WHY USE THE COMBINATION APPROACH WITH FILLERS?    AREN’T THEY ALL THE SAME?

Our experience has shown that fillers have different properties. There has been such a boom of filler types that the cosmetic dermatologist can now choose, selecting certain fillers for different area. For example, Juvederm™ or Restylane™ , which are derived from non animal synthesized hyaluronic acid (NASHA) have a natural feel and can be used in the lip and forehead areas. Sculptra™ , on the other hand is a volumetric enhancer. It can define cheek bones nicely, is used to reduce acne scars, and fill in hollowed areas. It can also be placed in the skin to form a lattice which gives more definition to the chin and marionette lines. Finely, we like to use Radiesse™ for the nasolabial folds. This product is derived from calcium hydroxyapetite spherules. It is wonderful to use in this area because of its longevity and safety.

At Ponte Vedra Dermatology & Aesthetic Surgery, we take a comprehensive approach to filler therapy. We like to utilize Juvederm™ or Restylane™ for lip augmentation, forehead lines, and eyebrow "lifts",  Sculptra™ to contour facial atrophy, e.g., acne scars, and improve cheek/ jaw areas, and Radiesse™ to reduce the depth of the nasolabial folds. Lipotransfer can also be used to treat all of these areas.

Cases above performed by R. Garcia, PA-C

HOW OFTEN ARE TREATMENTS PERFORMED?

Filler treatments are performed when the cosmetic effects of the procedure have worn off or are less noticeable. On average, Juvederm™ treatments are repeated at 8-12 month intervals or sooner for touch up of the lip areas. Forehead lines, when combined with Botox Cosmetic™ can maintain their effects for up to a year (Fig. 2) When using Radiesse™ , studies have shown that this material can last up to two years in the nasolabial folds. Finally, Sculptra™ is usually administered in three patient sessions over a 12 week period. Each time, wrinkle reduction is retained at 25%. After three to five treatment sessions, results on average are thought to last for at least two years or more. This is very satisfying for our valued patients who want to get the most out of their investment.

HOW IS THE TREATMENT PERFORMED?

Dr. Harvey advises you to discontinue blood thinners such as Vitamin E , St Johns Wort , and Aspirin 2 weeks before treatment. If you are prone to cold sores, let us know so that we can prescribe you a medication called Valtrex™ . Prior to the procedure, we will prescribe you a topical anesthetic cream. This is left in place for 30 minutes or so. If we are treating the lip area, Dr. Harvey and Dr. Hardy will perform a dental block. This is a virtually painless procedure and will help you to feel more comfortable. After numbing has been achieved, Dr. Harvey and Dr. Hardy will carefully place the filler agent into the superficial aspects of your skin. Ice packs and pressure will be used to minimize bruising. The overall treatment time takes between 10 and 30 minutes.

WHAT IS LIPOTRANSFER?

Lipotransfer refers to grafting of donor fat cells from your own body. This is carried out via liposuction. Self-harvested fat cells are referred to as autologous fat and are one of the most advantageous filler substances known to physicians. Facial wrinkles, acne scars, posttraumatic scars, rejuvenation of aging hands, and irregularities in the breast, calf, and buttock area have benefited from the use of this technique.

HOW LONG DOES THE COSMETIC BENEFIT LAST?

The survival of transplanted fat is sometimes difficult to quantify and is variable depending on the patient’s medical status, age and the location of the actual injection. Some studies have demonstrated that fat graft survival in areas like the forehead, cheek, and lips, may last up to six to eight months. Repeated treatments tend to have a longer lasting effect.

WHAT ABOUT THE AFTERCARE?

Filler treatments may induce some degree of swelling or bruising. Ice packs and/or pressure can minimize this unwanted complication. After your procedure, it is important that you massage the treatment areas using the “3-3-3” rule , e.g., massage the treatment area 3 times a day for 3 minutes for 3 days. In some instances, a medication called prednisone may be prescribed for you to decrease the duration and intensity of swelling. Discomfort after treatment is minimal and can be controlled with Tylenol™ . You may use makeup to camouflage bruising immediately after filler treatments. Bruising, when it occurs, resolves within a few days.

ARE THERE OTHER TREATMENTS WHICH COULD BE USED IN COMBINATION WITH FILLER TREATMENTS TO IMPROVE MY OVERALL APPEARANCE?

Sometimes, Dr. Harvey and Dr. Hardy will combine filler treatments with other treatments, such as Botox™ Cosmetic or Noninvasive Laser (PDT) (Fig. 2), to improve the overall health and texture of your facial skin and musculature. Combination treatments can help filler treatments last longer. If you are interested in learning about other cosmetic treatments, please feel free to inquire about them during your consultation with us.


Before and After Photos   (performed by Dr. Harvey)

Before (upper) and After (lower)
Radiesse™ treatment