Fillers Gallery

A challenging patient in her early 60s is bothered by the deflated appearance of her lips and the area around her lips.  Her case is more challenging because she has dentures, and when patients lose teeth they also loose bony support for the lips.  She is shown before and then again, 2 weeks after her third treatment.  She initially had 1 syringe of RHA 4 and 2 syringes of rha 3 to the “marionette lines”  ( Melo labial creases)   She then returned for rha 2 to the “smokers lines” of the upper lips and Restylane Kysse to the pink’resu portion of her lip.  She then returned for additional RHA 3 to the melolabial creases.  The RHA 4 (“resilient hyaluronic acid) is thicker and is placed deeper in the tissues.  The RHA 3 is intermediate and is placed at an intermediate level.  The RHA 2 is thinner and is placed closer to the surface.  The Kysse is soft and flexible and good for augmenting the vermillion.  The combination gives her a soft and natural correction of a difficult problem. 

The “whistle” afterview shows that the lips and the area around the lips remain soft and natural in appearance and move normally with the movement of the lips. 

A man in his mid 50’s who is bothered by “tear trough” hollows under his eyes as well as lines of the forehead and crow’s feet lines around the eyes.  He is shown before and again, 10 days after Botox to the forehead and crow’s feet lines ( lateral orbicularis) as well as the off-label use of REDENSITY to the tear trough area.  REDENSITY is a Non Animal Stabilized Hyaluronic Acid Filler ( NASHA) that was recently released in this country for the treatment of active lip lines, which is the “on label” indication.  It has been used “off label” in Europe for the tear trough area and I am excited that we now have it available in this country for the off-label treatment of the tear trough area.  This is a challenging area to treat, because other NASHA fillers can become puffy and swollen in this area, and if this area is over corrected it looks funny.  Redensity is part of the RHA line of fillers which have been in this country for almost 2 years and in Europe for almost 8 years.  In Europe it is called Teoxane TEOSYAL RHA® 1

It is reversible if needed with the injection of an enzyme, hyaluronidase.

A woman in her early 50’s who started to notice “smoker’s lines” or “lipstick lines” when she puckered her lips.  She has stopped using a drinking straw in hopes this would help.  She is not a smoker.  This is typically related to subtle loss of soft tissue support with aging and is a perfect application for Redensity, the new RHA filler from Revance, and the first filler to be approved by the FDA for the treatment of active lip lines.    The RHA line has been in Europe for 7 ½ years where it is known as Teoxane, and has been in this country for the last 20 months.  It is a “Non Animal Stabilized Hyaluronic Acid” ( NASHA)  filler. Which can be dissolved with hyaluronidase, and is very flexible but strong, so it can move with the lip but still return to shape.  She is shown before and again, 11 days after treatment of the upper lip lines with one syringe. It does not add “bulk” to the lips but markedly improves the active lip lines.

A woman in her early 60’s who has had significant weight loss after a gastric bypass is bothered by her deep set nasolabial creases.  She is deeper on her left side.  She received 2 syringes of Restylane Defyne and returned 2 weeks later for 2 more syringes.  She is shown 2 weeks after the second treatment.

Discussion: The volume loss seen with aging is often made worse by significant weight loss.  Proper replacement of the volume can give a significant improvement.  Enough product needs to be used to correct the deficit, and this is frequently more in patients in their 60’s or older.  She has a pleasing improvement

A woman in her mid 70s who came in to ask about a face lift. She was not a good candidate for a facelift because of poor skin quality from prior smoking and sun exposure.
“It’s not just the tailor, it’s the fabric we are working with” is a saying that emphasizes that the expected results are impacted greatly by the quality of the skin.

She does have age related volume loss and elected instead for 4 syringes of rha 3 to the “marionette Lines” and 4 syringes of RHA 4 to the cheeks. She is shown 10 months after placement of the rha 3 and 1 month after placement of the rha 4. The resilient hyaluronic acid fillers are a new line of Non animal stabilized hyaluronic acid fillers from Switzerland that were brought to this country in November of 2020 by Revance and allow a correction in parts of the face that move without looking stiff or abnormal- they are “resilient” and move with the face. They have been used in Europe for 6 years and the doctors there report that they are lasting 22 months or so.

A woman in her early 60’s who is shown before and again 2 weeks after the placement of 3 syringes of the RHA-3 .

We are pleased to be one of the first practices in the United states to be able to offer the Resilient Hyaluronic Acid fillers, which are manufactured in Switzerland by Teoxane and have been used in Europe for more than 5 years. They have just been brought to the US by Revance. They are still hyaluronic acid, and therefore have the same safety profile as the Juvederm collection from Allergan and the Restylane collection from Galderma. But they differ in being more Resilient, which allows them to move naturally with the face. This is described as the difference between a steel girder bridge and the golden gate bridge. They are both strong, but one is more flexible. This now allows me to treat the nasolabial creases and areas around the mouth without bunching or moving, and they are expected to last for 18 months. Our patient here is seen at rest and smiling. The correction is significant but appears absolutely natural with movement of the face.

A woman in her late 20’s who is bothered by submental fullness and weakness of her chin. Although she could consider liposuction of the submental area and a chin implant, her schedule did not allow for surgery and recovery at this time. She is shown 2 months after 3 vials of Kybella to the submental area, and 1 month after 2 cc of Restylane Lyft to the chin.

A woman in her late 20’s who is bothered by submental fullness and weakness of her chin. Although she could consider liposuction of the submental area and a chin implant, her schedule did not allow for surgery and recovery at this time. She is shown 2 months after 3 vials of Kybella to the submental area, and 1 month after 2 cc of Restylane Lyft to the chin. There has been no change in her weight.

A woman in her mid 20’s who is bothered by a hollow under her eyes. She is shown before and again, 1 month after the placement of a single syringe of Restylane Lyft to the “tear trough” area, with good correction that should typically last for a year or longer. The “chin down” view emphasizes the hollow area under the eyes. “dark circles” are not typically improved by filler because they represent the muscle just underneath the skin.

A woman in her mid 50’s who had blepharoplasty elsewhere 18 months ago and was still bothered by the appearance around her eyes. On examination she has some brow ptosis from the normal deflation that occurs with aging, and the excess skin around her eyes corrects as the brow is elevated. She also has prominent crow’s feet lines with smiling. Although we could consider a brow lift I thought it would be prudent to try Botox first and see how much shaping of the brows and lateral brow elevation that we might obtain. She also has some deflation of the midface and Juvederm Voluma was placed. She had 45 units of Botox and 2 syringes of Juvederm volume. The effect on her brows was dramatic. Her cheeks appear more youthful as well. Additional Juvederm Voluma could be placed to the cheeks but we plan to wait until she returns to repeat her Botox, typically at 4 months.