Dermal Fillers

Fillers are an effective way to restore volume to your face and other areas as you age. As we get older, the body’s production of collagen and elastin—two key components of youthful skin—naturally decreases. Experts agree that collagen production starts to decline around age 25, decreasing by approximately 1-1.5% each year thereafter. Read more here.

The effects of dermal fillers are temporary, lasting from 6-18 months, depending on the type of filler used, the area treated and the individual's metabolism and lifestyle. They are popular for their ability to provide immediate results with minimal downtime, making them a favored choice for those seeking non-surgical cosmetic enhancements. Whether you're looking to enhance your lips, soften facial creases, or redefine your jawline, dermal fillers offer a versatile solution for a wide range of aesthetic goals.

Hyaluronic acid is a naturally occurring substance in the body, primarily found in the skin, connective tissues, and eyes. It plays a crucial role in maintaining skin hydration and elasticity by binding to water molecules, helping the skin stay plump and hydrated. In the body, hyaluronic acid acts as a lubricant for joints and tissues, promoting smooth movement and reducing friction.

Fillers are most commonly made from hyaluronic acid, a preferred choice over other substances because it can be safely dissolved with an enzyme called hyaluronidase if necessary, whether due to complications or if the patient is unsatisfied with the results. Hyaluronic acid is highly effective in hydrating the skin, reducing fine lines and wrinkles, and enhancing skin volume due to its remarkable ability to hold up to 1,000 times its weight in water. When used in dermal fillers, it offers a temporary yet natural-looking solution for restoring facial volume, smoothing wrinkles, and refining facial contours, all with minimal risk of allergic reactions since it is a substance naturally found in the body. 

Dermal fillers are ideal for treating static lines — those that remain on the face even when it’s relaxed — and for enhancing facial contours. Common treatment areas include:

• Tear Troughs (under-eye hollows)
• Nose (non-surgical rhinoplasty)
• Cheeks, Cheekbones, and Apples of the Cheeks
• Marionette Lines (lines extending from the corners of the mouth down to the chin)
• Nasolabial Folds (lines on either side of the nose)
• Lips
• Chin and Jawline
• Temples
• Neck

For dynamic lines — those that disappear when the face is expressionless — Botox is typically the preferred treatment.

The most commonly experienced side-effects after a treatment include swelling, bruising, redness and minor bleedings in proximity to the injection points.

Less common are lumps and bumps, but they do occur. It takes usually two weeks for the filler to settle and during this time the patient can experience minor lumps or bumps, particularly in the lips and is more common in patients with thin skin. This typically goes away by itself, but after two weeks it can be helpful to massage the area to help the filler settle in the tissue. 

There is always a risk for infection and granulomas after injections. In the first 24 hours, it's crucial to avoid touching the areas that have been treated. 

Vascular occlusion is blockage of a blood vessel caused by the accidental injection of filler material into an artery, effectively cutting off blood supply to the surrounding tissue, potentially leading to skin necrosis (tissue death) if not treated promptly; it's a rare but serious complication of dermal filler injections. 

Downtime after dermal fillers is generally minimal compared to more invasive procedures. Here’s what to expect:

• Redness and Swelling: Some redness and swelling at the injection sites may occur, usually peaking within the first 24-48 hours and gradually decreasing over a few days.
• Bruising: Bruising around the injection sites is possible, especially if you’re prone to bruising. This typically fades within one to two weeks.

Most people can resume their normal activities immediately after the procedure. However, it might be wise to avoid social engagements where you could be self-conscious about any initial swelling or bruising. We recommend treatment at least two weeks ahead of any major event that you might attend. 

Recovery experiences can vary, but most side-effects are temporary and manageable. Adhering to your provider's aftercare instructions is essential for achieving the best results and minimizing downtime.

To minimize swelling, we recommend to avoid to avoid strenuous exercise and heat sources (such as saunas or hot tubs) for at least 24-48 hours.

Refrain from touching or massaging the treated areas unless instructed by your practitioner.

Your practitioner will use a topical numbing cream on the target area to minimize pain during the procedure. Many modern fillers also contain lidocaine, which helps numb the area with each injection.

Certain areas of the face, such as the lips and nose, tend to be more sensitive. If you have concerns about pain, discuss pain management options with your practitioner.

For Hyaluronic Acid Fillers, which are the most commonly used fillers, results can last between 6 to 18 months. The duration depends on the specific product used, the area treated and the individual's anatomy, metabolism and lifestyle. For example, fillers used for lip enhancement might last closer to 6-12 months, while those used for cheek volume can last longer. 

Regular touch-ups or maintenance treatments can help sustain the results over time and it's not uncommon that multiple sessions are required to achieve the wanted results.

The ‘Russian technique’ is known for creating a striking, dramatic effect with sharply defined Cupid’s Bow shapes. For individuals new to dermal fillers or those seeking a more natural appearance, this technique might result in a look that feels too intense.

In comparison, The Italian technique provides a more subtle result where the natural anatomy is respected, without a ledge and notably defined Cupids' Bow. 

We offer both the Italian and Russian lip technique, depending on your preference. 

Absolutely.

It’s crucial to choose a practitioner that is credible and experienced in creating the results that you look to achieve. All our practitioners have individual beauty standards that align with our philosophy of creating natural results for our clients and have been extensively trained using the same technique. 

At Good Genetics Aesthetics, our focus is on achieving natural-looking outcomes. We believe that a subtle, well-balanced appearance is ideal. 

Yes, you can dissolve dermal fillers, particularly those made from hyaluronic acid (HA). This is done by using an enzyme called hyaluronidase, which breaks down the hyaluronic acid in the filler. 

• Hyaluronidase Injection: The practitioner injects the dissolver in the area where the filler was previously placed. The enzyme breaks down the filler and the body will naturally absorb it. 
• Time: Hyaluronidase has immediate effect, but it might take two days to see the full effect. 

When to dissolve:

• Lumps and Bumps: If you have persistent lumps and bumps that don’t resolve with massage, dissolving the filler can help smooth the area.
• Migration: If the filler has moved outside the vermillion border (the edge where the red part of the lip meets the surrounding skin), it may need to be dissolved to restore proper placement.
• Long-Term Usage: If your lips have become overfilled with too much filler over time, and you desire a more natural appearance, dissolving the excess can be beneficial.
• Emergency: In cases of a vascular occlusion—when filler blocks a blood vessel, impairing blood flow—immediate dissolution is critical to prevent serious complications.

Risks:

• Just as with dermal fillers, using hyaluronidase carries certain risks and potential side effects. These may include temporary discomfort at the injection site, redness, swelling, bruising, and, though rarely, allergic reactions.
• To ensure suitability for hyaluronidase treatment, a skin patch test should be performed 30 minutes before the procedure. This helps verify that you do not have an adverse reaction to the enzyme.

Recommendation: We suggest dissolving lip fillers every couple of years. Fillers can break down unevenly and migrate over time, especially in the lips, where they tend to follow the path of least resistance. Even if you haven’t had fillers for some time, residual product may still be present. Introducing new filler on top of old material can lead to migration and unsatisfactory results.

To ensure optimal outcomes, dissolve all existing filler and allow 4-6 weeks for the tissue and pockets where the filler was previously located to heal. This approach helps reset the area and provides a clean slate for new filler, enhancing the likelihood of achieving the desired results.

It's important to familiarize yourself with the lip filler healing process. Swelling after lip injections is common, along with possible redness and bruising. However, with proper aftercare, the healing process tends to be swift.

Immediately After Treatment

Right after the procedure, noticeable swelling is common. Often, this swelling may be uneven. It’s important not to worry about any unevenness in the first few days, as this is due to inflammation, which will gradually subside. Redness and tenderness is also common.

Day 1: The Day After Treatment

Swelling is usually at its peak the morning after treatment. The upper lip may appear more pronounced than the lower lip, as more work is often done on the top lip, causing more trauma and swelling. Cold sores may also develop within the first one to two days after treatment.

Day 2: Managing Inflammation

By day two, the swelling remains but may begin to decrease gradually over the next few days. Bruising may appear, and lumps could be felt on the lips. While this can be concerning, it's normal and will improve over the week.

Day 4: Noticeable Improvement

On day four, patients usually notice a significant reduction in swelling. Eating and talking become more comfortable, though the lips may still feel tender to the touch.

One Week Later

By day seven, most swelling and bruising will have subsided, and the lips will settle into their final shape. At this point, the size of the lips may reduce slightly as the inflammation fully resolves, allowing the actual results of the filler to become visible. Swelling can linger for up to two weeks.

Two Weeks Later

Most patients are fully healed by two weeks post-treatment. Any remaining swelling, tenderness, or bruising should have resolved, and the filler will have settled completely. 

Four Weeks Later

Around four weeks post-treatment, the lips will have fully settled, and the final results can be assessed for symmetry and size. If adjustments or additional filler are desired, this is the ideal time for further treatment. Corrections should also be made at this stage if necessary.

Most filler syringes contain 1.0 ml (milliliters or cc) of product, which is the standard size for most treatments. Although some fillers come in larger or smaller sizes, the 1.0 ml syringe is by far the most commonly used.

The confusion usually arises because the amount is measured in milliliters, part of the metric system, rather than more familiar measurements like teaspoons. To put it in perspective, 1.0 ml is roughly equivalent to 1/5th of a teaspoon—a very small amount! For a more relatable comparison, think of a typical blueberry. A blueberry is about the size of 1 ml of volume, or approximately one syringe of filler.

This small amount of product is why one syringe is often enough to subtly enhance lips or smooth out a few lines and wrinkles, but not enough for significant augmentation in areas like the cheeks or jawline. It’s all about precision and knowing where to place the product to achieve natural-looking results.

 The amount of filler you’ll need depends on several factors, such as:

• Depth of wrinkles
• Volume loss
• Facial structure
• Type of filler treatment (e.g., liquid rhinoplasty, cheek filler, lip filler, tear trough filler).

Different fillers are used for specific areas of the face, with varying thickness (viscosity) based on the treatment. Here’s a breakdown of the average filler amounts for each area:

• Temples: 0.5-1ml of filler per temple
• Tear Troughs: 0.5-1ml of filler per tear trough
• Cheeks: 1-3ml of filler per cheek
• Nose (Liquid Rhinoplasty): Typically 1ml, depending on desired changes
• Nasolabial Folds: 0.5-2ml of filler per side
• Lips: 0.5-1ml, depending on desired plumpness (may require multiple appointments)
• Marionette Lines: 0.5-1ml of filler per side
• Chin & Jawline: 1-5ml of filler for shaping and definition

Hyaluronic acid is a naturally occurring substance found in the body, primarily in the intra- and extracellular matrix, functioning almost like a tissue glue. Due to its biocompatibility, hyaluronic acid is safely broken down by the body without causing adverse effects.

It has been widely used in surgeries for years and was FDA-approved for cosmetic purposes in 2004. So far, no studies suggest any detrimental long-term effects from aesthetic use of hyaluronic acid gels.

A 2013 study published in the Journal of Clinical, Cosmetic, and Investigational Dermatology reviewed adverse long-term events associated with dermal fillers and concluded that while all fillers can potentially cause complications, serious events are rare. Most reactions are mild, such as bruising and swelling, and are usually related to the volume used and injection technique. The skill and expertise of the injector are crucial in minimizing risks and ensuring safe long-term results.

Surgical rhinoplasty, commonly known as a “nose job,” is one of the most frequently performed plastic surgeries. However, many individuals are seeking less invasive methods. Liquid rhinoplasty can smooth out bumps and refine the nose's contours, offering a temporary solution with minimal recovery time compared to traditional surgery.

In contrast, surgical rhinoplasty can take up to a year to reveal the final results, along with experiencing bruising, pain, and discomfort during recovery. Liquid rhinoplasty serves as a non-surgical alternative to traditional rhinoplasty, effectively addressing issues like dorsal humps (small bumps), drooping nasal tips, and asymmetry.

To achieve the best results from your dermal filler treatment, proper preparation is essential. Start by maintaining overall health and good skincare. Keep your skin in good condition by moisturizing and ensuring the treatment area is clean. This helps protect your pores and prepares your skin for the procedure. 

Moreover, patients can take steps which may help to reduce swelling:

• Avoid Alcohol: Do not consume alcohol the day before your procedure.
• Skip Strenuous Exercise: Refrain from intense physical activity on the day and the day after your treatment to reduce the risk of bruising.
• Steer Clear of Certain Medications: Avoid Vitamin E, aspirin, herbal supplements, and non-steroidal anti-inflammatory medications (such as ibuprofen) 1-2 weeks before your treatment, as these can increase bruising.
• Arrive with a Clean Face: Make sure your face is clean and free of makeup to minimize the risk of bacterial infection.
• Avoid Dental Work: Refrain from dental procedures for at least 2 weeks before or after your filler injections.
• COVID-19 Vaccine Timing: Schedule your COVID-19 vaccination at least 2 weeks before or after your treatment.
• Treat Cold Sores: Address any cold sores before your appointment. If a cold sore is present in the treatment area on the day of your procedure, we may need to reschedule.
• Plan for Healing Time: Avoid booking your appointment close to a special event. Allow at least 2 weeks for the area to fully settle and for any swelling or bruising to subside.

By adhering to these guidelines, you'll help ensure a smoother procedure and achieve optimal results.

 When dermal filler is injected, it slightly stretches the skin, helping to fill out sagging areas and support weakened tissues. Once the filler gradually fades, your skin will return to its pre-treatment appearance. In some cases, depending on the type of filler used, your skin may even look improved.

If you decide to stop using dermal fillers at any time, your skin will simply revert to its previous condition.

It’s worth noting that 1ml of filler is roughly equivalent to 1/5 of a teaspoon—a relatively small volume. Significant skin sagging typically results from major weight loss rather than the minimal volume of filler used. Because of this, the amount of filler injected does not significantly affect skin elasticity.

The main difference between anti-wrinkle treatments and dermal fillers lies in how they address wrinkles and volume loss. Anti-wrinkle treatments works by reducing muscle activity in the face that leads to wrinkles, effectively smoothing out expression lines. Dermal fillers contain hyaluronic acid  used to fill in areas of volume loss, plumping and lifting the skin to counteract the effects of collagen depletion. 

Anti-wrinkle treatments are designed to tackle dynamic wrinkles, which are caused by muscle movements. By temporarily paralyzing the muscles that create these expression lines, wrinkles are smoothed. It’s most commonly used for:

• Lines between the eyebrows ("11" lines)
• Horizontal lines on the forehead
• Crow’s feet around the eyes

Anti-wrinkle treatments don't address static wrinkles, which are due to skin sagging or loss of volume.

Dermal Fillers are used to correct static wrinkles, which are visible when the face is relaxed, and areas of volume loss. They work by injecting  hyaluronic acid to plump and lift the skin: 

• Plump thinning lips
• Fill in and enhance shallow areas of the face
• Reduce or eliminate shadows and wrinkles under the eyes
• Soften the look of recessed scars
• Fill in and smooth out static wrinkles, especially on the lower face

Traditionally, dermal fillers have been administered using needles, and most fillers still come with short needles for this purpose. However, many practitioners now prefer using a blunt-tipped cannula for injecting dermal fillers due to its various benefits.

I generally favor the cannula for its safety and reduced trauma. It is especially useful for areas like the jawline and cheeks when aiming for definition rather than significant lift. For more precise applications, such as lip enhancements or lifting areas like the cheeks, I use needles. Needles offer more control and precision in these cases, especially when targeting specific areas or achieving a lift.

Pros of using a cannula

• Reduced Risk of Damage: Cannulas are blunt, minimizing the risk of piercing veins or arteries. This leads to less swelling, bruising, and a lower chance of intravascular injection.
• Enhanced Sensation: The practitioner can better feel the structures being navigated by the cannula’s tip.
• Fewer Entry Points: Cannulas are longer than needles, allowing for fewer injections and points of entry into the skin.
• Reduced Patient Discomfort: Cannulas can be inserted through the same entry point multiple times with less discomfort for the patient.
• Better Definition: For areas requiring more definition, like the jawline and cheeks, cannulas allow for more superficial deposition of the filler.

Cons of using a cannula

• Depth Limitations: Cannulas may struggle to reach deeper layers of skin and tissue.
• Additional Steps: Using a cannula requires creating an initial entry point, adding an extra step in the procedure.
• Resistance Challenges: Due to its blunt tip, a cannula must navigate the path of least resistance, which can sometimes require more force to maneuver into the desired position.

Ultimately, the choice between a needle and cannula depends on the treatment area and the specific goals of the procedure. Each method has its advantages and is selected based on the desired outcome and patient needs.