by Dr. E.Ronald Finger
at Savannah Plastic Surgery
As I have mentioned in many blogs and articles, the appearance of the aging face is mainly from:
- Loss of Volume
- Damaged skin
- Loss of elasticity
- Loss of hair
- Bad teeth
This article concerns Volume loss, but all in the above list can make significance in creating a younger looking you..
For loss of volume, the treatment is injection of “fillers” or fat grafts. The most common fillers are Juvederm, Restylane, Perlane, Sculptra, and Radiesse. All have their individual best specific uses, e.g., for the hollows under the eyes I have found in my hands the best fillers are either Restylane or Sculptra (most doctors will not use Sculptra in this area, and it must be injected very carefully or nodules may result).
Juvederm Voluma, which will probably be called simply “Voluma,” is the new kid on the block for fillers. Its attributes are over 60% will still be in place at the 2-year mark. This is pretty special as most other products last from 6 to 12 months, with the exception of Sculptra, which also last about 2 years.
Voluma, however, is FDA approved for only volumizing the cheeks and midface. I have used it on several patients and have been very satisfied with it, as have my patients. Volumizing that area can turn back the clock several years—more than you would think.
Conservative injections are the order of the day as far as I am concerned. It’s much better to have another injection session at a a few weeks later than to have over-injected any product. Also it takes a few weeks for some patients to get used to the new look like they did 5-10 years ago.
Fortunately, hyaluronic acid products such as Juvederm, Restylane, Perlane and even Voluma are reversible with injections of the enzyme hyaluronidase–a rare situation.
So which fillers do I use? All of them, according to the patient’s volume loss and goals. A careful examination of the patient is necessary and a discussion of the goals and the pros and cons of each product. None of the products are perfect for all areas. Sometimes I use a couple of products in one session, such as Voluma for volumizing the cheeks and Restylane for under the eyes. All injectbles take about 30 minute to perform.
A final pearl — patients should be injected sitting up and not lying down. People look quite different in the supine and sitting position.