Fillers General Information
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
Who does the injections?
In many offices nurses, interns or other staff perform filler injections. It is important for our patients to realize that Dr. Niamtu personally does 100% of the filler treatments. Last year Dr. Niamtu personally injected over 1,760 syringes of filler putting him in the top 10 percent of injectors nationwide. He also teaches other doctors in filler and neuromodulator techniques for all the major filler companies.
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.
Common FDA Approved Injectable Facial Fillers used by Dr. Niamtu
- Juvederm, Juvederm Ultra, Juvederm Ultra Plus (Stabilized Hyaluronic Acid)
- Restylane, Perlane (Stabilized Hyaluronic Acid)
- Radiesse (Hydroxyappetite)
- Sculptra (Poly lactic acid)
- Silikon 1000 (silicone oil)
- Autogenous fat
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 such as Restylane and Juvederm last up to 12 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.
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
Some Notes from Patients
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