Dermal Fillers

What are Dermal Fillers?

Fillers such as JUVÉDERM® Ultra, JUVÉDERM® Ultra Plus, Vollure®, Volbella®, Voluma®, Volux®, Restylane® L, Restylane Lyft®, Restylane Silk®, Restylane Refyne®, Restylane Dyfine®, Restylane Contour®, RHA2®, RHA3®, RHA4®, Redensity, Radiesse®, and Sculptra® are all types of dermal fillers of various classifications that offer lasting wrinkle correction. These fillers are safe and natural cosmetic products that correct moderate facial wrinkles and folds such as the smile lines, vertical lip lines, “marionette” lines at the corners of the mouth, and tear troughs. These fillers can also be used to re-establish more youthful facial contouring and create a non-surgical lift. Some fillers can be used to improve skin texture, stimulate collagen, and improve skin hydration. There are 3 types of absorbable (temporary) fillers that we use on a regular basis: Hyaluronic Acid fillers (the Juvederm family, the RHA family, and the Restylane family of fillers), Calcium Hydroxyappetite (Radiesse), and lastly, Poly-L-Lactic Acid (Sculptra). These treatments are one of the cornerstones of facial rejuvenation, allowing years to be erased without surgery.

Dr. Stolley and his team of talented injectors are masters of using these fillers alone or in concert with neuromodulators such as Botox/Dysport/Jeuveau/Xeomin/Daxxify combined with energy modalities and advanced skincare, to dramatically rejuvenate your skin.

Hyaluronic Acid

Hyaluronic Acid is a large molecule that is naturally found in the human body and almost all living organisms. The HA found in JUVÉDERM® and other products on the market comes from bacteria. The main difference between the HA found naturally in your body and those found in fillers is that the HA in injectable fillers is cross-linked to each other via a glucuronidate molecule. The body has natural enzymes called hyaluronidase that breakdown the HAs into sugar and water. The HA fillers as a whole are the most versatile fillers available.

Available Hyaluronic Acid Fillers:

• JUVÉDERM® Ultra
• JUVÉDERM® Ultra Plus
• Volbella® 
• Vollure® 
• Volluma® 
• Volux® 
• SkinVive® 
• Restylane-L®  
• Restylane Lyft® 
• Restylane Silk® 
• Restylane Refyne® 
• Restylane Defyne® 
• Restylane Contour® 
• RHA Redensity® 
• RHA2® 
• RHA3® 
• RHA4® 

The differences in the HA fillers are due to how the HA molecules are cross-linked, sized, sorted, and concentrated. These small differences create different properties and affect how they work in the body. Taken together, these properties are known as the rheology of the fillers. Understanding these variables and having a vast working knowledge of how these properties affect how the various fillers behave under the skin and in different areas of the face and body is why experience is key. At MediSpa Maui, we have the most experienced injectors in Hawaii, led by Dr. Brian Stolley, who has over 20 years’ experience and is a nationally recognized expert and trainer. 

Calcium Hydroxyappetite

These fillers consist of calcium microspheres surrounded by a methylcellulose carrier. In 3–4 months, the methylcellulose carrier or vehicle is absorbed, leaving the calcium microspheres behind to stimulate collagen growth, a process known as biostimulation. Radiesse is often used over bony areas due to its firm nature and whitish color. A benefit of Radiesse is the relatively large amount in the syringes—roughly 50% more than the amount of other fillers. This allows for more volume per syringe and some financial savings. Radiesse is often used on the back of the hands and is also used to treat body contour issues such as focal cellulite dimples on the buttocks.

Available Calcium Hydroxyappetite Treatments:

• Radiesse®

Poly-L-Lactic Acid

These fillers are made from a synthetic form of lactic acid (also used to create absorbable sutures) that, when injected, stimulates the body’s own production of collagen. These small particles are mixed with sterile water and injected into areas to stimulate collagen growth, thus thickening the tissue in that area, and to help create subtle volume enhancement in areas in which the tissue has thinned over time. In some areas, they are used deep over the bone, and in others, such as the lateral face and lower cheeks, they can be used under the skin. The benefit of Sculptra is its longevity and subtle, yet significant improvements in skin thickness, texture, and facial contouring. After a series of several treatments, the product can last for 2 or more years, with maintenance doses typically occurring once a year, depending on the initial correction. In addition, the collagen production of this product creates very healthy and luminous skin.

Available Poly-L-Lactic Acid Treatments:

• Sculptra®

What are the Possible Complications with Fillers?

Dermal fillers are great tools for helping patients create a smoother and more youthfully contoured appearance. The right filler can be used in the right place to fill in bothersome lines and wrinkles, improve skin texture, and/or lift and create more youthful facial contouring, giving back what time has taken away. Though fillers are great tools, they are not without their issues and potential complications.

Bruising – Any time you enter the skin and soft tissue with a needle, especially the face, which has many vessels, bruising is possible. Bruises usually resolve within a week, but large bruises can take up to 3 weeks to fully resolve. If a significant bruise occurs, patients are recommended to follow up at our offices to receive special pulsed light treatments that greatly speed up the recovery of bruises. If a patient has naturally dark skin or a tan, these pulses of light will not be offered because the pigment in the skin can result in excessive heating. This could lead to a burn and possibly subsequent complications. Less often, a bruise can leave what is called a hemosiderin stain. This is when the iron from the blood remains in the skin for some time after the initial bruise has resolved. Hemosiderin stains almost always go away on their own, but they can be hastened with the use of a special laser only available on Maui at MediSpa Maui.

Infection – Although rare, injections are possible after dermal fillers. The risk of injection is very small and is limited by the use of alcohol or other tissue disinfectants. If you have a history of recurrent skin infections, cleaning the skin the night before with chlorhexidine soap is prudent. If you have an active injection in the area, we do not recommend treatment. If you have a viral or bacterial infection or think you may have one, we will not perform a filler treatment.

Cold Sore Outbreak – If you have a history of cold sores in an area to be treated, please inform your medical assistant and injector. We will discuss with you the use of an antiviral such as Valacyclovir. This medication can be taken prophylactically to help prevent a breakout or at the first sign of a breakout.

Visible Product – One relatively common problem with fillers is that the product can be visible from the surface of the skin either as a bluish hue or clear lump with HA fillers, a whitish bump with Radiesse®   or as a lumpy/bumpy area with any of the products. A benefit of the HA fillers is that this problem can be removed relatively easily with extrusion of the product or via the use of hyaluronidase. With Radiesse®, the product can be removed via extrusion at times, broken up by injecting saline into the area, or left to dissolve over time, though it may still be visible more commonly with Radiesse®.

Nodules (deeper lumps and bumps) – At times, subtle or significant areas of fullness can be felt under the skin or even seen. If the areas of fullness are not visible and are not bothersome to the patient, they are most often left to resolve on their own. If they are visible, the bumps are often massaged for approximately one month and/or injected with the enzyme hyaluronidase, which will greatly hasten the resolution of the issue.

Arterial Compromise – Though rarely an issue, the most serious complication of a dermal filler is arterial compromise, or the shutting off of arterial blood flow to tissue near or distal to the injection site. This loss of blood flow can result in skin death and, in extremely rare situations, vision loss or stroke.

The expert injectors at MediSpa Maui are always looking for signs and symptoms of arterial compromise and are ready to treat them if needed. Treatment would include first recognizing the issue, then treating it with massage to the area and the application of a warm compress. This can be done by administering aspirin, injecting hyaluronidase into the area to break up the HA filler (if one was used), and administering Nitroglycerin paste to the areas to help open up the blood vessels. Other experimental measures could also be recommended if the signs and symptoms do not resolve.

What are the signs and symptoms of arterial compromise or occlusion?

Dr. Brian Stolley has seen several cases where arterial occlusion was suspected. He was able to treat them successfully, and the patients had no long-term issues. One important warning sign to watch for from a patient’s perspective is severe pain or tenderness minutes to hours after treatment in the area treated or nearby tissue. This is an important sign that cannot be ignored. It is a sign of tissue ischemia (lack of oxygen), and it is your skin screaming out to you to do something. If you experience severe pain described as throbbing, pulsating, and worsening minutes to hours after your treatment, call your doctor. Other signs include whitish discoloration, blue discoloration, or an alternating red/pink/white lacy discoloration. These discoloration patterns can occur at or near the injection site or distally, often originating from the injection site and appearing segmentally from the injection site. Later signs of arterial occlusion include blistering, which can lead to scar formation and eventually scarring and tissue loss. If filler were to be injected into an artery and move distally, tissue injury could occur distal to the site of injection and can include the retina (which could lead to partial or total vision loss on the affected side) or the brain (which could result in a stroke and loss of neurological function in the area of the brain and body affected by the lack of blood flow).

What are the signs and symptoms of a cold sore breakout?

By the age of 49, nearly 60% of the US population had been infected with the cold sore virus, known as HSV-1, according to the CDC. Filler injections do not cause cold sore infections, but they can trigger a breakout in someone who has already been infected. Signs and symptoms of a cold sore breakout include a tingling/burning sensation at the sight of a pending breakout, followed by a blister and surrounding redness on the skin. Antivirals can be used to prevent a breakout by taking them before or immediately after a treatment or to minimize the size and duration of the breakout, but they should be administered as soon as possible, ideally within the first 12–24 hours.

Complications with dermal fillers are rare but can happen. At MediSpa Maui, we are always available for complimentary consultations prior to any treatment. Skillful technique can minimize (but not eliminate) the possibility of complications. We educate all of our patients on the appropriate pre- and post-care that can limit the possible side effects of a treatment.

Contact Our Office

Dr. Stolley is an aesthetic dermatologist located near Maui, Hawaii who is very skilled and has a vast amount of experience with the botox procedure. Contact Dr. Stolley to see how he can help you achieve your desired appearance.

Results

Photos Courtesy of Brian Stolley, MD ~ Individual results may vary.

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    Marionette Lines – Corners of Mouth
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    Lip Rejuvenation and Subtle Nasolabial Fold
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    Lip Rejuvenation
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    Lip Rejuvenation
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    Lip Rejuvenation and Corners
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    Lip Rejuvenation and Corners
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    Lip Rejuvenation – Full
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    Subtle Lip Rejuvenation and Vertical Lines
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    Subtle Lip Rejuvenation and Vertical Lines
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    Marionette Lines and Corners
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    Liquid Lift: Cheeks, Nasolabial Folds and Lip Rejuvenation
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    Marionette Lines

Softened Nasolabial Fold

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  Nasolabial Folds and Smile Lines

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