These are (usually) clear, jelly-like substances, often 97-98% water, injected into or under skin in order to fill lines or hollows, or to build volume where volume is aesthetically lacking. For the most part these substances are designed to be inert, and just sit there, but all have been found to stimulate some degree of collagen formation as well.
Injections of dermal fillers we perform every day, and the great majority of patients are well pleased with the results, but the injection of a dermal filler is not without risk. You should be very certain of the qualification and experience of any person purporting to inject your face with a dermal filler.
The filling of lips is probably the commonest purpose to which dermal fillers are put, but most patients seeking lip filling would benefit more from a total face assessment.
I usually start with just 1/2 a syringe or even a 1/4 of a syringe. The idea is that you look better. Better is better. Unnatural, artifactual or exaggerated is *not* better!
First-timers can be assured that we will proceed with this treatment very carefully.
These lines, from the side of your nostril to the corner of your mouth, are very commonly treated with dermal fillers. In most cases, though, it is important to *improve* them without *entirely* filling them. While it might be OK to fill-to-flat these lines when they are shallow and young, once they are deeper and older the whole face looks fake if the nasolabial lines are completely gone while the rest of the face looks aged.
Every facial feature has to be seen in its broader context in order to improve the entire look.
Replenishing and repleting the volume of the malar eminence, or apple of the cheek, can improve the appearance of the whole face in a number of ways. It helps eliminate the nasojugal line, helps to lift the nasolabial *fold* which in turn improves the nasolabial *crease*, and restores or contributes to a general "heart" shape to the face, which is frankly ideal in women.
That said, the focus must be on the malar eminence itself. Too full, or too filled, and proportion is lost, resulting in a fake look.
Proportion is everything.
This is the little valley between the lower eyelid and the malar eminence. Often neglected when other injectors rush to fill the tear trough, filling the palpebromalar groove helps pull across the tear trough and complements malar filling, requiring only small volumes.
Tear trough filling must be done with a cannula, at least 25gauge, as inadvertent injection of the angular artery nearby can lead to the disaster of permanent blindness in the ipsilateral eye. Using a cannula instead of a needle is vastly safer.
The tear trough, peculiarly, is very often overfilled leading to the development of an unsightly Tindall effect - like a transparent bluish hue under the skin. Once again, a *partial* filling improves the situation when a *complete* filling causes other problems.
The treatment is often completed with a series of ever-so-tiny dermal injections within any persisting creases requiring such help. Tiny, in the order of 5 microlitres per shot, and way-too-superficial for any artery.
The youthful mandible is characterised by a relatively vertical ramus, a rather-horizontal mandibular body, and a sharpish-if-not-acute mandibular or gonial angle
The aged mandible is marked by a long lazy curve from condyle (at the TMJ) to mention.
Thus, filling at the gonial angle can help reproduce a youthful outline to the jawline.
And since almost no one knows to look for this effect, almost no one will perceive that a treatment has been performed.
A youthful temple is convex, whereas an aged temple has often become concave. Therefore, filling the temple helps deliver a youthful shape to the face, in a manner everyone can appreciate but few can perceive.
I follow the Arthur Swift approach, utilising his "safe zone", which I also check with a 20MHz Clarius ultrasound to ensure there are no arteries at the injection site.
A tell-tale trough of volume loss often occurs horizontally across the forehead as age progresses. This can be ameliorated with filler placed *by cannula* in the space deep to the frontal muscle. Filler injections at this site are not safe, but a cannula used from a lateral insertion can (relatively) safely fill this space, rendering the forehead smooth and more-convex, and thus more youthful
Mandibular border.
Melomental or "marionette" lines.
Smokers' lines.
Cupid's bow
Ergotrid.
Pyramidal fossae.
A-frame-deformity
Ear-lobes.
Pre-auricular lines
Smile lines (aka "accordion lines").
Brows
These are all areas for which dermal fillers can help, and are all areas regarding which I have wide experience and many happy patients.
Peach Cosmetic Medicine
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