Facial Fillers: Juvederm and Restylane

Facial Fillers: Juvederm and Restylane
Remember, a grape and a raisin are exactly the same thing-- a raisin has just lost volume. With age, most faces lose fat and fluid volume which is why the skin appears thinner and wrinkles occur.
Facial fillers, which are much like pancake syrup in a syringe, refill the decreased volume and create a more youthful effect when precisely used and manipulated correctly until they become firmer in approximately 5-7 days. The nice part about using fillers is you can always add more, and yes, you can remove fillers in some areas to decrease an undesired affect. Women love these fillers in lips.  Some reported examples somewhat recently were Jennifer Anniston, Britney Spears, and Kelly Ripa.  Women instinctively use lipstick for color but more importantly, they stretch their lips to spread the fissures in the lips and fill them with the waxy lipstick. This gives it a softer and smoother appearance to the lips. Fillers add the same volume inside the lips to remove these fissures and gives enhancement or enlargement to the lips.
More importantly, women use the color of lipstick to enhance a definitive margin of lip vs. face. This is called the vermillion border. By very carefully outlining the vermillion border with minimal filler, this distinctive margin becomes much more apparent and much more aesthetically pleasing. This takes about 30 – 45 minutes to properly produce.  If a "medical-type" person injects your lips in less than 3 minutes, they are bigger but they may not be aesthetically blending and pleasing as they could be.  It simply takes a lot of time and tweaking to get the proper, exact look.
These fillers are also great at filling in the tear troughs; these are the 45 degree whack lines coming from just below your eyes where they meet the nose laterally. They appear black because the fat pad in your face has settled down lower into the cheek bur they are not actually black--they are just a shadow. Hyaluronic acid injected underneath these lines remove the shadow, adds volume, and takes away the dark look under your eyes. 
Usually at the same time, women sometimes as early as 35-40 years of age and almost always by the age of 50 have a decreased bone re-absorption near the eyebrows, making the eyebrows look smaller, more hairless, and creating a trapezoid pattern from the chin, cheeks, and to the eyebrows. This is called the "trapezoid of terror." By adding volume back behind the eyebrow with just a few millimeters of the filler, this brings back the triangular look across the top of the brows. Additionally using the filler from the paranasal area down to the corners of the mouth works excessively well.  However, reversing the mouth with Botox creates a less upside-down “U” to the mouth. Reducing pressure on these lines usually uses about half the amount of these fillers, creating a happier facial look at a lower cost.
"Candying the apple" (like the expression, "apply blush to the apples of your cheeks") by enhancing the cheeks, much like those Hillary Clinton, adds fullness and a happier look to the face and can accentuate an Asian look or simply a happier expression via the cheek areas.
Combining Botox to the lateral one-third of the eyebrows creates a seagull wing affect, which gives it a very feminizing look. These are just some of the many creative techniques that can be used for fantastic enhancements, but they take time, experience, and in-depth discussion between the doctor and the patient to create the desired effect.
John Laurusonis, MD
Doctors Medical Center