At MediSpa Maui / The Stolley Center, we incorporate many different treatments, devices, and techniques to help our patients look their very best. Many of you have heard or read about how I classify rejuvenation treatments into minimally invasive techniques. While those techniques work from the inside out, we do also offer surgical techniques. See my list of strategies, or as I call them, “Pillars of Rejuvenation” and then let’s jump into a discussion about pillar #6 and the focus of our discussion today: Fillers and Collagen Stimulators.

Doc Stolley’s “Pillars of Rejuvenation”:

1)Functional Medicine: Functional medicine is all about working from the inside-out with nutrition, supplementation and detoxification that work to optimize the body’s functions. Meet our naturopathic physician, Dr. Teri Jackson and let her guide you to a better functioning self.

2)Optimal Skin Care: Using the best and most bioavailable active ingredients, such as those found in SkinCeuticals, as well as optimal sun protection and decreased damage from oxidative stress. (Be sure to join us for our Skincare Day and Jane Iredale Makeup Day every month.)

3)Neuromodulators: Botox, Dysport and Xeomin to relax action lines such as the frown, forehead and squint lines, but also the “bunny lines”, vertical lip lines, chin wrinkles, enlarged jaw muscles and neck bands. They can also be used to decrease sweating!

4)Surgical Procedures: Face lifts, neck lifts, brow lifts, eyelid surgery and nose surgery from our acclaimed facial plastic surgeon, Dr. Carlo Honrado.

5)Energy Modalities: Using energy based medicine from lights, lasers, radiofrequency, focused ultrasound, percussion therapy and cold based therapy with our state-of-the-art technologies and expert providers.

6)Fillers, Collagen Stimulators and Fat Dissolver: Using Fillers to return more youthful contouring to the face, restoring the “Triangle of Youth”, enhancement of lips, nasal augmentation and jawline recontouring.

Now, Let’s Take a Closer Look at #6: Fillers & Collagen Stimulators


Hyaluronic Acid Fillers

The most common fillers used today are hyaluronic acid fillers, and you’ll be pleased to know that Hyaluronic acid is actually found naturally in the human body. The hyaluronic acid in injectable fillers only differs in the fact that it is “cross-linked” to allow it to stay in the tissue for a longer period of time then “free” hyaluronic acid. How the filler is cross-linked and the different sizes and concentrations of fillers determine their characteristics once injected. Different fillers work better in different parts to the face and some last longer than others. In fact, one filler may last longer in one part of the face than another. The cause for this can be anything from motion, friction, to circulation. Hyaluronic acid fillers are naturally broken down by enzymes that the body produces and can also be broken down by enzymes injected into the area, making these fillers both versatile and reversible. For all of these reasons, the hyaluronic acid fillers are the most commonly injected fillers in the USA and around the world.


Another injectable filler in a different class, is called Radiesse.  Radiesse is made out of calcium hydroxyapatite, the main ingredient in bone (although this product is not animal derived.) Radiesse works both as a filler and a mild collagen stimulator. I will often use Radiesse on the back of the hands but I don’t use it common on the face as it can be a bulkier filler. In my opinion, the HA (hyaluronic acid fillers) have several advantages over Radiesse.


Also in the filler/collagen stimulator class, is Bellafill.  Bellafill has the distinction of being the longest lasting filler. In fact, it is considered a permanent filler because the PMMA microspheres contained in the product are never broken down by the body. I have years of experience with this product, but I now mostly use it in scars. While I have many very happy, great looking patients that have had them for years, I like the reversibility of the HA fillers. I also find that it takes a lot less HA filler to get the desired results, resulting in less of an investment for my patients.


The last product to talk about is called Sculptra. Sculptra is considered a “pure” collagen stimulator, meaning this product does not work as a filler but rather a catalyst to build your own collagen. I especially like this product in my patients who have lean faces with good bone structure, that need subtle amounts of volume in many areas of the face. Sculptra can also be used in the depressed areas of cellulite and some are using it in large amounts for gluteal lifts.

Fat Grafting

I should also mention the use of fat, also known as fat grafting. Years ago, before I learned how to do fat grafting, I felt that this could be the solution to most patients’ filler needs. After detailed and intensive training, I determined that fat grafting is not the ideal treatment for most people for several reasons.

1) Only a fraction of the fat injected stays to create long term results. That means that patients need to be significantly overfilled to gain the result they are looking for.  (As you can imagine, most of my patients do not want to look like a cabbage patch doll for 2 weeks.) To top it off, many patients need a second treatment for ideal correction, so that overfilled look is now at least 4 weeks.

2) Fat is very temperamental. Some syringes do well in the body and others don’t. Because it takes multiple syringes to get the result you are looking for, if one syringe lasts in the lips on one side of the face and the other syringe does not last, then you have a long-term asymmetry issue. Not good.

3)There are much higher levels of infection with fat grafting, which is very rare with other fillers. I am hopeful that one day fat grafting will be the cornerstone of facial contouring but at present, I prefer the predictability of the “off the shelf” fillers and collagen stimulators.

Patient 1 (click image to view)

PRP and PRF as fillers

These products are better classified as skin conditioners. They do not do so well in regards to improving youthful facial contouring. Put another way, they are not ideal to give back volume where it has been lost. PRP and PRF are better at improving the health of the skin and they are also good for stimulating hair growth in both women and men. For men, it is best if hair loss is within the last 5 years or if they have been using finasteride on an ongoing basis.

Most of our patients do not just do one kind of treatment but rather a several, spanning across the Pillars of Rejuvenation to really look their true best. Most are doing neuromodulators, fillers, and Ultherapy to tighten the skin in the lower face and lift the brows; photorejuvenation to help their skin looks its best; and optimal skincare with the best inactive ingredients and sun protection.

Our goal at The Stolley Center / MediSpa Maui is to give patients healthy and beautiful looks that never seem “treated”. We are experts at providing combination treatments to help our patients actually achieve their health and aesthetic goals.

I am proud of our team of dedicated health and aesthetic professionals and I am confident that we can help you look and feel your very best. In my next post, I will review the principles of how fillers and collagen stimulators are used to help re-establish more youthful facial contouring, including bringing back that Triangle of Youth. Stay tuned.

For a free consultation contact MediSpa Maui at 808-879-4909.

Patient 2 (click image to view)

Patient 3 (click image to view)

Thank you,
Brian Stolley,  MD