Are there ways to make fillers last longer?

People are sometimes hesitant about having cosmetic filler treatment because they worry that the results may

not last as long as they would like another reason for hesitation is fear of

ending up with exaggerated looking cheeks particularly after seeing people

in the media with pillowy or doughy looking faces I’ll discuss how cosmetic

fillers can be placed in a way that’s not performed by most doctors I apply

this method every day in my practice and achieve long-lasting and natural results

for my patients 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 New York City and Long

Island for over 25 years I routinely perform facial cosmetic surgery such as

facelifts and the surgical placement of facial implants this surgery based skill

set has been instrumental in my ability to place cosmetic fillers at the deeper

bone level I call this deep placement of filler Structural Volumizing as it adds

structure and definition to the face not just volume the advantage is that you

look natural not overfilled or doughy as a cosmetic eyelid surgery specialist I

believe in having a natural aesthetic in my approach to upper and lower eyelid

surgery I also routinely perform filler treatments for the eyelids lips and nose

these areas are subject to different variables that affect longevity which I

will elaborate about further to begin with when we talk about types

of cosmetic fillers I prefer using hyaluronic acid fillers such as from the

Restylane and Juvederm family of fillers hyaluronic acid exists naturally in the

body so these fillers are safely metabolized over time this is in

contrast to permanent and semi-permanent fillers which can become very complex to

manage in the event of a complication such as an infection or foreign body

reaction there are three variables which impact the metabolization of hyaluronic

acid fillers the physical characteristics like the elasticity and

viscosity the effects of facial movement and the presence or absence of the

enzyme hyaluronidase in a particular anatomic location

generally speaking thicker and more viscous hyaluronic acid fillers last

longer than softer and less viscous hyaluronic acid fillers I place thicker

fillers in facial areas where there tends to be little to no movement such

as the cheeks jawline and chin a thicker filler such as a Juvederm Voluma can

last in these areas for up to two years I find that softer fillers are better

for areas where there’s more movement such as the lips when placed in an area

such as the lips softer fillers typically last about six months to a

year the placement technique used for softer

fillers in delicate areas such as around the eyes and lips is critically

important to achieve an aesthetic appearance with maximal longevity in my

experience this is best achieved using techniques where there is minimal

inflammation and minimal swelling the hyaluronic acid which naturally exists

in your skin plays a vital role in the support and hydration of your

skin as part of your body’s natural metabolic processes the enzyme

hyaluronidase breaks down hyaluronic acid in the skin as new hyaluronic acid

is produced this means that hyaluronic acid placed during a procedure can also

be affected by the hyaluronidase which exists naturally in

your skin since hyaluronidase is not present in

the space between the bone and the overlying muscle hyaluronic acid filler

placed in the space does not break down in the same way as it would in the skin

as I mentioned earlier a major issue associated with conventionally placed

cheek filler is too frequently seen unnatural results like the people

walking around with soft and pillowy looking faces this doughy look is due to

filler being placed in the fat or soft tissue level which is not strong enough

to hold the filler in the intended shape it was originally placed the filler

weighs down the face or migrates to make the face look bloated by performing the

technique I use called Structural Volumizing for deeper filler placement

I’m able to achieve facial definition and more natural-looking results for my

patients this method of placing filler at the foundational bone level allows a

hyaluronic acid to essentially be stabilized by the bone and the overlying

muscle layer my patients look more defined and natural without the risk of

filler migration or their face looking soft or bloated when Structural

Volumizing is performed for the cheekbones chin jawline and jaw angle

it’s referred to as the Y Lift the Y Lift is often referred to as a

non-surgical facelift I found that my experience performing

facelift surgery as well as surgical implants has been invaluable in my

approach to performing Structural Volumizing as a surgeon I’m able to feel

the levels I’m placing the filler in and be certain about the anatomy of where I

am in fact I’ve often observed many well-intended doctors mistakenly

believing that by contacting the bone with the needle while performing filler

placement that they’re placing the fillers at the bone level in actuality

the fillers are placing is being placed at the soft tissue level or just below

the skin Structural Volumizing not only allows for enhanced filler longevity and

better definition but it can also have a lifting effect as we get older and

facial volume decreases due to bone muscle and fat loss this shrinking of

facial structure leaves less support for the skin as a consequence there appears

to be a perception of the skin sagging or stretching when volume is added at

the bone level to rebuild facial structure

a skin lifting effect often results Structural Volumizing does not replace a

facelift for people whose skin soft tissue and underlying muscles need

lifting tightening and repositioning however for a lot of my patients in

their 40s 50s and 60s with facial volume loss that is more

significant than the skin is soft tissue sagging structural volumizing or why

lift can look as if they had a facelift one of the characteristics of Structural

Volumizing is that there is very little use of needles in comparison to

conventional filler placement in fact the precision placement of filler is

done not with needles but rather blunt tip cannulas this strategic application

of blunt tip cannulas means that there is typically minimal to

no bruising swelling or discomfort I often see patients who come in

requesting a facelift assuming that they have sagging skin and jowls they’re

often surprised to learn that what is commonly referred to as jowls may

actually be the result of volume loss at the mandibular notch making the area

appear to be sagging by restoring volume to the jawline particularly in the

mandibular notch area you can achieve a continuous contour and better defined

jawline your profile can be enhanced by improving your chin projection without

placing a chin implant sunken cheeks can be made more full and youthful looking

with a better definition and structure that simply isn’t possible with more

traditional filler placement techniques it’s important to understand that

youthful faces are not just full but also defined and balanced while results

can resemble a facelift the actual procedure to treat the jawline chin and

the cheeks can be done in about 20 minutes

patients can look pretty good right after the treatment and can even return

to work afterwards which is why some patients come in during their lunch hour

I routinely see my patients after two weeks to see how they look after

everything has settled oftentimes doctors try to overcome the limitations

of hyaluronic acid fillers placed in the traditional fashion by choosing or

selecting semi-permanent or permanent fillers which generally tend to be

thicker as mentioned earlier should there be any

complication such as infection these fillers need to be surgically removed

with structural volumizing my patients get better definition

the safety of reversibility unique to hyaluronic acid fillers should the need

arise to have to dissolve hyaluronic acid the enzyme hyaluronidase sold under

brand names such as Vitrase or Hylenex can be used to safely dissolve the

hyaluronic acid without needing to perform surgery by combining

longer-lasting and thicker hyaluronic acid fillers with advanced

techniques such as Structural Volumizing I’m helping my patients look their best

at any age my approach to maximizing safety with

longevity and reversibility has helped my patients enjoy a more youthful look

for much longer periods of time than had been previously possible with

traditional approaches to the application of hyaluronic acid fillers

I hope you found this information helpful thank you for your question