Cosmetic Injectable Fillers

What are facial fillers and why should I insist a doctor administer them?


Before Juvederm Voluma Filler Cheek Augmentation and After Juvederm Voluma Filler Cheek Augmentation

Facial fillers are one of the most popular facial cosmetic procedures in the world today.  There are a myriad of products on the market, and many more are emerging every year.  Filler materials include hyaluronic acid gels, poly lactic acid gels, hydroxyapatite gels, silicones and fat injections.  The choice of the material is somewhat the preference of the doctor, but also depends on the area or problem being treated.  The most important factor in having a filler procedure is who the injector is.  Some doctor’s practices have physician assistants, interns or other medical staff members performing the filler injections.  Often, these practitioners have only attended a weekend training course in injectables before laying hands on the doctor’s patients.  This is hardly adequate training.  Dr. Mueller is a boarded surgeon, is extensively trained in anatomy and cosmetic injectable fillers, and personally performs all of the filler injections personally in his practice.

What areas can be filled and how long will it last?

Photo immediately after the right nasolabial fold is injected with Juvederm Ultra 3

Photo immediately after the right nasolabial fold is injected with Juvederm Ultra 3

Fillers are different than Botox and other neurotoxins.  Where neurotoxins are injected into muscles to prevent the patient from creating a “wrinkle in motion,” fillers are injected under the skin or lips to plump out these areas.  Fillers are injected under the nasolabial folds (laugh lines), other deep lines, tear trough deformities in the lower eye lid, and to plump out other areas such as the cheeks and lips.

Lip augmentation with fillers can plump up the lips and also create definition.  As the lips age, vertical lies cross the vermillion border that can make lipstick “bleed” into the skin.  Fillers can define the vermillion border and eliminate these lines.

Nasolabial folds after both sides injected with Juvederm Ultra 3

Nasolabial folds after both sides injected with Juvederm Ultra 3

How long the results will last depends on several factors.  Each patient metabolizes fillers at a different rate.  Juvederm, Radiesse and Restylane will last about a year.  Hyaluronic acid helps promote collagen regeneration.  Dr. Mueller has noticed that some patients, after returning a year later for a second lip treatment, do not require a treatment the third year due to collagen production.

The Procedure

Lip augmentation and fillers are a passion of Dr. Mueller’s.  He takes great care to make sure that his patients are comfortable and that the procedure is painless.  Many other practices have their patients “suck it up” and endure the pain of injections because they do not use topical and injectable anesthetics.  Dr. Mueller uses numbing creams, topical anesthetic gels and several small dental injections to totally numb the lips.  This makes your lip procedure virtually painless.

Once the patient is completely numb, the filler is injected into the lips.  The procedure takes about ten minutes.  Ice is then immediately applied to the lips and should be used at home periodically for about 24 hours.  Due to their vascularity, the lips swell almost immediately.  This will resolve in about 48 hours.  You can return to work the next day if you wish.  It is best to refrain from aspirin, Naprosyn, Aleve, Motrin, Ibuprofen and other NSAIDs for two weeks prior to your procedure to help reduce swelling and bruising.  As symmetry is important, you should return in two weeks to evaluate your result as occasional touch-ups are necessary.

I had my filler done somewhere else and it was overdone.  What do I do?  Can I have it removed?

Yes, it is possible to reverse an over-correction of hyaluronic acid fillers like Juvederm, Restylane and Prevell Silk.  These products can be dissolved by using a product called hyaluronidase (Amphadase or Vitrase).  The injection of these products dissolves the hyaluronic acid gels in a simple and effective procedure that takes about ten minutes.  Results are seen in 1 – 2 days and there is no recovery.  Dr. Mueller has treated many patients to reverse filler mistakes from other offices.   Again, this is where experience, not a weekend course, shows.  Dr. Mueller was able to reverse these mistakes and make happy patients of our unhappy ones.

Excessive fat injections or transplants have to be removed surgically with either local anesthesia or light sedation.  Swelling and recovery lasts about 3 – 4 days.