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  • By Dr. David Shafer

    The new uses for facial fillers continue to expand as does their popularity as an alternative to surgical facelifts as well as a way to maintain the results of surgery. We can use facial fillers to smooth fine lines and creases around the mouth, but that is just the beginning. Wrinkle fillers are a proactive way to address the early signs of aging as well as to take years off your face.  Fillers are not just for wrinkles anymore; in fact, we can combine multiple fillers for a dramatic beautifying effect.

    juvederm, restylane

    There are two basic types of fillers: absorbable (temporary) and non-absorbable (permanent).  The former are gradually broken down by the body while the latter will remain indefinitely. Hyaluronic acid is naturally found in the human body, so it is very biocompatible, and gets resorbed over time. Hyaluronic acid is lost as the skin ages. However, when injected into the skin, it binds to water and adds volume and contour changes.

    The most popular of these in the U.S. are Restylane and Juvederm. In addition to lines and wrinkles, they can be injected to build up cheek contours, enhance the lips, and fill in hollows under the eyes, which are considered off-label applications. Some expanded uses for these fillers include the feet.  Restylane® can be injected into the soles and pressure points to help your high heels stay on with ease. A pointy chin can also be reshaped and volume can be added to a receding jawline for a younger appearance. Smoothing under-eye hollows show wonderful results with Restylane® injected under the eye padding to give the area some volume and decrease dark circles. Plumping up thin earlobes is another great use for deflated, old looking earlobes drooping from wearing heavy earrings. Both Restylane® and Juvederm® last for approximately 6-12 months, or longer in some people, and the results are instant.

    Another highly popular filler is Radiesse®, which is composed of calcium hydroxylapatite that is made up of calcium and phosphate. It is the same mineral component found in your bones and teeth, so it is very biocompatible.  Over time the tiny microspheres gradually break down and are absorbed into your body. Traditionally, Radiesse® is injected into the deep dermis to smooth out nasolabial creases, marionette lines, depressed scars, and the chin area. It also works well for cheek enhancement. Expanded uses for Radiesse® include tipping up long noses, and filling out a small or pinched tip, dents, and divets in the nose, which can help avoid having another operation to fix previous rhinoplasty surgery. Radiesse® can also be used to add projection to inverted nipples that are pushed in. It can last aproximtaly12 months, depending on how much is injected.

    Another important use for Restylane, Juvederm and Radiesse are to enhance the areas of the face that show volume depletion with age. The cheekbones become flatter and the face appears more squared off, rather than a more desirable tapered appearance.  The midface can be rejuvenated by careful filling of the cheek fat pads to replace the softness and curves shown in youth. The face will look younger and early signs of sagging can be lifted with this technique.


    Wrinkle relaxers such as BOTOX® Cosmetic and Dysport® play a vital role in facial injectable procedures and are often combined with fillers for best results.

    Today’s expanded use of facial fillers seems endless, and only limited by the tools we have available and our aesthetic judgment.

    About Dr. David Shafer: A New York City board certified plastic surgeon, Dr. Shafer specializes in breast and body contouring, SmartLipo, and facial rejuvenation with fillers, peels and wrinkle relaxers. www.shaferplasticsurgery.com

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