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How Long Do Cosmetic Fillers Last?

How long do cosmetic fillers last?
Cosmetic fillers are very effective non-surgical solutions for facial volume issues such as hollow under eyes lip enhancement cheek definition the lack of chin projection and other problems
related to genetics or age-related volume loss cosmetic fillers can also
treat other issues such as wrinkles lines and folds as well as acne scars
and even thinned earlobes although filler can be used for many
situations some people have reservations about
filler treatment because of concerns about the longevity and about using
something they think is not natural in their body I’ll discuss how I counsel my
patients who have the same questions and concerns about fillers in my practice
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years as an eyelid and
facial cosmetic surgery specialist I’m well known for my work with injectable
fillers in the delicate upper and lower eyelid area as well as deeper placement
of fillers in the facial bone structure for more natural looking results
applying a technique called Structural Volumizing people often want to improve
their appearance caused by loss of volume as we get older our faces
gradually lose bone muscle fat and soft tissue in some younger people a genetic
lack of volume in the face such as in the cheeks and eyes make them look older
and more tired than they actually are facial volume loss can also be seen in
people who are very athletic who have very low body fat this can also be seen
if you’ve lost a lot of weight from diet or weight loss surgery a lot of people
who we see come in requesting fillers which are permanent so they can avoid
having to come back regularly for filler placement in my surgical practice I’ve
had patients come from around the world to have me remove permanent and
semi-permanent fillers such as silicone and poly acrylamide in addition if an
infection such as a biofilm were to occur in its with a semi-permanent or
permanent filler they would have to be removed surgically the reality is that
you can never completely remove this filler material which means that the
possibility of recurrent infections will be more than likely in my practice for
any procedure my recommendations are based first on minimizing risk and being
able to address any issue that may potentially arise quickly and safely I
don’t recommend the use of permanent or semi-permanent fillers further as aging
progresses these fillers will not easily adapt to changing anatomic relationships
there are more than a few celebrities who have publicly expressed regret about
having permanent fillers particularly in their lips in any discussion about a
natural filler the subject of fat grafting always comes up in order to
address facial volume loss at the bone level fat grafting simply cannot be used
fat grafting is placed under the skin which makes it similarly susceptible to
the same issues as superficial filler placement
healing from fat grafting is unpredictable with frequent complaints
about lumpiness and asymmetry fat grafting simply does not meet my
criteria for predictability and benefit from the placement at the bone level my
preferred injectable filler material is hyaluronic acid hyaluronic acid fillers
meet my criteria for safety predictability versatility and
reversibility hyaluronic acid fillers occur naturally in the body which
significantly lowers the risk of foreign body reaction seen with permanent or
semi-permanent fillers hyaluronic acid fillers come in a range of thickness and
longevity allowing me creative flexibility to help my patients look
their best hyaluronic acid fillers are also reversible as they can be dissolved
with the injectable enzyme hyaluronidase how long hyaluronic acid fillers lasts
depend on structure and composition of the filler as well as an individual’s
rate of metabolizing the material I use softer hyaluronic acid fillers in the
under eye area for hollow looking eyes and to camouflage minimal eye bags
further I also use it for the enhancement of the lips these fillers
include Restylane L and Restylane Silk Juvederm Ultra a filler like Juvederm
Vobella can be used for vertical lip lines above
the upper lip these fillers last anywhere between 6 to 12 months before
they are fully metabolized and need to be reapplied I often combine fillers in
the under eye area with platelet-rich plasma or PRP a concentration of wound
healing and growth factors derived from your own blood
PRP helps improve the skin quality and skin thickness under the
as well as improved discoloration and pigmentation which is often seen
accompanying hollowing which is often described as dark under-eye circles
PRP often extends the effective life of filler under the eyes and the two
materials work well together fillers in a medium thickness and viscosity are
often used for the nasolabial folds the folds around the upper mouth and lower
nose often refer to as parenthesis lines in addition the mesolabial folds
the folds around the lower mouth also called the marionette lines these areas
have thicker skin but still have a fair amount of active movement when smiling
and talking both of these types of folds around the mouth become deeper due to
volume loss associated with aging these types of fillers that can be useful in
this area include Restylane Refyne Restylane Defyne which can last about
six to twelve months a filler like Juvederm Vollure also be used and lasts
about eighteen months the thickest hyaluronic acid fillers can be used on
bone structure and an area which doesn’t really move with facial expression areas
where I use these thicker fillers include the upper cheeks the jawline and
the chin these areas are pro to bone loss which naturally occurs with aging
the cheeks appear to deflate due to diminishing cheekbone structure as well
as loss of muscle and soft tissue the jawline may appear to sag and lose
continuity due to hollowing of an area called the mandibular notch the chin can
lose projection as bone continues to decrease I prefer to use a filler like
Juvederm Ultra Plus which can last about a year and Juvederm
Voluma which can last up to two years a filler like Restylane Lyft can also be
applied in these areas and can last up to 18 months successful
placement of facial fillers for diminishing facial volume at the cheeks
chin and jawline is highly dependent on technique most doctors placed these
fillers more superficially at the dermal and fatty tissue layer at this level the
skin cannot support a significant volume and can actually be weighed down by the
filler the fillers can shift and make the face look doughy I use my experience
as a facial cosmetic surgeon with extensive work in placing facial
implants to place fillers at these deeper layers which are on top of the
bone structure and under the muscle layer for more natural-looking results
this technique is called structural volumizing and is a technique practiced
by very few doctors it results in a more defined and balanced facial structure
and can even have a lifting effect by restoring volume at the bone structure
level the skin and soft tissue that may appear to have collapsed and descended
due to volume loss becomes more defined and the overall effect can produce a
vertical lift Structural Volumizing requires more filler than traditional
filler placement as the material is placed at the foundational level of bone
where most of them volume loss occurs therefore more volume is necessary at
this level results can actually last longer than more commonly performed
superficial filler placement this is an exciting time for people interested in
improving their appearance with safety predictability and convenience in my
practice the use of hyaluronic acid fillers has been a great tool for me to
help my patients I would remind anyone considering having fillers to understand
that fillers are just tool or materials used in the hands of a
sculptor the doctor’s expertise experience and artistry are critical to
achieve the best results for you recognizing that filler placement needs
to be done at regular intervals it’s very important for you to find a doctor
who you feel comfortable with this means someone who shares your aesthetic vision
who communicates well and makes you feel at ease I hope you found this
information helpful thank you for your question

Cosmetic fillers are very effective non-surgical solutions for facial volume issues such as hollow under eyes, lip enhancement, cheek definition, the lack of chin projection, and other problems related to genetics or age-related volume loss. Cosmetic fillers can also treat other issues such as wrinkles, lines, and folds as well as acne scars, and even thinned earlobes. Although filler can be used for many situations, some people have reservations about filler treatment because of longevity, and concerns about putting something they think is not natural into their body. I’ll discuss how I counsel my patients who have the same questions and concerns about fillers.

cosmetic fillers injection
Cosmetic fillers are a popular non-surgical procedure to add youthful looking volume.

People often want to improve their appearance caused by loss of volume. As we get older, our faces gradually lose bone, muscle, fat, and soft tissue. In some younger people, a genetic lack of volume in the face such as in the cheeks and eyes make them look older and more tired than they actually are. Facial volume loss can also be seen in people who are very athletic who have very low body fat, or if you ‘ve lost a lot of weight from diet or weight loss surgery.

Patient look younger after cosmetic filler treatment
Hollow faces from aging and/or weight loss can look younger with non-surgical filler application

A lot of people who we see come in requesting fillers which are permanent so they can avoid having to come back regularly for filler placement. In my surgical practice, I’ve had patients come from around the world to have me remove permanent and semi permanent fillers such as silicone and polyacrylamide.

semi-permanent filler removal after complications
Permanent or semi-permanent fillers are prone to complications from infection, foreign body reactions, and difficulty in removal

In addition, if an infection such as a biofilm were to occur, the filler would have to be removed surgically. The reality is that you can never completely remove all the filler, which means that recurrent infections would be likely. In my practice, for any procedure, my recommendations are based first on minimizing risk, and being able to address any issues that may arise quickly and safely. I don’t recommend the use of permanent or semi-permanent fillers. Further, as aging progresses, these fillers will not easily adapt to changing anatomic relationships. There are more than a few celebrities who have publicly expressed regret about having permanent fillers, particularly in their lips.

semi-permanent filler removal surgery
Permanent and semi-permanent fillers require surgical removal, and it’s likely that not all the filler material can be removed.

In any discussion about a natural filler, the subject of fat grafting always comes up. In order to address facial volume loss at the bone level, fat grafting cannot be used. Fat grafting is placed under the skin, which makes it similarly susceptible to the same issues as superficial filler placement. Healing from fat grafting is unpredictable with frequent complaints about lumpiness and asymmetry. Fat grafting does not meet my criteria for predictability and benefit from placement at the bone level.

fat transfer for volume loss
Fat grafting can be done underneath thicker skin, but it is a surgical procedure, and some fat will be absorbed by the body, requiring a second procedure.

My preferred injectable filler material is hyaluronic acid. Hyaluronic acid fillers meet my criteria for safety, predictability, versatility, and reversibility. Hyaluronic acid occurs naturally in the body, they don’t have the same risk of foreign body reaction like semi-permanent fillers.

Hyaluronic acid fillers come in a range of thickness and longevity allowing me creative flexibility to help my patients look their best. Hyaluronic acid fillers are also reversible as they can be dissolved with the injectable enzyme hyaluronidase.

before and after hyaluromic acid fillers on nasolabial and mesolabial folds
Hyaluronic acid fillers can be applied in minutes, without surgery, with thicker fillers lasting 1-2 years.

How long hyaluronic acid fillers last depend on the structure and composition of the filler, as well as an individual’s rate of metabolizing the material.
Longevity of hyaluronic acid fillers

I use softer hyaluronic acid fillers in the under eye area for hollow looking eyes, and to camouflage minimal eye bags, and for plumping the lips. These fillers include Restylane, Restylane Silk, and Juvederm Ultra. A filler like Juvederm Volbella can can be useful for vertical lip lines above the upper lip. These fillers last anywhere between 6-12 months before they are metabolized, and need to be reapplied.

Lip augmentation with hyaluronic acid filler
Lip enhancement is among the most popular cosmetic filler procedures for younger and older people

I often combine fillers in the under eye area with platelet-rich plasma, or PRP, which is a concentration of wound healing and growth factors derived from your own blood. PRP helps improve the skin quality and skin thickness under the eyes, as well as discoloration and pigmentation which often accompany hollowness, often described as dark circles under the eyes. PRP often extends the effective life of filler under the eyes, and the two materials work well together.
Fillers in medium thickness and viscosity are usually used for nasolabial folds, the folds around the upper mouth and lower nose, often called the parentheses lines; and the mesolabial folds, the folds around the lower mouth otherwise called the marionette lines.

nasolabial folds and mesolabial folds treated with cosmetic filler
Nasolabial and mesolabial folds, commonly called smile lines and marionette lines, can be treated with cosmetic filler

These areas have thick skin, but still have a fair amount of movement when smiling and talking. Both these types of folds around the mouth are due to volume loss due to aging. These types of fillers include Restylane Refyne, Restylane Defyne, which last between 6-12 months, and Juvederm Vollure that can last up to 18 months.

The thickest hyaluronic acid fillers can be used on bone structure and doesn’t really move with facial expression. Areas where I use these thicker fillers include the upper cheeks, jawline, and chin. These areas are prone to bone loss which naturally occurs with aging.

Jowls and jawline improved with cosmetic fillers
Jowls and jawline continuity can be improved with thicker filler added into the mandibular notch along the jawbone.

The cheeks appear to deflate due to the diminishing cheekbone, as well loss of muscle and soft tissue. The jawline may appear to sag and lose continuity due to the hollowing of an area called the mandibular notch. The chin can lose projection as bone diminishes. I prefer to use Juvederm Ultra Plus, which can last about a year, and Juvederm Voluma which can last up two years. Restylane Lyft can also be applied in these areas, and can last up to 18 months. Successful placement of facial fillers for diminishing facial volume at the cheeks, chin, and jawline is highly dependent on technique.

Deeper placement of hyaluronic acid fillers in the cheeks can avoid the pillowy look
The Structural Volumizing technique can be applied to the cheeks, without looking soft and doughy like traditional filler placement

Most doctors place these fillers more superficially at the dermal and fatty tissue layer. At this level the skin cannot support a significant volume can be weighed down. The filler can shift and make the face look doughy. I use my experience as a facial cosmetic surgeon with extensive experience with facial implants to place filler at the deeper layers, atop the bone structure and under the muscle layer for more natural looking results. This technique is called Structural Volumizing, and is practiced by very few doctors. It results in a more defined and balanced facial structure, and can even have a lifting effect.

cosmetic filler at the dermal level can migrate and look heavy
Most doctors place filler at the dermal level, where filler can migrate, and look heavy
cosmetic filler placed at fat or soft tissue level
Filler is often placed at the deeper fat or soft tissue level, but it still can’t hold much filler material, and can look soft or heavy

By restoring volume at the bony structure level, the skin and soft tissue that may appear to have collapsed and descended due to volume loss become more defined and the overall effect can produce a vertical lift. Structural Volumizing requires more facial filler than traditional placement as it’s placed at the foundational level of bone e where most of the volume loss occurs therefore, more volume is needed. At this level, results can actually last longer than more commonly performed superficial filler placement.

Y Lift place filler at the bone level
Structural Volumizing/ the Y Lift can place filler between at the bone level, between the muscle layer, which is a much more solid foundation, and the muscle can hold it in place so it looks firm and contoured.

This is an exciting time for people interested in improving their appearance with safety, predictability and convenience. In my practice, the use of hyaluronic acid fillers has been a great tool for me to help my patients. I would remind anyone considering having fillers to understand that fillers are just tools, or materials used in the hands of a sculptor. The doctor’s expertise, experience and artistry are critical to achieve the best results for you. Recognizing that filler placement needs to be done at regular intervals, its very important for you to find a doctor who you feel comfortable with. This means someone who shares your aesthetic vision, who communicates well and makes you feel at ease.

Structural Volumizing by Dr. Amiya Prasad
Structural Volumizing/ the Y Lift allows patients to have youthful volume that looks contoured and full, without looking soft and pillowy like traditional filler placement

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