes they are like “Coke” and Pepsi” in that they are made of the same ingredients and do the same thing. Some patients or doctors simply like one better than the other.
All doctors and patients want fillers to last long. As filler science progresses the longevity of fillers is increasing. Although we want things to last long, sometimes it is a good thing that they go away. What looks good or is in style today may not look good or be in style in 5 years. Due to this, fillers that will eventually be absorbed by the body may be preferable.
The contemporary cosmetic surgeon is somewhat of a “filler bartender” and has multiple filler choices specially tailored for specific applications.
What are Common Approved Injectable Facial Fillers used by Dr. Niamtu?
- Juvederm Ultra Plus
- Voluma
- Vobella
- Volux
- Restylane
- Restylane Lift
- Restylane Silk
- Restylane Defyne
- Restylane Refyne
- RHA 1, 2 3, 4
- Versa
- Radiesse (Hydroxyappetite)
- Sculptra (Poly lactic acid)
- Silikon 1000 (silicone oil)
- Bellafil
- Belotero
- Autogenous fat
- This list is not inclusive as new fillers seem to appear on a monthly basis. The newer fillers are becoming more specific intended for use in specific regions of the face.
What Can Fillers Do?
Many patients misunderstand fillers and sometime confuse them with Botox. Fillers are substances that are injected under the skin or lips to plump up the tissues. For the lips, fillers can provide an increase in lip size as well as enhancing the definition. They can also plump out “lipstick lines” that develop in many female patients.
For skin wrinkling, fillers are usually used for nasolabial folds (laugh lines) or bigger, deeper wrinkles. Fillers can also be used to augment facial anatomy to make bigger cheeks, chin or to fill in defects and scars.
How Are Fillers Administered?
Fillers are injected through small needles. Dr. Niamtu goes to great lengths to make this procedure painless. All patients are first treated with numbing cream on the areas to be injected, then several small injections of local anesthetic are given to totally numb the lips and related areas for a truly painless procedure. Many surgeons do not take the time to properly numb their patients and we have had many patients switch to our practice because of this painless injection technique.
Dr. Niamtu has written numerous journal articles and textbook chapters on filler technique and local anesthesia techniques for painless filler injection. They can be seen by clicking on Plastic Surgery Products: Voluptuous Lips or on Dr. Niamtu’s Online Library.
The filler is then injected in the lips, wrinkles or folds. The actual injection only takes minutes. Ice is placed on the lips immediately after the injections. The lips generally swell somewhat but most patients are able to return to work the next day. Rarely, some patients experience more significant swelling. For this reason, a first time filler patient may want to be treated on a day where they don’t have big plans for the next several days. It is also a good idea to refrain from aspirin or drugs that delay clotting for 1-2 weeks to decrease bruising when injecting fillers.
Dr. Niamtu recommends having the patient return in two weeks to check the result and make sure everything is symmetric. Occasionally a touch up may be performed at the follow up appointment. It is important to view filler injection as a sculpting process and in some cases multiple appointments are required to provide that special result that patients desire.
How Long Does the Filler Last?
There is no correct answer to this question as each patient metabolizes fillers differently. Research has shown fillers last up to 12-18 months. Radiesse has been shown to last over a year and silicone and Artefil are permanent. Fillers may not last as long in areas of increased movement such around the mouth. Different fillers will last different periods of time in different patients. One thing for sure is that the newer fillers last considerably longer than the first generation of fillers available in the past
Dr. Niamtu is a Certified Trainer and lecturer for Allergan, Medicis and Merz and teaches filler techniques internationally.
Dr. Niamtu demonstrating contemporary filler techniques at the Dr. Niamtu Cosmetic Surgery Course
To learn more about lip and wrinkle fillers, click below to see Dr. Niamtu‘s entry on the subject.
Dr. Joe’s Blog on Lip and Wrinkle Fillers
More information about injectable facial fillers from Dr. Niamtu's library of articles
Dr. Niamtu discusses and demonstrates Versa filler injection to the nasolabial folds using a blunt, flexible cannula.
Dr. Niamtu discusses filler disasters.
As an Injection Trainer for Allergan I am happy to be one of the first practices on the East Coast to offer the new filler Vollure for moderate to severe wrinkles and folds. I discuss and demonstrate this filler in the video below.
For more information on cosmetic facial surgery visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery
Richmond, Virginia
www.lovethatface.com
yaluronidase is an enzyme that is used to dissolve unwanted injectable fillers such as Juvaderm, Restylane, Voluma. It is most frequently used to remove unwanted filler where too much filler has been placed or the filler is lumpy, etc. Examples would be lips or cheeks that were over treated and need reduced or tear trough filler that is lumpy or discolored. It can also be used in emergency situations if filler is inadvertently injected in an artery or vein.
For more information about this subject or cosmetic facial surgery visit www.lovethatface.com and cosmeticsurgeryeducation.com
Dr. Niamtu J.
Facial rejuvenation using neurotoxins and injectable fillers. Gen Dent. 2013 Nov-Dec;61(7):38-46
Dr. Niamtu J.
Filler Rejuvenation of the Lips and Lower Face. Cosmetic Dermatology. 2012;25:250-52
Dr. Niamtu J.
Adjunctive Facial Aesthetic Procedures in Milaro M., Ghali, G.E.,Parsen P., Waite P.eds. Peterson’s Principles of Oral and Maxillofacial Surgery, Third Edition Peoples Medical Publishing House-USA, Shelton, CT 2012,1609-20
Dr. Niamtu, J
Complications in fillers and Botox.
Oral Maxillofac Surg Clin North Am. 2009 Feb;21(1):13-21
Saunders, Philadelphia
Dr. Niamtu, J
New Lip and Wrinkle Fillers Pg. 17-27
In: Minimally Invasive Cosmetic Surgery
Oral and Maxillofacial Surgery Clinics of North America
2005, 17:1, Saunders, Philadelphia
Dr. Niamtu J.
Perioral soft tissue rejuvenation techniques
Compendium Journal
Volume 22, number 11 pg 729-36, 2003
Dr. Niamtu, J
Fat transfer gun used as a precision injection device for injectable soft tissue fillers.
J Oral Maxillofac Surg. 2002 Jul;60(7):838-9.
Dr. Niamtu, J
Minimally Invasive Cosmetic Surgery
Oral and Maxillofacial Surgery Clinics of North America
2005, 17:1, Saunders, Philadelphia
Dr. Niamtu, J
Simple technique for lip and nasolabial fold
anesthesia for injectable fillers
Dermatol Surg 2005;31:1330-1332
Dr. Niamtu, J
The use of Restylane in cosmetic facial surgery
J Oral Maxillofac Surg 64:317-325, 2006
Dr. Niamtu, J
Reply: Foreign body reaction to hyaluronic acid: an adverse outcome of lip augmentation.
J Oral Maxillofac Surg 64: 1299, 2006
Dr. Niamtu, J
Rejuvenation of the Lip and Perioral Areas In:Bell WH, Guerrero CA (eds): DIstraction Osteogenesis of the Facial Skeleton BC Decker, Ontario, Canada 2007
Dr. Niamtu, J
Facial Aging and Regional Enhancement with Injectable Fillers.
Cosmet Dermatol. 2007;20(suppl 2):14-20
Dr. Niamtu, J
Accurate and Anatomic Midface Filler Injection by Using Cheek Implants as an Injection Template.
Dermatol Surg 2008;34:93-96
Dr. Niamtu, J
Experience and Evaluation of a New, Saline-Filled Implant for Cosmetic Lip Augmentation.
Am Journ of Cosmet Surg 2008;24(4):183-191
Dr. Niamtu, J
Vo-lip-tuous: Injectable Lip Fillers
Plast Surg Prod 2008;18(3):28-32
Injectable fillers in cosmetic facial surgery. In: Fonseca R, Barber HD, Matheson JD. (eds) Oral & Maxillofacial Surgery.
Saunders Elsevier, St. Louis pp 629-651, 2009
Dr. Niamtu, J
Interspeicalty Battles: Who Should Perform Cosmetic Facial Surgery?
Cosmet Dermatol 2009;22:341-342
Dr. Niamtu, J
When good fillers go bad
Plast Surg Pract 2009;(28): 16-20
Dr. Niamtu, J
Injection gun used for precision device for fat transfer. In Shiffman (ed).Autologous Fat Transfer. Heidleburg: Springer, 2010, 397-400.
Dr. Niamtu named to faculty of Progressive Aesthetic Learning Essential to Technical Expertise
P.A.L.E.T.T.E .
The PALETTE faculty is made up of well known filler experts across the USA and has to goal to teach safe and effective filler techniques to doctors from multispecialties.
Dr. Niamtu named to teaching faculty of Aesthetic Health Dimensions Editorial Review Board
In September of 2008, Dr. Niamtu had the honor of being appointed to the Editorial Review Board of Aesthetic Health Dimensions. This group is composed of well known plastic surgeons and dermatologists who are leaders in the teaching and development of facial fillers.
Dr. Niamtu is a physician member of the Medicis Aesthetics Advisory Council
Dr. Niamtu Co-AuthorsInjection Technique Teaching DVD Sponsored by the University of South Florida