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Dermal fillers lift the skin from within to restore lost volume and fullness, while also stimulating the natural production of collagen proteins. These are one of the fundamental building blocks of healthy, youthful skin, alongside elastin proteins, both of which diminish over time as we age. This allows dermal fillers to offer long-term results that continue to improve, not only minimising the appearance of even the deepest wrinkles, but also volumising the skin to create the perfect structure and shape that has been lost over the years. 

• Plump & enhance thin lips, dimish vertical lip lines
•  Smooth out lines around nose and mouth (a.k.a. marionette lines, smile lines, and nasolabila folds) 
• Cheeks and chin augmentation
• Enhance & restore volume to sunken cheeks or temples 
• Improve the appearance of recessed scars
• Reconstruct contour deformities in the face
• Decrease or remove under-eye hollows or dark circles

Hyaluronic acid (HA) is a naturally occurring substance that is already found in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 to 12 months or longer before the body gradually and naturally absorbs the particles. Most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment. 

FDA approved HA fillers include:

• Juvéderm products: Juvéderm XC, VOLUMA, VOLBELLA, VOLLURE
• Restylane products: Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, and Restylane Defyne
• Belotero Balance

Calcium hydroxylapatite is also a naturally occurring substance, found primarily in our bones. When used in a filler, the calcium particles are nearly microscopic and suspended in a smooth gel. The consistency of a CaHA filler is typically thicker than that of a hyaluronic acid filler and typically last longer as well, about 12 months for most patients. Calcium hydroxylapatite is also reported to help stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved CaHA fillers include Radiesse®. 

Click here to see before-after pictures of Radiesse.

Poly-L-lactic acid (PLLA) is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has been used for many years in medical devices, such as dissolvable stitches. Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines is by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment. Poly-L-lactic acid is typically used to treat deeper facial wrinkles, and results can last more than 2 years. FDA approved Poly-L-lactic acid fillers include Sculptra® Aesthetic.

Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. In dermal fillers, PMMA takes the form of a “microsphere” or tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Bellafill® (formerly known as Artefill).  The Off-label use of an FDA-approved cosmetic filler is a safe and common practice by experienced physicians for other aesthetic needs. Find out more about it on next page. 

Wrinkles, deep folds, facial sagging, loss of facial contours are some of the most common concerns of aging patients. We have been treating these with Botox and dermal fillers for many years and over the years the treatment techniques have remarkably improved.

We lose about 1 teaspoon of facial volume per year after age 40. This is due to combined loss of subcutaneous fat, muscle, bone mass and thinning of dermis itself. The result of volume loss is the formation of deep wrinkles, folds, facial sagging and loss of facial contours. Just filling in nasolabial folds or jowls is less than ideal approach to facial rejuvenation. 

We use the JUVÉDERM® or  Restylane® family of dermal fillers, and Radiesse® with BOTOX® depending on the area treated and patient’s prior experience with dermal fillers. The most natural results can be achieved by “lifting” the middle of the face and restoring lost contours which by itself leads to a reduction of nasolabial folds and jowls. A non-surgical approach in experienced hands can accomplish:

• Subtle mid face lift of cheeks
• Improvement in facial contour
• Reduction of deep wrinkles and folds
• A relaxed well rested appearance.
• A happier, friendly smile with elevation of angles of mouth

Non-surgical Skin Tightening and Liquid Facelift

Your skin firmness and thickness is an important consideration with your dermal filler treatment. Excessive skin laxity and very thin skin lead to less than desirable outcome with the dermal filler treatments. To improve the skin firmness and thickness, we may recommend a non-surgical skin tightening procedure such as Fractional Radiofrequency Microneedling with the liquid facelift for your desired results.

Non-surgical skin tightening, dermal fillers, and Botox can improve skin firmness, volume, and deep wrinkles but some individuals may need an actual “lift” of pre-jowls, eyebrows or jawline. For these, we provide the “thread-lift” with absorbable PDO sutures which can be done the same day as the liquid facelift with Botox and dermal fillers.

For patients seeking a way to enhance their profiles, non-surgical Profiloplasty is an option. This is a non-surgical, minimally invasive treatment used to create a more balanced appearance to the face by enhancing the best individual facial features. Most commonly enhanced areas are the jawline, chin, cheekbones, nose and lips.

Instead of surgery, a combination of minimally invasive treatments such as PDO threads, Botox and dermal fillers is used for jawline lift, upper eyelid lift, Botox masseter reduction for facial slimming, cheekbone enhancement, chin augmentation, rhinoplasty, and lip enhancement. Together, these alterations result in more balanced facial proportions. When patients come in for consultations, they often do not realize how much each facial feature influences the appearance of the others; indeed, many cite their most dominant aesthetic features as the area of concern.

Profiloplasty involves enhancement of the facial skeletal framework, such as cheekbones, jawline and chin, and modifying some of the softer facial structures such as the double chin or wider jaw (due to masseter hypertrophy), to achieve aesthetically optimum face shape and contours. Profiloplasty non-surgical face sculpting is achieved by combining a variety of minimally invasive cosmetic treatments to improve facial proportions for enhancement of the overall facial balance and shape.

Non-surgical rhinoplasty, or non-surgical nose job, is achieved with the use of dermal fillers such as Radiesse or Juvederm or Restylane to give you a more refined profile, elevate a down sloped nose tip. Non-surgical rhinoplasty can even out mild to moderate lumps and bumps giving a more aesthetically pleasing nose without resorting to surgery. The treatment may be performed for some people to correct the nasal hump that frequently results from surgical rhinoplasty. This treatment option allows you to improve the contour, profile and aesthetics of your nose without going under the knife. The downside of the dermal filler non-surgical nose job is that the filler is not permanent and requires repeated treatments to maintain the shape of your nose.

Non-surgical nose job is not for everyone. Because there is no surgical incision, there are certain limitations to non-surgical rhinoplasty. Generally, the size of the nose cannot be decreased with the non-surgical rhinoplasty. This treatment is ideal for people with the following:

• Mild to moderate humps and bumps
• Mildly Crooked nose
• Sharp nose angles
• Flattened tip of the nose
• Nasal Depressions
• Small or flat nose bridge

Under-eye hollows and dark circles are common concerns among our cosmetic patients. Under-eye hollows are hereditary and caused by one or a combination of several reasons. The best treatments are those that address the cause or causes of the under eye hollows. The treatment of under-eye hollows for thicker, firmer skin is a little different that that for thinner skin and loss of skin elasticity of the under-eye area.

Safety is a concern when treating the under-eye hollows with a dermal filler more so than other dermal filler treatment areas. It is IMPERATIVE that the treatment provider has a thorough knowledge of facial anatomy and advanced injector skills for this area. The treatment technique and the type of filler need to be taken into consideration for safety and best results from the under-eye hollows treatment.

Risks and Possible Complications From under-eye Filler Injections

Most of the complications associated with hyaluronic acid filler injection in the under eye are mild, transient and reversible. Serious complications are rare and occur due to vascular occlusion. These include cutaneous necrosis and blindness, which although rare can occur due to the compression of the vessel or direct intravascular injection. Use of a correct technique and the appropriate dermal filler can reduce the complication risk. Dr. Rafi likes to inject “thin” or low concentration HA fillers with a blunt cannula using aseptic technique and slow injection method to minimize complications and to achieve natural looking results.

Dr. Rafi uses a Hyaluronic acid filler for the under eye area. HA fillers vary in consistency and formulation which helps me determine the suitability of an HA filler for any particular area. Under eye area has very thin skin and you need to be careful to use the right type of HA filler. At this time, we use the JUVEDERM VOLBELLA XC or RESTYLANE SILK which are much thinner in consistency than other fillers

The traditional HA fillers are much thicker and may lead to bluish discoloration when placed in  the under eye area, a phenomenon known as the Tyndall effect, which is basically is light scattering by particles in a colloid or else particles in a very fine suspension

If age spots, wrinkly skin, or other signs of aging bother you, you can have more youthful-looking hands. Thanks to advances in dermatology, it’s possible to diminish these signs of aging safely and with little or no downtime. 

For age spots, sun spots, fine lines, and crepiness of the skin, the chemical Peels can be used effectively. More than one peels will be required to achieve optimum result.  Laser Therapy can also be used for removal of pigmentation and skin rejuvenation of hands.

When hands lose their youthful fullness, skin becomes lax and starts to develop a crepe-paper-like texture. With less fullness, the veins in your hands also become more noticeable.

To restore lost fullness, we can inject:

• A dermal filler
• Fat from another part of your body

The U.S. Food and Drug Administration (FDA) has approved RADIESSE (calcium hydroxylapatite) and Restylane Lyft to treat the hands. With this filler, you’ll see more fullness immediately. The results last 6 months to 1 year.

Other fillers are also used to restore youthful fullness to the hands. Sometimes a person’s own fat may be the most effective option.