Why is the face I see in the mirror every morning suddenly looking droopier? It couldn’t have occurred overnight, but why does everything suddenly appear to be looking down, not up? If these questions bother you, you are not alone.

At the Esthetic Clinic, we believe that a subject of beauty is anything that resonates with personal meaning, whether in a man or a woman. Beauty needs to be taken care of. Preserving beauty is important as just like anything else which is not taken care of, physical appearance can also worsen on lack of care. More and more consumers are opting for non-surgical techniques of preserving beauty as these techniques have ‘less downtime’ – A consumer can literally see changes in days, without going thru the pains of healing from surgery.

With the passage of time the face and lips tends to lose volume, which causes the skin to look less full and less tight. Fillers are synthetic materials that are injected into the face to increase lip, cheek, or chin volume. Fillers can also be used to reduce the nasolabial fold and to fill in creases in the skin. In some cases, filler can be used to treat the hollows beneath the eyes.

Filler treatments are no recovery treatments that can be performed over the lunch hour. The primary fillers we offer include Elevesse, Juvederm, Radiesse, Aquamid, Sculptra, Esthelis, Fortelis, Mesolis and Restylane. Dr. Shome is happy to discuss with you what you might achieve with the use of fillers and which one is best for your individual concerns.

Frequently asked questions about Dermal Filler Injections:

1) What is a dermal filler?
A dermal filler is a material injected into or beneath the skin to add volume to the face.

2) Why are dermal filler injections popular?
Dermal filler injections typically cause a consistent subtle improvement in facial appearances that can be seen immediately after the injection yet with little or no recovery.

3) Why do dermal fillers make people look younger?
With the passage of time we loose volume in the face. Loss of volume results in deflation of the face. Our face is much like a round inflatable ball. If the ball is fully inflated there are no wrinkles on the surface. If we let some air out of the ball wrinkles form on the surface. If more air is let out of the ball it no longer maintains a round shape. Dermal filler essentially re-inflates the face.

4) Who gives dermal filler injections at the Esthetic Clinic?
All injections are given by Dr. Debraj Shome, our internationally trained facial plastic surgeon. A Facial Plastic Surgeon administering Botox ensures that consumers have the best possible results. Besides, if Botox is not suitable for a particular condition or line, being a plastic surgeon, Dr. Shome has other tools in his armamentarium to deal with those.

5) What areas of the face are fillers used in the most?
Dermal fillers are used most frequently in the nasolabial folds (the fold between the cheek and mouth) and the lips. More and more fillers are being used to accomplish changes that formerly required face lift surgery or surgery to place cheek or chin implants. In these cases filler is injected beneath in the cheeks or chin to generally add volume to the face.

6) Do dermal filler injections and Botox injections do the same thing?
They both can make one look younger and more rested, but do so in different ways and in different parts of the face. Botox reduces wrinkles caused by contraction of muscles by relaxing those muscles. It works best in the forehead, between the eyebrows, and in the area just lateral to the eyelids (crow’s feet wrinkles). Filler adds volume to the face and works best in the areas of the face that lie below the eyes.

7) Can one receive Botox and dermal filler injections at the same time?
Yes. Dermal filler and Botox are often used simultaneously to treat different areas of the face resulting in a synergistic effect. Rarely, people will wear very deep wrinkles in the area between the brows, crow’s feet, and forehead that do not resolve completely even when the muscle is relaxed with Botox. In these situations filler can be used in combination with Botox to elevate the deep wrinkles.

8) Can one receive dermal filler injections and have cosmetic surgery at the same time?
Yes. In some cases dermal filler injections can delay or even alleviate the problems formerly treated with cosmetic surgery. However some issues such as excess skin in the upper eyelids and sagging skin in the neck cannot be improved with dermal filler. We often use dermal filler at the time of cosmetic surgery to enhance the results of surgery.

9) How do filler injections in the lips work?
Some young people simply like having full lips. Adding filler can give one more full lips. In middle age there are some aging changes that alter the appearance of the lips. The upper lip gets longer which allows some of the red part of the lip to roll under resulting in the appearance of less redness in the upper lip relative to the lower lip. There is also a loss of elasticity and volume in the skin. This allows vertical wrinkles to form in the upper and lower lips. Injecting filler into the lip can roll out the upper lip exposing more of the red portion of the lip. Injecting filler on the edge of the red part of the lip and into the vertical wrinkles can reduce these wrinkles. These changes can be accomplished without markedly increasing the size of the lips or giving one an unnatural appearance. Juvederm is the most commonly used filler in the lips. These injections are typically repeated once every 4 months.

10) How do filler injections work in the lower eyelids?
Some of the aging changes in the lower eyelid are caused by separation of the cheek fat from the lower eyelid fat. This leaves a depression or valley at the intersection of the lower eyelid with the cheek. Many people refer to this as a dark circle. Adding filler to this valley or depression can cause the dark circle to resolve. Juvederm is the most commonly used filler in the lower eyelids. These injections are typically repeated about once every 1.5 years.

11) Do filler injections in the lower eyelid work equally well in all patients?
No. It works better if the skin is pigmented or thicker. In lightly pigmented female patients the skin tends to be translucent allowing the filler to be visualized beneath the skin. We have found this technique to work better in patients of pigment and in male patients as men tend to have thicker skin in the lower eyelid. This is only a concern for the lower eyelids because this skin is so thinner than the skin on rest of the face.

12) What fillers are used at The Esthetic Clinic?
Juvederm and Restylane are currently the most popular fillers. We use many other fillers on a less frequent basis including: Radiesse, Collagen, Esthelis, Aquamid and Sculptra.

13) What is Juvederm?
Juvederm is a cross-linked hyaluronic acid. Hyaluronic acid occurs naturally in the skin and it attracts water increasing the fullness or plumpness of the skin. As we age we loose hyaluronic acid from the skin resulting in loss of fullness and deflation. Injecting Juvederm can increase the fullness and inflate the skin. The fact that hyaluronic acid occurs naturally in the skin accounts for the low incidence of allergic reaction to Juvederm.

14) What is Radiesse?
Radiesse is a calcium based microsphere suspended in a gel. It is a long acting filler that is best used for injections deep in the skin. It is used most commonly to add volume beneath the nasolabial folds. It should not be injected superficially in the skin and we do not use it to treat lips. It can be used very effectively in those who have generalized loss of volume in the face to add volume over the cheeks and even along the jaw line. Radiesse injections are repeated roughly once every six months.

15) Is it necessary to perform skin testing prior to Juvederm or Radiesse injections?
No. Allergic reaction to Juvederm and Radiesse is so rare that skin testing is not recommended by the manufacturers.

16) What filler is best for me?
It depends on the patient and the problem that is being treated. For instance we do not typically recommend the use of Radiesse in the lips because it can cause the lips to feel lumpy. If you are not sure about the use of filler but would like to try it out you may want to use Juvederm because if you do not like the appearance it can largely be reversed with injection of a second medication. The answer to this question is best achieved with a formal consultation with Dr. Shome.

17) What needs to be done to prepare for filler injections?
Very little needs to done. Some medications such as Motrin, aspirin, vitamin E, gingko, and glucosamine thin the blood and promote bruising with filler injections. If these have been prescribed by a doctor or to treat a specific medical problem such as cardiac disease, you should continue to take the medication.

18) Do filler injections hurt?
Most patients report little pain. First of all the smallest needle possible is used. We offer numbing cream to reduce the sensation of the skin. At one time Radiesse injections were quite uncomfortable but we are now able to mix Radiesse with a small amount of medication that numbs as the medication is injected. We also have a special machine (Zimmer) that blows very cold air on the region to be treated in order to make the treatment as painless as possible.

19) What is recovery like for filler injections?
One of the great things about filler injections is that it requires little or no recovery. Most patients treated with filler get little or no bruising. The exception to this is the lower eyelids where patients will often get some bruising. The face develops some small bumps from swelling adjacent to the injection sites. These typically resolved in about an hour. Patients often apply a cold compress over the treated portions of the face to reduce the swelling. Their may be some areas that feel but do not look lumpy. This typically resolves in a week or less.