Minimally-invasive cosmetic injectables are a great way to improve volume and correct early signs of aging on the face. The key is to achieve natural-looking results and maintain appealing facial proportions. Dr. Jess Prischmann’s personal philosophy is that every patient deserves an individualized treatment plan. She has performed thousands of filler injections and understands that each injectable has its advantages and disadvantages. For example, some fillers are great in the lips, while others are great in the cheeks. Understanding the differences between fillers, along with the experience and judgment to know how to use them, is the combination that leads to a safe and successful result.
Injectable fillers can be used to shape areas of the face (for example: the temples, cheekbones, chin, and lips). They can also be used to lessen the appearance of lines and wrinkles (smile lines, lip lines, marionette lines). While fillers do not replace surgery, they can be a perfect complement to facial plastic surgery or laser resurfacing procedures. Injectable fillers can give you a very natural result with minimal downtime.
While fillers are very safe, they do carry risks. That is why it is important to carefully select your injector. Dr. Prischmann’s experience as a facial plastic surgeon gives her an intimate knowledge of anatomy that is required to prevent many serious injuries. She is also up-to-date on the prevention and treatment of filler complications. Although unlikely, Dr. Prischmann is committed and prepared to guide her patients through unforeseen circumstances.
There are several fillers that we use in our practice. Each has its own benefits:
JUVÉDERM® VOLUMA™ XC:Excellent for volumizing cheeks, long-lasting.
JUVÉDERM® Ultra XC:Excellent for lips and smile lines.
Restylane®:Excellent “all-purpose” filler. Can give natural results in many locations on the face. Does not last as long as some of the other fillers but is easy to dissolve if necessary.
Restylane® Refyne:Excellent for nasolabial folds and lips*.
Tear Trough FillersNot currently offering this service due to concerns over longterm safety
Restylane® Defyne:Excellent for deeper nasolabial folds and chin augmentation*.
Restylane® Silk:Excellent for lines around the lips (smoker’s lines/lipstick lines). Also excellent for those who are looking for subtle lip augmentation.
Restylane® Lyft:Excellent for defining cheekbones and chin augmentation*.
RADIESSE®:Used for cheek and chin augmentation. Dr. Prischmann has moved away from using this filler due to the fact that it is not dissolvable/reversible (more information below).
(*indicates “off-label” use)
JUVÉDERM® VOLUMA™ XC
JUVÉDERM® VOLUMA™ XC is a hyaluronic acid (HA) based injectable specifically designed for cheek augmentation and midface volumization. Using VYCROSS® technology, VOLUMA™ is able to volumize the midface beautifully with results that can last up to two years. The concentrated HA formulation provides volumization and longevity. Dr. Prischmann prefers to start with one syringe of VOLUMA™ at a time. Sometimes, more than one syringe is necessary to achieve the desired result and that can be performed as early as two weeks after the first injection. VOLUMA™ injections are not typically painful, and the swelling decreases over the first few days.
JUVÉDERM® Ultra XC
JUVÉDERM® Ultra XC is a filler that can be particularly useful for enhancing lip contours and filling smile lines. The hyaluronic acid component of JUVÉDERM® Ultra XC binds with water, making it possible for it to provide more volume to the lips than other fillers. Because of this, it is the most popular filler for lip augmentation in our practice.
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JUVÉDERM® Ultra XC contains lidocaine, which decreases pain. However, because the needle injection is uncomfortable, we often perform a dental block for anesthesia. A dental block can make lip injections painless.
JUVÉDERM® Ultra XC can last for up to a year. Downtime is comparable to other fillers and is related to swelling and bruising.
As one of the first hyaluronic acid-based injectable fillers introduced in the United States, Restylane-L® has a long track record of use and safety. It is indicated for use in the nasolabial folds and lips; however, Dr. Prischmann also uses this filler in other areas of the face.
Dr. Prischmann feels that Restylane-L® can look very natural in many areas of the face. She often uses this filler if she is looking to rejuvenate the temples, midface, and lower face in the same appointment. She also feels that it is a good filler for those who are nervous about injectables because the results are very natural.
One of the disadvantages of Restylane® is that it doesn’t last as long as some of the other fillers on the market. Because of this, Dr. Prischmann will often start patients with Restylane® (to get them comfortable with fillers) and then use longer-lasting products at future appointments.
Restylane® Refyne and Restylane® Defyne
Restylane® Refyne and Restylane® Defyne are hyaluronic acid-based fillers and are the newest additions to the Restylane® family of fillers. They differ from the other Restylane® products because they are uniquely cross-linked. This increases the longevity of the filler and theoretically makes them more elastic and natural-looking.
Refyne and Defyne are indicated for use in the nasolabial folds. Dr. Prischmann uses Refyne in the lips and finds that it can very nicely define lip borders and has less swelling in comparison to other lip fillers. Dr. Prischmann uses Defyne in deeper nasolabial folds and for chin augmentation.
Restylane® Silk is our go-to filler for those who are looking for subtle lip enhancement. It is also excellent for smoker’s lines/lipstick lines or deeper lines around the mouth.
Restylane® Silk contains a very smooth, small-particle hyaluronic acid gel that volumizes without creating an overly “plumpy” look. During a 30-minute office visit, Dr. Prischmann is able to use Restylane® Silk to enhance lip shape and treat fine lines around the mouth. With the use of a simple dental block, the procedure is typically painless. Downtime is related to swelling and bruising and is similar to other fillers.
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Formerly known as Perlane®, Restylane® Lyft is a hyaluronic acid-based filler for the midface/cheek area. It can enhance contour of the cheekbones without excessively volumizing the area. Dr. Prischmann also often uses Lyft for chin augmentation and for deeper acne scars. Restylane® Lyft typically lasts nine months. Injections are not typically painful and downtime is related to swelling and bruising.
RADIESSE® is a unique filler because it is made of calcium hydroxyapatite. Dr. Prischmann has used this filler and found it to be reliable with good longevity. However, RADIESSE® is not reversible, and for that very important reason, Dr. Prischmann does not use it often in her practice. (All hyaluronic acid-based injectables are reversible with an enzyme called hyaluronidase).
Not technically considered a dermal filler, Sculptra® Aesthetic minimizes the appearance of age or health-related wrinkles and volume loss by stimulating natural collagen growth. Sculptra® Aesthetic works by being highly inflammatory, leading your body to break it down and deposit collagen. Because of the risk of nodules and the potential for immune-related reactions, Dr. Prischmann uses this product judiciously.
Who is a good candidate for fillers?
Good candidates for dermal fillers are typically individuals who have:
- Reasonable expectations
- Smile lines
- Marionette lines
- Lipstick lines
- Thin/Undefined lips
- Volume loss in cheeks
- Mildly sagging midface
- Prejowl sulcus
- Small or under-projecting chin
- Overall volume loss/temporal hollowing
- Acne scars
Dr. Prischmann does not perform dermal filler treatments to enhance the shape and appearance of the nose (commonly known as a “liquid rhinoplasty”) due to the high rate of complications that may be associated with that procedure.
How is the procedure performed?
After a consultation, Dr. Prischmann will help you decide which fillers are best for you. Procedures are performed in-office. Topical numbing creams or local numbing blocks are also used when necessary or requested.
Pre- and Post-Injectable Treatment Instructions
What is the recovery?
Recovery depends on the type of injectable. In general, there is minimal downtime. Downtime is related to swelling and bruising. We tell our patients that most of the swelling subsides in the first three days, although it can take up to one week before all swelling goes away. Bruising is also typically most noticeable in the first few days after injection. Most bruising can be camouflaged with makeup the day after filler injection. The injection sites may be slightly sore the day after injection, but this subsides very quickly. Most patients go back to work the day after filler injections.
We recommend the use of a homeopathic supplement called Arnica Montana the day of your treatment to reduce swelling and bruising. This can be purchased directly at our office and is less than ten dollars.
What are the risks?
Injectable fillers are generally considered to be very safe and effective. However, there are risks, including, but not limited to, infection, nodules, immune reactions/granulomas, and vascular occlusion. We advise that you thoroughly read consent forms and ask us any questions that you might have about the risks of filler injections.
Are fillers reversible?
One of the reasons why hyaluronic acid-based fillers are so safe is because they are dissolvable. In other words, there is an enzyme called hyaluronidase that can be injected at the site of the filler to make it go away. This enzyme is very safe but cannot be used in patients with a bee sting allergy. Please let us know if you have an allergy to bee stings.
Schedule a Consultation with Dr. Prischmann
For more information on cosmetic injectables and dermal fillers contact Dr. Jess Prischmann today. Dr. Prischmann can meet with you in a consultation to discuss all aspects of procedures and how they can help you meet your goals.