Dermal Fillers

As we age, our facial skin loses its natural fullness, elasticity, and volume. This occurs because the subcutaneous fat that lies just below the surface of our skin diminishes. As a result, the muscles that form our smile (or frown) lines are closer to the skin’s surface and are more visible. Lifestyle factors, heredity, and sun damage also cause the facial skin to stretch and thin, adding to the loss of volume. Dermal fillers combat these effects by hydrating the skin, softening facial creases and wrinkles, and creating a firmer, plumper appearance. 

What Are Fillers?

A non-surgical procedure, dermal fillers are gel-like substances injected into the skin at varying depths to help fill in wrinkles, augment facial features, and provide facial volume. Three FDA-approved fillers are available in the United States, but the most commonly used filler is Hyaluronic Acid. 

Hyaluronic acid is a sugar that occurs naturally in the body that attracts and retains moisture. It lifts the skin, restores nutrients to the area, and creates a smooth, soft appearance. 

The experts at PuraVida also use other fillers, such as injectable poly-L-lactic acid, a biodegradable, synthetic material that helps rebuild lost collagen. Collagen rejuvenates the skin by improving hydration and elasticity, reducing the appearance of wrinkles and fine lines.

Dermal Fillers Treatment Areas

Dermal fillers have many applications, including reducing facial wrinkles and skin folds, increasing the volume of lips, cheeks, under the eyes, and jawline, and correcting facial acne scars. Anyone who is physically healthy is a good candidate for the procedure. 

Fillers are commonly used in the upper, middle, and lower face:

Upper Face

• Forehead lines: Unlike Botox, which temporarily paralyzes the muscles that crumple the forehead, fillers smooth the wrinkles visible when the muscles are relaxed. Essentially, the injections fill in the lines, creating a firm appearance.
• Crow’s Feet: Crow’s feet are the fine smile lines outside our eyes. Fillers effectively treat crow’s feet because they make the skin appear plumper.
• Glabella lines: Glabella lines are the lines between the eyebrows that typically form when you frown. When fillers are injected into these lines, they lift the area and smooth the skin.

Midface

• Nasolabial Folds: The nasolabial folds extend from both sides of your nose to the corners of your mouth. These folds become deeper and more prominent as we age. Fillers effectively fill these folds, achieving a refreshed, more youthful appearance. 
• Nose: Can you believe it’s possible to reshape your nose using filler treatments? Non-surgical rhinoplasty is an outpatient procedure where fillers are injected into strategic areas to contour and shape the nose. The experts at PuraVida can decrease nostril size, reduce the appearance of humps on the nose, and create a lift.
• Cheeks: With age, the subcutaneous fat that makes our face appear full and youthful diminishes. Cheek fillers create volume and minimize the appearance of wrinkled, drooping, and sagging skin. 

Lower Face

• Chin: Injecting fillers into the chin is a non-surgical procedure to change the definition and contours of the chin. 
• Lips: Lips lose color, elasticity, and volume with age. Lip fillers increase the fullness of lips, improving lip definition by filling in the fine lines around the mouth.
• Jawline: Jawline filler injections add shape, volume, and definition to thinning or sagging skin. A non-surgical procedure, fillers help you achieve a more angular, youthful jawline.
• Marionette lines: Marionette lines are the folds that cause the mouth to turn downwards. Fillers treat these deep lines, resulting in a lifted, plumper, and smoother appearance around the mouth. 

Other Uses

There are many other ways that fillers help improve our appearance, including:

• Improving the appearance of scars
• Decreasing or removing age spots
• Reducing the appearance of the shadows under the eyes. 

Filler Brands We Like to Use

PuraVida uses several different fillers, depending on the client’s goals and needs.

RHA fillers

RHA fillers are Resilient Hyaluronic Acid fillers that can mold and bend, giving you the most natural results. At PuraVida, we use various RHA fillers: RHA 2, RHA 3, RHA 4, and Galderma. Each filler treats different types of wrinkles, depending on how deep the injection must penetrate the skin. RHA fillers can address both static and dynamic wrinkles. Specifically, RHA fillers can address concerns like dynamic wrinkles, nasolabial folds, crow’s feet, and marionette lines. A new technology, Dr. Apgar is highly skilled at working with these fillers and their effects last up to 15 months.

Restylane

Restylane is also a well-known hyaluronic acid-based wrinkle filler designed to soften the appearance of moderate to severe lines and wrinkles. Having been around for many years, these fillers are considered safe and effective. At PuraVida, we use various Restylane brands, including Restylane Contour, Restylane Kysse, and Restylane Lyft. The results of these fillers tend to last for up to 12 months. 

Sculptra

Sculptra differs from the RHA and Restylane fillers in that it contains poly-L-lactic acid (PLLA), a biocompatible synthetic substance that stimulates collagen production. Collagen is responsible for maintaining the elasticity and hydration of your skin. Like the HA-based fillers, it is injected below the skin’s surface and is used to treat deep lines, creases, and folds to give a more youthful appearance. However, unlike the HA-based fillers, although you may notice immediate results, it can take a few months to see the full effects of your treatment.

Bellafill

Bellafill is a long-lasting dermal filler used to treat wrinkles and skin folds. It’s also the only filler we use at PuraVida to treat acne scarring. It contains tiny polymethyl methacrylate (PMMA) beads and collagen, which occurs naturally in the body. When Bellafill is injected into your skin, the collagen is slowly absorbed by your body, but the PMMA beads remain in place. This provides ongoing support long after the collagen has been absorbed by your body and replaced by your own. 

What to Expect During Your Dermal Filler Injections

Pre-treatment

Before your procedure, you will meet with Dr. Leslie Apgar and one of her highly skilled Aesthetic Nurse Practitioners. They will have an in-depth look at your medical history, assess your areas of concern, and then perform a skin analysis using specialized 3-D technology. The skin analysis provides a comprehensive overview of your skin, including a view of your skin conditions at the dermis and epidermis levels. It also allows the PuraVida staff to accurately record and measure the changes in your skin for ongoing monitoring.

Once it has been established that you are an ideal candidate for the filler procedure, your treatment goals will be discussed. The team at PuraVida will then present you with a detailed, personalized plan. Pre and post treatment photos will also be taken to compare the progress of your filler treatments.

During the Procedure

Before the fillers are injected, your nurse will prepare your skin by cleaning it with a non-alcohol antiseptic cleanser. 

Using a thin needle, Dr. Apgar will inject small amounts of fillers just below the surface of your skin. You may feel a slight pinching or stinging sensation, but these procedures are generally pain-free. The fillers may be injected into many areas on the face and may take a few minutes, up to an hour. A soothing salve will be applied to the skin after the procedure.

During the procedure, you are comfortably seated in a reclined position on a cosmetic bed. 

Post Treatment

After the treatment, it is normal to experience some swelling and redness at the injection sites, which may last up to 24 hours. 

The patient can apply cold packs or ice to the area to reduce swelling and inflammation. They will be instructed to use a gentle cleanser, and the doctor may prescribe topical antibiotics if necessary. Patients must also wear sunscreens to protect their skin for several weeks after the procedure.

After the procedure, patients will also be warned to:

• Avoid strenuous exercise for 24 hours
• Avoid alcohol for 24 hours
• Not to use makeup for 24 hours
• Avoid facials and waxing for two weeks

Before and Afters

The recovery period after filler treatments varies from patient to patient. For most people, the recovery time is one to two days. Dermal filler procedures also have very few side effects. Patients may experience redness and swelling after the procedure, which is to be expected. Other people experience hypersensitivity and numbness, which is not uncommon either. 

Most people see an immediate improvement in the appearance of their skin following the procedure. However, it can take a few weeks for the final results to show. This will also depend on the procedure, products used, and the facial areas that were treated. 

Patients should be aware that the effects of one dermal filler treatment don’t last forever. Over time, the body will reabsorb the filler. 

You may also see a vast difference in your dermal filler before and after pictures. See below for some inspiration and just how well derma fillers work:

Cost

The costs of dermal filler treatments depend primarily on the size of the area to be treated, which filler is being used, and your cosmetic goals. 

For example, in Maryland one syringe of filler can cost anywhere between $600 – $1200 per vial. A single vial will be enough for those targeting the lines around the lips, but for people who have deep forehead furrows, two or three vials of filler may be necessary.

Dermal Fillers FAQ

Are filler injections safe?

Yes, provided your doctor performs an in-depth physical examination and determines that you are a good candidate for filler treatments, filler injections are safe. The most common side effects are redness and swelling at the injection site, which lasts for 24 hours.

Who shouldn’t get fillers?

Unfortunately, fillers are not suitable for everyone. You shouldn’t get dermal fillers if you:

• Have connective tissue disorders such as scleroderma or lupus
• Have active cold sores (herpes simplex virus 1)
• Have a fever or infection
• Have uncontrolled diabetes

How long do fillers last?

Depending on the type of filler and the area of the face it was injected, Hyaluronic Acid fillers can last between 6 and 15 months, while the Bellafill products can last up to 5 years.

What happens when you stop using fillers?

Over time, the effects of the fillers will naturally dissolve, but this usually takes between 6 – 15 months, depending on the product you use.

What is the difference between fillers and botox?

Dermal fillers add volume and hydration to your skin. They fill the wrinkles that appear when your face is at rest. Botox, on the other hand, causes temporary paralysis in the muscles that cause your skin to wrinkle, temporarily smoothing the lines.

Can I combine fillers and botox injections?

Yes, it is possible to combine fillers and botox injections; however, your doctor may suggest waiting for two weeks after the application of Botox to see its results before administering dermal fillers to the same area.