Fill this, fill that. Fillers!


Doctor, make me beautiful. NOW!

Immediate gratification is very, well, gratifying! We, in plastic surgery are always leaving our mark on people’s faces, feelings and psyches. Sometimes in big ways, sometimes in minute ways. Sometimes it happens fast, more often it’s gradual. It’s a lot of pressure, but along with that responsibility comes great rewards. We love fixing things. Removing a defect. Erasing an unwanted fold, line or crinkle. And when we can do that instantaneously, all the better!

 Enter: The world of dermal fillers. Immediate gratification that is all up side and no downside. Using the products I am about to describe is so impressive, safe and predictable that I have done it on live TV in front of hundreds of people. And I have done that without a modicum of doubt about a great result. I can count on great results because of the great advances that have come along in the world of injection of dermal fillers in recent years.

 It’s one of those few times sugar is good for you! Hyaluronic acid products are a sugar-based filler that is hydrophilic. They like water. They bind with water and hold onto it to keep lines smooth, folds filled and lips poufy. Restylane and Juvederm are what I rely upon mostly in the non-surgical, aesthetic side of my practice. My partner surgeon my nurses, physician assistant and I use these “H.A.” fillers as the all-around, most versatile solution to folds, lines, crinkles, wrinkles and lips. The reason is the flexibility. These products are placed intra-dermal. Within the layers of the skin. If placed deeper with more material, a generalized crease like the nasolabial fold (the crease between the nostril and corner of the mouth) can be filled nicely and naturally. If placed closer to the surface, more superficially we can satisfactorily fill fine lines like those that occur on the upper lip (smokers lines). One or two syringes of this material can almost have the impact of a mini-facelift with instant results.

One major advance within the last year is the addition of the drug Lidocaine to these two fillers. Lidocaine is an anesthetic that makes the treatment nearly painless when used with a topical anesthetic cream. Before this advance, we had to do dental nerve blocks before each treatment that added to the pain, swelling and recovery of the injection experience. No more! With Restylane-L and Juvederm XC the anesthetic within the injection material just adds more “minimal” to “minimally invasive” therapy.

Sometimes we need a bit more support from beneath the skin than these two products can provide. That’s when we add sub-dermal fillers to the regimen. These products come in larger volume and support the skin from beneath. They can be used in lieu of, or in addition to the H.A. fillers. For this kind of deep support I often choose Radiesse or Sculptra. I add a little anesthetic to these products as well, so often the only thing a patient feels is my “first pass” in the cheek. After that, I am sculpting a “liquid facelift” with so little discomfort for the patient that it we are usually chatting about unrelated topics the whole time. It’s really a nice way to spend an hour with my patient. We have a nice talk and then they walk. With a whole new outlook and a new look, thanks to today’s dermal fillers.

Article by
Beverly Hills Plastic Surgeon