Fillers are used to fill in or plump areas where tissue has been lost or was always deficient. As the face ages, volume is lost and there are a variety of options for filling the face.
Superficially, the most common fillers are Hyaluronic Acid , which has become a huge component of cosmetic surgery and skin care. There are a variety of products which come from different sources or have different preparations, with some variability in durability (Restylane®, Perlane®, Juvederm®, Belotero®, Voluma, etc. ). Hyaluronic acid is a glycosaminoglycan which is a normal component of skin and the human body and is important in skin hydration. Its presence attracts water, thickening skin in the area of injection. Since it is a naturally occurring substance, an allergic reaction to hyaluronic acid is not possible although it is possible to have an allergic reaction to a preservative in a particular product. Hyaluronic acids are thin liquids which are easy to inject and are ready off the shelf. Hyaluronic acid products are frequently used for fine wrinkles, perioral creases, lips, and smile lines by injecting in the mid-dermis. Topical anesthetic or field blocks are frequently used, but now these products are available pre-mixed with lidocaine. The major uses for hyaluronic acid for are small wrinkle filling especially around the mouth, conservative lip filling to blunt wrinkles, and minor depressions.
Mid – depth, Radiesse® is the most common mid depth filler used in The Medspa at the Park. It is a long-lasting (18 month) injectable filler made with calcium hydroxyapatite, a normal component of bone that stimulates new collagen growth. This is a biocompatible filler that does not require skin testing. We typically use Radiesse® for deeper folds and troughs, such as the nasolabial folds, prejowl sulcus, hollow temples, and aging hands.
Deep, Sculptra® is a biocompatible poly-L-lactic acid, FDA approved for the restoration of atrophy associated with the loss of fat in HIV, but is frequently used for aesthetics. The effects are not immediate and are cumulative. It is used deep to provide fullness rather than specific wrinkle filling. Typically 3–4 treatments are needed spaced out by 1-2 months to gradually increase the thickness of the skin and the face. This restores the appearance that occurs due to deeper changes such as bone loss and fat loss with age.
Fat can be harvested from one area, prepared, and injected in other areas to treat deep wrinkles, depressions, skin folds, areas of fat atrophy, and thin lips. Some fat resorption occurs over the first year with fat injection and may lead to irregularities but with the appropriate techniques employed by Dr. Park using tiny aliquots of fat well distributed in multiple planes, this risk is minimized. Some fat stem cells are transplanted with fat grafting and remain viable long-term, reversing some of the damage done by other mechanisms, such as sun, radiation, aging, etc.