WHAT IS A FILLER?
A filler is a substance that is injected into the skin to smooth away wrinkles and add back volume to areas if the face which have developed due to a combination of age, sun damage, and gravity. Depending on the wrinkle, a specific filler is chosen based upon the unique presentation of the wrinkle whether it be a fine line, a deep set fold or crease. The following is an overview of the different fillers used by Dr. Silbret She has selected these particular fillers based upon their safety profile and aesthetic, natural outcomes. Finally, Dr. Silbret only uses fillers that are FDA approved and are biologically compatible with your skin which means they are the most naturally and closely matched to your own skin's DNA so the acceptance of these molecules by the skin is tolerated very well. No skin testing is necessary prior to the use of the following fillers. The effect is immediate and, depending on the filler, the anatomical site injected, and if a booster is performed, the filler may last from 4 months to 1 year or greater. Although these are the averages for duration, each person metabolizes product differently. There are some patients that come once a year for a treatment and others who need to come twice a year.
Dr. Silbret specializes in what she calls "Facial Sculpturing" and will select the ideal filler based upon your individual skin's presentation and what you personally desire to correct, smooth, or soften a particular wrinkle or problem area.
HOW DOES A FILLER DIFFER FROM BOTOX OR DYSPORT?
Botox and Dysport are muscle relaxants. They work by inactivating the nerve from firing temporarily so your muscle does not contract to make a wrinkle. Botox and Dysport, in effect, relax the wrinkle and the skin appears smoother. The wrinkle relaxation may not occur from 3 to 5 day. Hence, there is a delay of onset from the time you get injected to the time that the wrinkle is gone.
With fillers, the cosmetic effect is immediate and you can truly see the wrinkle improved and even erased before your eyes when you walk out the door. This is because the filler is a type of soft tissue augmentation which is injected directly into your skin's dermis or below to "fill" the crease. The cosmetic result is a smooth and natural softening of the wrinkle with preservation of movement and expression.
AM I GOING TO LOOK 'FAKE' OR 'PLASTIC'?
Dr. Silbret, in her practice of Facial Sculpturing, always strives for a natural, refreshed look. "I want the patient to walk away feeling pretty and refreshed I don't want any of my patients to look 'done' or artificial. I want their friends to say to them they look so rested or refreshed, but not be able to quite put their finger on it, even question if they got a new haircut or use new foundation... A lot of my patients are moms, career women, and mature women who have busy, active lives. They don't have 'time for downtime' and some don't want to have the discussion with their friends or spouses about what they choose to do for themselves to look young, so I am very careful to respect that privacy and to sculpt a natural, rejuvenated look that is in line with their own personal goals and comfort zone.
DOES IT HURT?
My most direct answer is that I feel Botox and Dysport are relatively painless and the fillers, depending on your pain threshold, tend to be more uncomfortable. Therefore there are anesthetic choices for each patient. "A lot of my female patients will joke with me that if they can survive child birth, injections are a piece of cake," says Dr. Silbret. "Being a big chicken myself, my feeling is if you have an option to decrease the possibility of pain, why would you deny yourself that option as long as medically there is no harm caused?" For that reason, I try to get to know each patient and design a pain management strategy based upon your own individual needs and anxiety about the procedure. I offer topical anesthetic and an injectable form. In addition, here in our exam room, we also have a CD player so either the patient can bring in their relaxing CD or I can choose a CD from our own calming collection. Our staff, who are all moms, are expert handholders as well if you need it...
Prior to your procedure, if you would like a topical anesthetic, we can arrange for you to have it before coming to the office as long as there is no medical contraindications.
WHAT WILL I LOOK LIKE THE NEXT DAY? WILL I BRUISE?
With most of the fillers, even under Dr. Silbret's gentle hands, you may have some bruising, swelling or redness. All of which, you can hide with a bit of cover-up and foundation. Dr. Silbret's staff can instruct you on how to apply the right concealer to diminish the appearance of any redness or bruising, should you experience it. The swelling with the hylaronic acids like Juvederm, Restylane and Perlane usually last from 1-3 days and depending on the anatomic site, such as the lips, it may be as long as 5-7 days. In the case of Radiesse, some slight swelling may linger up to a week or 10 days.
With Botox and Dysport, bruising is less likely. Directly after the injection treatment, you will most likely have what Dr. Silbret calls the "bug bite" appearance at the site of each injection for about an hour. This is simply the Botox fluid in the skin at the site where the needle goes in. As your skin absorbs it, the bug bite appearance goes away. Rarely you may have mild bruising at the injection site. Should this happen, simply apply ice to the site and you can, again, cover it up with make-up. The bruising may last from 1-7 days.
IS THERE SOMETHING I CAN DO TO DECREASE THE POSSIBILITY OF BRUISING PRIOR TO MY PROCEDURE?
Yes. If you are not on any aspirin or NSAIDS treatments for medical reasons, refrain from taking such medicines such as aspirin, ibuprofen, Motrin, Advil, Aleve, and Naproxen. In addition, again, unless medically warranted to, do not take Ginseng, St. John's Wart, Vitamin E, Fish Oil, and Ginko Biloba. For a more comprehensive list, please click here: Anticoagulants.
Please DO NOT STOP any medications before conferring with your internist or physician for medical reasons as this could jeopardize your health.
You CAN take anti-inflammatory herbs and vitamins, like Arnica Montana and Bromelein, found in pineapple, as long as you do not have any medical contraindication to these agents or a medical precondition that prohibits their use. Dr. Silbret and Dr. Schechter can discuss this option with you at greater detail on your visit.
Cool compress, not ice, can be applied as well to decrease the possibility of bruising and swelling.
ONCE THE FILLER OR BOTOX WEARS OFF, WILL MY WRINKLES BE WORSE?
No. If anything, your wrinkles will be somewhat softer and as you continue your treatments, you will notice that your wrinkles may need less filler per wrinkle and the time between treatments may be greater. Some people have the misconception that once their filler or Botox wears off, they will wake up wrinkled and aged one morning. This does not happen because the time frame of the degradation of the filler and toxin are gradual.
CAN I RESUME MY NORMAL ACTIVITY AFTER I AM INJECTED?
During the first 24 hours, the main objective is to relax the muscles of mastication around the mouth. This means no apples or steaks for dinner. In addition, you should avoid very hot or cold food like soup or ice cream, as well as alcohol consumption. In some cases, swelling is stimulated by exercise, sun exposure, and menstruation (which many women cannot avoid). This may be secondary to the hydrophilic (water loving) properties of the product. Therefore, for the first 24 hours do not exercise or have any heavy sun or cold exposure. If you are a belly sleeper, try to sleep on your back for the first night.
WHEN DO I COME BACK FOR MY NEXT TREATMENT?
It depends on the procedure.
For Botox and Dysport, it can range from 2-4 months, averaging about 3 months. However, everybody is different, and how you metabolize or respond to the toxin may be shorter or longer depending on your body.
For fillers, the average is between 4-12 months depending on the filler used. There are some patients that come only once a year and there are others who come back as soon as they see the start of the filler going away.
All of these fillers may have even greater longevity and duration, if you come back for a booster or touch up between the 4-6 month mark.
RESTYLANE AND PERLANE
- Biocompatible, non-toxic
- Immediate correction
- Well-defined safety profile
- Contain no animal proteins
- No allergy testing required
- Available with an anesthetic
RESTYLANE:
PERLANE:
Perlane is also a hyaluronic acid product manufactured by the same company as Restylane. Perlane has larger gel particles and is injected into the deep dermis for moderate to severe wrinkles and folds. Perlane is ideal for very deep nasolabiall folds giving a natural look and restoring skin's fullness. Perlane can last up to 10 months and even greater with a booster treatment.
JUVEDERM:
- Biocompatible, non-toxic
- Immediate correction
- Contains no animal proteins
- No allergy testing required
- Safe
- Available with an anesthetic
Juvederm is primarily composed of hyaluronic acid (HA) and cross-linked with butane-diol-diglycidyl ether like Restylane. Juvederm differs from other HA products as it is a homogeneous gel with the highest concentration of cross-linked HA (90%) of any dermal filler currently available. As we get older, through a combination of natural aging and sun damage, the amount of hyaluronic acid diminishes with time. Juvederm is indicated for injection into the mid to deep dermis for the correction of moderate to severe facial wrinkles and folds (such as the nasolabiall folds - the parenthesis areas around your mouth). With a booster treatment at the 4-6 month mark, Juvederm can last up to 1 year.
- Biocompatible, non-toxic, and non-antigenic
- Immediate correction
- Stimulates the body to produce new collagen
- Long-lasting
- Safe
- Available with an anesthetic
Radiesse is Calcium hydroxylapatite or CaHa. It is the major mineral component of bone and is identical in its molecular and chemical composition to that found in the human body. Radiesse is a bio-stimulatory dermal filler consisting of CaHa micro-spheres suspended in an aqueous gel matrix that also contains glycerin and sodium hydroxycellulose. The gel matrix is absorbed at 6 to 8 weeks after injection and during the same time your own skin cells, called fibroblasts, are stimulated to make new collagen over the bony matrix that serves as a scaffold for the new collagen. Upon injection, it initially acts as a filler. It is easily malleable, can be used to shape and contour large areas of the face, and provides an immediate one-to-one correction for results patients can see right away.
CaHa is considered a semi-permanent filler with clinical effected reported to last up to a year or more. Most people do need a booster or touch-up to achieve this type of longevity. It is used for correcting moderate to severe facial folds and people with large areas of volume loss and elasticity can see a beautiful cosmetic result from this filler. Finally, if a person is a bit squeamish about injections or needles, Dr. Silbret mixes lidocaine, an anesthetic, into the Radiesse syringe to decrease the possibility of pain and make the treatment more comfortable and relatively painless.
Radiesse dermal filler is proven to be safe and effective, biocompatible, non-toxic, non-antigenic, and long-lasting. It has received CE mark certification for plastic and reconstructive surgery, including soft-tissue augmentation of the facial area, and vocal fold insufficiency. In the United States, it is FDA approved for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds.
POSSIBLE SIDE EFFECTS OF FILLERS:
Side effects for all the fillers used in Dr. Silbret's office are usually mild to moderate usually lasting up to 7 days or less. These include temporary injection site reactions like redness, pain, firmness, swelling, bumps, and bruising.
Again, each patient is different, and some people show very little redness or bruising while others who have more "sensitive skin" or "bruise easily" may have side effects that last longer than a week. Make-up can be applied over any areas of redness as you are healing and both Dr. Silbret and her staff can discuss with you the best way to camouflage redness should you happen to experience it.
