“Fillers”- Help, I am Confused!

The world of injectable cosmetic fillers has exploded over the last few years. In our clinic alone we have seen over 30% growth in filler use each year for the last five years. This year we have seen a 37% increase year to date. There are several things that contribute to this growth.

  • Increased societal acceptance of cosmetic treatments
  • Expanded uses for fillers
  • More fillers to choose from
  • The biggest reason however, is that we get great results

What are Fillers?

Part of the aging process is that the support layers (fat, muscle and bone) get smaller and thinner with age. As a result, the skin is not supported and stretched. You see sagging and shriveling, just like a grape becomes raisin as the water leaves the grape. We often describe this as “volume loss” in the face. To correct the volume loss we need to “refill” this lost volume and hence the term “fillers” is used to categorize the products used in this capacity. There are a variety of filler materials that can be used; fat, hyaluronic acid, PMMA, PLLA, calcium hydroxylapatite (better known as fat, Juvederm, Bellafill, Sculptra, and Radiesse). This is the confusing part. However, the most important part is getting the right amount in the right place. Choosing the filler is a secondary issues based on the nuisances of the filler and the desired goal.

The Art of Fillers

Getting the desired results is a 4 step process: listening, understanding facial esthetics, planning, and executing. Each of these is more art than science. Listening: First we need to understand your goals, experience, budget, and knowledge. What bothers you? What are your fears? What has worked well in the past? Understanding Facial Esthetics: This part requires an understanding of anatomy, such as:

– How deeper structures affect the surface appearance
– How the aging processes in one part of the face affects a different part of the face
– How fillers affect these structures and processes
– What is esthetically pleasing
– What do fillers do well, what not so well, etc.

Planning: Taking your goals and experience and combining them with our knowledge and experience, we can customize a plan for each person. Once this is complete and understood by all parties, the final step is Executing: This is my favorite part, the artistic application of our plate of fillers to bring about a natural and more beautiful you.

Which Filler?

This is where most of the confusion comes in. There are so many different ways to use and combine fillers it is hard to give simple guidelines. By the time you have completed the consults you should have a comfortable understanding of your customized plan. Generally speaking, you will be considering which part of the face matches what filler works best. Then you will balance longevity with cost. Finally is reversibility an important consideration for you. Below is a table that summarize the available fillers.

A couple of tips:

1. When in doubt do less. (You can always do more later.)

2. Where and how much filler is more important than what filler. Who is holding the syringe is more important than what filler.

3. There is no substitute for a good consultation. The collaborative decision making should bring about understanding and the results you want.

Please contact our office at (760) 472 5088 (Carlsbad) or (858) 943 2443 (Rancho Bernardo) if there is something more you would like to know about fillers.