David LaMond, DO

This is often related to technique and amount of filler and depth of placement of the filler. For example, someone with prominent cheek/body mid face structure may not need much ‘superficial’ filler placed. However, they may need some deeper filler placement with a cannula, laid under the muscle, or along the bone. This is an advanced technique.

Alternatively, you may consider something less ‘filling’ like a bioactive filler to help more with your own collagen production. These fillers (Sulptra and Bellafill are two examples) are more subtle and create a slow/gradual improvement over months/years and work with your body’s natural ability to build collagen. HA fillers like Voluma, are more dramatic at filling lost volume and have an immediate effect.

There are several ways to improve the appearance of Jowls or sagging skin along the jaw. At Dermablue, we look at the underlying cause, ie where the skin laxity/jowling is happening. In most patients, this is a result of mid face bone/fat loss because of normal aging. It is well known that you lose about the equivalent of a ‘tablespoon’ size of bone/fat for every decade of aging beyond your ‘peak’ in your 20’s. When you lose fat/bone in the mid face, your skin no longer has the ‘scaffolding’ to hold up the skin, which can create ‘jowls’ in the lower face.

The most cost-effective way to replace this fat/bone loss is through filler treatment. There are two common ‘categories’ of filler.

1. HA, ie Hyluronic Acid fillers, or ‘temporary’ fillers. These fillers last anywhere from 1 or more years in the midface/cheek area and are made of Hyluronic Acid, which is ‘bioidentical’ or what your body recognizes as collagen. These are safe, effective and there are ways to reverse these fillers if you do not like the appearance of them. At Dermablue, we commonly use Voluma for this area. Although there are several other HA fillers which we use in this area. Often a ‘syringe’ of filler is the equivalent of a ‘tablespoon’ of volume. So, for a patient in her 40’s I would replace the equivalent of 2 syringes of filler (Voluma) on each side of the face (one for each decade of bone/fat loss).

2. Bioactive Fillers or ‘permanent’ fillers. There are three long term/permanent fillers on the market in the US, which have long term data, ie they last 5 more years. Like HA fillers, they will occupy space, although not as much volume/space, however they work by providing a scaffolding/space for your body to rebuild collagen slowly over time. Often this effect can take months to see the full benefit and often we use these along with HA fillers (which have an immediate filling effect).

Other treatments we provide at Dermablue to help minimize the appearance of jowls include lifting the skin with thread lifting, which is using very special absorbable stitches. These have been used for over a decade and provides a safe/immediate result with works well with fillers.

Last, we use technology to help ‘tighten the skin’ and our favorite for ‘jowls’ is RF microneedling with the Genius system. Genius® uses very tiny needles that are sterile and insulated to deliver RF energy to precise locations and depths in the skin while reducing damage to the surface of the skin. This stimulates both collagen and elastin to tighten skin and smooth imperfections for an effect that can be a good option for patients who are seeking an anti-aging procedure with minimal downtime. You can use RF microneedling along with thread lifting and fillers; however there needs to be some time between the treatments, often up to a month or more to avoid damage to the thread or filler. At Dermablue, we can create a care plan to get the most out of these combination treatments.

With microneedling, you are not able to break down collagen, as it’s only a mechanical process. This can be an effective starting point to treat acne scarring for a very mild effect. At Dermablue, we use RF microneedling for acne scarring. With RF microneedling, you add ‘heat/energy’ to the needles to enhance the effectiveness of neocolagenesis, ie collagen formation (volumization, ie mild filling of scarring) along with the ‘mechanical’ or physical breaking up scar tissue with the microneedles.

Yes, you need to be careful with the depth of treatment with RF microneedling. If you treat ‘too deep’ you can theoretically break down fat. With advanced machines/technology, this effect is minimized, as the machine is ‘smart’ enough to know the difference between scar tissue/dermal tissue and fat based on the different water content of the tissues. Not all machines are created equally; at Dermablue we use the ‘Genius’ system by Lutronic. It’s been a game changer for us.

Often with severe scarring, you need to fill the scarring with fillers. CO2 laser works well to smooth and tighten the top layer of skin. For significant scarring, I recommend a variety of treatments to use together to get an optimal outcome.

Based on your description above, it sounds like you did not have enough filler injected in one place. Typically we would inject one syringe for the lips alone and often more than one syringe to see significant results in the mid face/cheek area.

At Dermablue, we use various HA products—however, if you would like a more robust filling effect, I’d suggest Juvéderm Ultra or even Juvéderm Ultra Plus, if injected into the body of the lip (not for everyone, and based on your photo, I’d stick with plain Juvéderm). We also like Vollure for lips and often start with this product. It’s not as robust as Ultra.

If your lips are overfilled, you have two options. The first, leave it alone and the HA filler will slowly break down and go away over the span of a year or so, depending on the filler and where it was injected.

The other option is to find a practice/provider who is skilled in the use of hyaluronidase, which is an enzyme which can be injected into HA fillers to accelerate the breakdown of the product. It typically works within one to two weeks and is extremely safe and effective.