Part B Dermal Fillers

Let’s not waste time and jump right in to which fillers I, Leighann Landy, injector at Landy HE, consider best” for which areas and how much a syringe of each will cost you here at the spa. This brings up a good point, fillers are sold by the entire syringe which either comes in 0.5cc or 1cc. This brings me to my next point, how much filler is actually in a 1cc syringe? For all you bakers out there, think in terms of teaspoons. A 1cc syringe of filler is only equivalent to 1/5 of a teaspoon, which means it would take a total of 5 syringes to give you just 1 measly teaspoon. When I learned this, it was easier for me to put the pressure required on the plunger of the syringe of filler.

Remember earlier I said that all of the fillers being injected at Landy HE are made from hyaluronic acid. Hyaluronic acid is a complex sugar that is naturally present in all living cells in our bodies. Hyaluronic acid exists right alongside collagen and elastin in the skin. Collagen keeps your skin looking young and full, elastin keeps your skin elastic, and hyaluronic acid is responsible for maintaining the moisture in your skin. When you inject hyaluronic acid into the skin it attracts water and allows your skin to hold moisture. So, to some degree, hyaluronic acid-based fillers are what we call hydrophilic or water-loving/water-attracting. Therefore, ALL hyaluronic acid-based fillers will somewhat pull water to them, meaning they are going to create more volume than what you see when they are just injected. Some are just more hydrophilic than others. The Restylane family is one of the least hydrophilic fillers and what this makes me think about is if the under eye area had an FDA indication for injection, I would elect a Restylane product to be injected in this area because you do not want any extra water to be pulled into this particular area. 

Choosing between Juvederm and Restylane:

The major difference between these two families of dermal fillers is when it comes to texture and the main difference is, Juvederm is smooth and Restylane is granular. This means a few things:

  1. Juvederm is less likely than Restylane to leave bumps” during the injection process.
  2. Restylane tends to integrate with your own tissue better than Juvederm due to its granular composition and as a result, looks better in places that need a fuller effect. Because of its cohesive properties,
  3. Restylane tends to stay in place after being injected. This property, in particular, tends to be my favorite property in a dermal filler; being able to mold them into the area you want them or smooth them to create the contour you desire.
  4. When it comes to longevity, both of these fillers last several months but the consensus is that Juvederm may be somewhat longer-lasting.

Facts about fillers at Landy Headache & Esthetics and Leighanns, LAs preferences.

CHEEKS: Voluma- 2 syringes to be precise, 1 syringe on each side. Injected along the zygomatic bone in multiple injection sites depositing a precise amount in each site to create symmetry. Cost: $800 per syringe.

CHEEKS: Restylane Lyft- 2 syringes, 1 on either side injected in the same manner as voluma going deep into the cheeks down to the covering of the bone and depositing the same amount of filler (0.1-0.2) in each injection site along the zygomatic bone to create symmetry. Cost: $600 per syringe.

LIPS: Restylane Kysse, Juvederm Volbella, and Vollure- 1 syringe injected into the lips using the Russian lip tenting” injection technique to give the lips a nice semi-flipped look. The infamous duck lip” is most likely due to your injectors technique. Fortunately, Im not a fan of that look! Cost: $700 per syringe.

Restylane Refyne and Defyne: 1 syringe for someone with marionette lines or nasolabial fold concerns, 1 syringe on each side for a total of 2 syringes for someone with DEEP nasolabial folds. Cost: $650 per syringe.

Juvederm Ultra and Ultra Plus: Has FDA indication for the lips and nasolabial folds as well. I currently do not have a favorite place for either of these but will have them for those individuals who request them. Cost: $600 and $625 per syringe.

Restylane Silk: 1 syringe in the lips and etched in vertical lip lines. Silk does particularly well in those pesky vertical lip lines. Cost: $600 per syringe.

Fun facts about fillers you probably didnt know!

Progressive cities inject filler into patients noses who have a hump they are not happy with for a liquid rhinoplasty.

Dr. Rajani, this guy is AMAZING, injects filler into the point of the chin to elongate the look of someones lower face/jaw area.

Sculptra, a poly-L-lactic acid (PLLA) filler that works well at stimulating collagen in the deeper layers of the skin, is used progressively in bigger cities as a butt lift” procedure. Since this is NOT FDA approved, there is no research done to evaluate its effectiveness.

Currently, the FDA hasnt approved any filler on the market for the under-eyes or nose. It takes rigorous research to get the FDA’s approval on any medication on the market.

If you would like to save money on any of these prices, my recommendation, depending on the product you want, is to sign up for rewards points or programs at either Galdermas, www.aspirerewards.com or Allergans, www.alle.com. Both of these programs keep up with filler that you purchase from here on out and as you build up points, points turn to dollars.

A few pearls of wisdom if you are getting injected with filler in the near future.

  1. I think, first and foremost, it is worth mentioning that the new Moderna COVID-19 vaccine has caused facial swelling in 3 recipients who had previously been injected with dermal filler. 2 of the vaccine recipients had received cheek filler within the last 6 months and 1 had lip filler 2 days after receiving the vaccine. The FDA did find that this swelling resolved after treatment of the patient with oral steroids or antihistamines. The Pfizer vaccine has not, to date, had any swelling noted with their vaccine. In my opinion, DO NOT TURN DOWN THE VACCINE because you have had dermal filler in the past. The risks of contracting COVID or suffering from the VERY SERIOUS EFFECTS of this virus outweigh the potential to develop temporary facial swelling if you have received dermal fillers in the past. I also think it is important to note that this swelling was only noted in 3 recipients of the Moderna vaccine.
  2. The lips are vascular and bruise and swell quite easily. You can attempt to combat the bruising by finding arnica tablets from the homeopathic section of your local pharmacy. Arnica is a natural anti-inflammatory and if you start taking it as directed you can potentially decrease the severity of bruising you experience.
  3. If you take NSAIDs, BC, or excessively drink alcohol regularly, you are going to bruise and bleed more than the next person. It is best to stop taking these types of medications about 5-7 days before you are scheduled for your filler to be injected. If you are on prescription NSAIDs, please check with your prescribing MD to be sure it is ok for you to stop these before injections.
  4. Another good thing to know before going in for lip filler is that the lips are very sensitive to injections, especially the cupids bow of the top lip. Here at LHE, we have a specially formulated topical numbing cream that has been specially formulated for our patients and you can apply this to the area you are getting injected for 30-45 minutes. 
  5. Surprisingly, the cheeks do not hurt that bad when they are getting injected, but they can be a bit sore for a week afterward.
  6. Filler is moldable for a few hours after it is injected, this also means that you can change the shape of it with enough pressure.
  7. Any loss of color, severe pain or dark discoloration noted at the site of injection of filler is an indication worth calling your injector ASAP!

This two-part blog has been a ton to take in, but hopefully, it has been quite informative and has given you a bit of insight into the dermal filler aspect of the aesthetic world! Stay tuned and check back for my next blog on Botox, the quintessential botulinum toxin!