fillers - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about fillers or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Dermal Fillers
As part of the aging process, our skin stretches and loses some of its elasticity and the face loses some of its subcutaneous fat. As a result, the skin looks loose, and we lose the plump skin we had in our youth.
Dermal fillers replace the fat we lose and help to restore the full appearance of our face. In addition, fillers serve as a buffer between our facial muscles and our skin. This buffer reduces the impact of the constant muscle movement of the face and fills indentations and lines left in the skin
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What until recently could only be corrected by an invasive and expensive surgery can now be corrected by Juvederm and Restylane, the two derma filler brands that revolutionized cosmetic surgery since they were introduced to the market at the beginning of the millennium.
Time to results: 1-10 days.
The most common dermal fillers in the US are manufactured and distributed by a handful of pharmaceutical vendors. The Juvederm line and Kybella are produced and distributed by Allergan and Restylane by Galderma. Other products are Radiesse, Belotero, Prevelle, Artefill, and Sculptra.
Most of these products address the same facial areas such as the Nassolabian lines, vertical upper and lower lip lines, and cheeks. Cost, lasting results, and personal preference are the most common differences between the various products. Also, an experienced injector may prefer one product over another in specific situations. For example...
Static vs. Dynamic Lines
Static Lines - Lines/wrinkles visible at rest.
(usually treated by dermal fillers)
Dynamic Lines - Lines visible with forceful movement of muscles. (usually treated by Botox)
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restores cheek volume
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reduces creases and wrinkles
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enhances lips
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rejuvenates hands
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corrects scars
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Marionette lines - Radiesse / Juvederm / Restylane / Prevelle- 1-2 syringes will fill in the longer grooves that extend to the jawline.
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for more information about Botox injection in areas marked as
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Price List
| Treated Area | Price / syringe | Lasts (months) | |
|---|---|---|---|
| Juvederm Ultra | Lips, nasolabial folds, marionette lines, under eyes | $680 (1.0 ml) | 6-12 |
| Juvederm Ultra Plus | Lips, nasolabial folds | $680 (1.0 ml) | 6-12 |
| Juvederm Voluma | Midface, lower face, and marionette area | $880 (1.0 ml) | 12-24 |
| Juvederm Volbela (1ml) | Lips, undereye | $750 (1.0 ml) | 12-18 |
| Juvederm Volbela (0.55cc) | Lips | $480 (0.55 ml) | 24 |
| Juvederm Vollure | Around the mouth and nose, marionette lines, cheeks | $750 (1.0 ml) | 12-18 |
| Juvederm Volux | along the jawline, at the angle of the jaw, and in the lower chin | $895 (1.0 ml) | 12-18 |
| Belotero | cheeks, around the eyes, nose, mouth, and lips | $680 (1.0 ml) | 6-12 |
| Radiesse | Hands , cheeks, lips, nasolabial folds, marionette lines | $920 (1.5 ml) | 12-15 |
| Versa | Face: Lips, Nasolabial folds, Cheeks | $680 (1.0 ml) | 6-12 |
The purchase of a full syringe is required. When only a partial syringe is needed, the remainder can be injected into another area.
Juvederm Ultra
Juvederm Voluma
Radiesse
Hands rejuvenation with Radiesse
Hands rejuvenation with fillers before and after
I am interested in using facial fillers for volume restoration in my jaw and cheeks and perhaps around m nose. Is this able to be done, is it safe and have you done many procedures like this? Is one syringe usually enough or do you often use many more? Thank you.
I have a small dent on the bridge of my nose as a result of a prior rhinoplasty. Can fillers be used to correct the problem?
Filler may be the best option.
As a person horribly afraid of needles is there a way to lessen the discomfort of being stuck during the procedure? Topical creams?
Topical numbing medicine can prescribed to you and applied 30-45 minutes prior to the procedure. This will blunt an initial needle stick. Fillers nowadays contain numbing medicine which makes the procedure tolerable when the filler is deposited in areas in need of volume.
The numbing medicine does not usually influence the psychological component of fear, which must strongly be considered, especially in an elective procedure.
I am interested in an injectable for under-eye tear troughs as well as one deep brow line. Is there a filler that is more natural and actually builds collagen over time? I know there are new products coming out all the time. I am not interested in Botox.
Also, do under-eye injectables have side effect like noticable bruising (black eyes)??
Thank you.
Hyaluronic acid based fillers are the only injectables currently considered appropriate for visible tear troughs. Unfortunately, none of the hyaluronic acid fillers available stimulate any significant collagen production. The most common brands are Restylane and Juvederm which typically last 6-12 months before our body’s own enzymes dissolve them. Other shorter lasting hyaluronic acid fillers are also available. The same way that any needle stick into our skin may cause a bruise, all fillers may cause bruising. If it occurs, it typically lasts 8-10 days.
Tear troughs can also be corrected by fat injections, which have a high failure rate and are therefore not widely performed. Botox does not correct tear troughs.
Hi doctor!
I am a 30 yr old woman who has sagging skin in the jaw area (jowls?) I was wondering what is the best way to get this corrected? Can it be done with fillers? If so, which ones and how many treatments?
Beginning jowls can often be corrected by several different fillers while moderate to severe jowls require a lower face and neck lift for best results. Radiesse, Juvederm ultra plus XC or Perlane are used in a single treatment. The amount can be determined after examination and may range between 1-2 syringes. These fillers last between 9-12 months for Juvederm and Perlane and between 12-18 months for Radiesse. Sculptra may also be an option, and between 1-3 vials can be injected in 2-3 sittings that are spaced 6 weeks apart. Sculptra last about 2 years. Artefill is a much longer lasting filler and between 1-2 syringes can be injected in 1-2 sittings.
Your facial features, degree of laxity or any volume loss in the cheeks will determine which fillers are best for you.
I walked in last Thursday without an appointment and was able to been seen later by the physician’s assistant and nurse. Their care and concern were wonderful and I understand you too weighed in on my situation. The outcome will hopefully be successful.Am having a blood test before I start the medication you prescribed. Thanks to all of you for the time,energy and support. What a incredible group of professionals! Thank you!
Used an over the counter face cream with retinol correxion and had my upper lip waxed. The waxing left two areas on my upper lip very reddened and now discolored. It has been over two months and has faded somewhat but it is still visible. It looks a little like I have a mustache! Any suggestions are appreciated?
You should be evaluated by a dermatologist for treatment options. Diligent use of sunscreen and reapplication every 2 hours to your upper lip between
10 am and 4 pm for the next few years will avoid further darkening and will keep the results after treatment of the darkening.
have you used filler such as alloderm or radiesse to enhance nipple projection on post mastectomy patients?
I have not used fillers for this purpose. Please consult with your breast surgeon. There are a number of plastic surgeons who offer this procedure.
Does weight loss after the procedure impact the results of Artefill as a filler for facial scarring.
Yes it does. However, if only minute amounts of filler are used for small scars, weight loss does not adversely affect the cosmetic outcome. If a larger scar is treated and weight loss follows, the filler placement may become obvious. Filler placement is best performed with a stable weight. If weight loss is anticipated, a non-permanent filler should be favored.
dI am very disappointed with my first treatment with juvederm today. A MD Dr injected one syringe of juvederm around my mouth for all the deep vertical lines. It did not fill them in. The only result was swelling and bruising. Any suggestions?
When I perform this procedure I explain to my patients that vertical upper lip lines are not easy to treat when they have started to show permanently. The treatment choices include hyaluronic acid fillers (Juvederm, Restylane, Belotero and others), botulinum toxin and laser resurfacing or any combination thereof.
Filler treatment for vertical upper lip lines does not instantaneously remove the lines that had time to form over many years. Hyaluronic acid fillers are injected with the intend to enforce the thinned skin of the cutaneous lip. While swelling and bruising usually resolve after one week, it can take the deep lines up to 3 weeks to significantly flatten. I often compare this to the effort it takes to remove a crease that was accidentally ironed into a pair of woolen slacks.
Fine lines in the upper lip will resolve entirely with filer placement.
Moderate lines will much improve, yet best results are typically seen with repeated treatments. Deep lines also improve with filer placement but you were probably counseled that 100% effacement of these lines is not possible.
Another technique for reduction of deep vertical upper lip lines is laser resurfacing. The results after single procedure last for years and it is often standard during a face lift. It reduces the lines by about 50%.
Filler can be injected after laser resurfacing, which yields additional improvement.
I have ice pick scars on my nose, some big others look like enlarged pores. These scars cause me to be self concious. I hate to see my reflection and look at the awful scars, most were caused by blackheads . I was wondering what could be done , can the tretments make my skin smooth again? Also what would be the cost? And lastly does insurance cover any of these costs? Please let me know thanks, Jay
Enlarged pores and scars are generally difficult to treat. The degree of improvement with any type of treatment is dependent on the severity of pore enlargement or scar formation and is tough to judge by description. Please understand that a blog cannot replace an in-person consultation and therefore specific treatment recommendations and their associated fees cannot be provided. Insurance covers neither treatment for enlarged pores no scars. Please schedule a consultation.