Female Voice: As we age, fat in our faces redistributes itself throughout the face. So as you have volume changes throughout the face here and here, there's a role for volume replacement. When you start to lose fat in this portion of the face, the mouth becomes a little bit heavier because the skin that was supported by the fat or volume, if you will, that was there has now gone away. Then you can also have some hollowness here. That makes the jaw line then become a little bit heavy.

There're two different fillers that we use here primarily in the office, or two categories of filler. We use hyaluronic acid based fillers, which are your Juvederm, Restylane, Belotero, Perlane, things of that sort. They're made up of hyaluronic acid. Hyaluronic acid is something that you find naturally in your body. It helps as a moisture component to your cells, but it's found all throughout your body. So your body doesn't recognize it as something foreign or something that you have to worry about being allergic to or having a reaction to.

Those fillers work primarily well in the mid face here, throughout the cheeks, around the mouth, underneath the eyes. That's where we primarily use those. Those fillers are something that you can inject. You get immediate volume replacement, aside from a little bit of bruising, a little bit of swelling, which usually subsides within a few days to a week. Then they last about 6to 12 months. Your body just slowly breaks them down over that period of time.

The other filler that we use, primarily for the hollowing out of the outside portion of the cheeks and of the temples, is a product called Sculptra. Sculptra is a little bit different than your hyaluronic acid based fillers like Juvederm and Restylane. How it works is it's actually a synthetic material. It's a material that they have used in surgical suture for decades. It actually causes a little bit of inflammation. What that does and why that's good is because inflammation actually activates the cells in your body that make collagen. So this product isn't necessarily a filler in and of itself, but it's a filler by what it does.

So when we inject the product, it actually stimulates a little bit of inflammation in the area that it was injected, which in turn activates the cells in your body that make collagen. So those cells go to that area and build up new networks of collagen. Because this is a process that takes some time to take place, you don't get that immediate volume replacement that you would get with your other hyaluronic acid based fillers. It takes a little bit of time because your body actually has to make its own filler or build up that collagen.

So initially you do see the volume replacement, just as a result of the water and the local anesthetic that we use to suspend the product. But in about a week or so, your body reabsorbs that water, and then you go back to looking how you did prior to your injections. Then within a period of about four to six weeks, that product actually starts to grow. It's almost like we're planting grass seed, and it takes a little while for that to grow in. But once it does, it's a subtle look, but it's dramatic because you can get some really good contouring of the jaw line and helping to soften the hollowness that was once there.

There's really not a lot of downtime associated with either filler, aside from a little bit of bruising, some swelling. Cold compresses are helpful with that. Avoiding things that thin your blood, like Aspirin, Motrin, Ibuprofen, fish oil, flax seed oil, things of that nature. You really don't have any sort of activity restrictions or anything like that. You can go on like you normally would.

Sculptra is a little bit different than hyaluronic acid in one other way, is that we will have you actually massage that product. If we use any hyaluronic acid based fillers in addition to your Sculptra, we'll not want you to massage those. We'll want you to avoid that. But go ahead and massage the areas that we did inject the Sculptra, and one of our nurses will show you how to do that.

Sculptra lasts a little bit longer than your H.A. fillers because, again, it's stimulating collagen production. So you've built up these new networks of collagen. So once you get the volume correction that you're looking for, and it sometimes does take more than one treatment of Sculptra to get there. But once you get that volume correction you are looking for, the product itself usually lasts about two years, sometimes longer.

Volume Replacement

Doctor Brian Biesman and team discuss facial volume replacement.