Fillers

As we age, our faces are one of the first areas to change. We lose some of the fat under the skin, our facial muscles work closer to the skin’s surface, which means smile lines and crow’s feet become more noticeable. The facial skin also stretches some, exacerbating the loss of facial volume. Fortunately, at the Jonathan Zelken, MD for Aesthetic Medicine, you have plenty of minimally invasive options to restore your youthful appearance.

WHAT ARE DERMAL FILLERS?

Dermal fillers give you a more youthful appearance by helping to diminish facial lines and by restoring volume and fullness in the face. Though the process can be accomplished quickly in an office, it’s in your best interest to trust a board-certified plastic surgeon like Dr. Zelken, who has specialized training and a vast knowledge of facial anatomy. Alternatively, you will love Aesthetic Nurse Miki Omori, who has observed filler procedures for over 5 years and was handpicked and hand trained by Dr. Zelken. Dr. Zelken and Nurse Miki will be able to recommend and inject an appropriate filler, giving you natural and youthful results. You’ll look like the best version of yourself.

Dermal fillers are used for a variety of purposes, including to plump thin lips, enhance shallow contours, soften facial creases and wrinkles, improve the appearance of recessed scars, reconstruct contour deformities in the face and decrease or remove the shadow of the lower lids. While dermal fillers can help with the early signs of aging, they cannot achieve the same results as a facelift, brow lift or other surgery. As with any medical procedure, complications can arise, which is why you should rely on a skilled plastic surgeon like Dr. Zelken or nurse injector like Miki Omori, RN for your safety and for optimal outcomes.

ARE DERMAL FILLERS RIGHT FOR YOU?

Some clients might benefit more from surgery, such as a facelift or brow lift. For others, though, dermal fillers are a quick and easy way to look their best almost immediately. Dr. Zelken, Nurse Miki, and their team will help you make the best choice based on your particular situation and your goals. If it’s determined that dermal fillers are right for you, we will make sure that you are physically healthy, you are a nonsmoker and that you have realistic goals in mind for the improvement of your appearance. It’s also important that you’re committed to maintaining good skin health. And also that you understand dermal fillers are temporary treatments; ongoing treatments may be needed for long-term results.

BEFORE YOUR DERMAL FILLERS PROCEDURE

Prior to any dermal filler procedure, you will have a consultation with Dr. Zelken or Nurse Miki, and their team. This is the perfect time for you to ask us any questions you might have regarding your procedure. We will have questions for you pertaining to any medical conditions you may have, and we will want to know about your drug allergies, current medications, vitamins, herbal supplements, alcohol, tobacco and drug use. Be prepared to document any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other non-surgical facial procedures, as well as any prior facial surgery.

During this time, Dr. Zelken or Nurse Miki will use their years of experience to recommend the best type of filler for your case. We will also explain the outcomes of using soft tissue fillers, the longevity of the result and any risks or potential complications. You will be asked to sign consent forms to ensure that you fully understand the procedure. While severe complications from dermal fillers are uncommon, risks do exist, including acne-like skin eruptions, asymmetry and infection at the injection site. In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers do dissipate over time, so in order to maintain your new appearance, you will need to consider repeating the injection process at intervals.

OUR DERMAL FILLERS ARE TAILORED TO YOUR NEEDS

CALCIUM HYDROXYLAPATITE

Calcium hydroxylapatite, which is known commercially as Radiesse (among other brand names), is found naturally in human bones and is a mineral-like compound. It’s often used to lessen the appearance of moderate and severe creases, such as nasolabial folds, marionette lines and frown lines. It can enhance fullness of the cheeks and other facial contours and improve volume in areas of facial wasting. Calcium hydroxylapatite is biosynthetically produced, which means no animals or animal products are used. This lowers your risk of an allergic reaction and it means no skin testing is required. This type of dermal filler is known to produce a very natural result, doesn’t migrate and has minimal side effects.

HYALURONIC ACID

Hyaluronic acid, a natural substance found in your body, is marketed as Captique, Esthélis, Elevess, Hylaform, Juvederm, Perlane, Prevelle, Puragen and Restylane. The injections can be used to improve the skin’s contour and reduce depressions in the skin due to scars, injury or lines. It is indicated for everything from acne scars, cheek depressions, crow’s feet and frown lines to deep smile lines, marionette lines at the corners of the mouth, smoker’s lines and some facial scars. Hyaluronic acid has become one of the most popular kinds of injectable fillers. It’s actually the same substance often injected into the joints of arthritis patients to ease pain and provide extra cushioning.

POLYALKYLIMIDE

Polyalkylimide is a semi-permanent dermal filler used by plastic surgeons to treat deeper wrinkles, such as nasolabial folds or depressed scars, plump thin lips, enhance cheekbones and the jawline, and to replace facial volume lost due to age and treat facial wasting from HIV medications. Aquamid is one of the more popular brands of polyalkylimide on the market. It has very little reaction with human tissue, meaning it’s biocompatible, and no allergy test is required — it also won’t interfere with x-rays. After the injection, a thin layer of collagen slowly forms over the course of about a month until the gel is eventually completely surrounded.

POLYLACTIC ACID

Polylactic acid, known popularly under brand names such as Scupltra, is a synthetic dermal filler that’s injected into your face, causing your body’s own production of collagen. This type of dermal filler is known as a stimulator. It’s non-toxic and biodegradable, and it has been used for more than 40 years as suture material. Polylactic acid is known to work particularly well in the lower half of your face to fill the lines caused by laughing, plump thin lips and treat deep nasolabial folds. Polylactic acid is unlike other dermal fillers because it doesn’t produce immediate results. Instead, it stimulates your own body’s collagen production, so results appear gradually over a period of a few months. You will likely need about three monthly treatments to achieve your desired results. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.

POLYMETHYL-METHACRYLATE MICROSPHERES (PMMA)

PMMA is considered a semi-permanent filler and is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips. It appears on the market under a few brand names, including Bellafill. When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, Dr. Zelken and Nurse Miki will likely under-fill on the first treatment, adding more later if needed. In most cases, a number of injections are needed to create volume, so it can take up to three months to realize the full effects. To avoid any unwanted results, it’s important you rely on a plastic surgeon like Dr. Zelken, or Nurse Miki who are familiar with the proper technique.

DURING YOUR DERMAL FILLER PROCEDURE

Dr. Zelken and Nurse Miki will first assess your facial appearance and skin tone and examine the areas of your face to be augmented. Strategic points on your face may be marked as the appropriate injection sites for the filler. We may also take photographs of the areas to be treated. The injection sites will then be cleansed with an antibacterial agent. Dr. Zelken or Nurse Miki may alleviate pain at the injection by using a very cold instrument to chill the skin, anesthetic ointment to numb the skin or possibly injection of local anesthesia. While not painless, the injections are usually easily tolerated.

The injection usually takes only a few moments per site. The process of injecting, massaging, and evaluating the result will be performed, and Dr. Zelken or Nurse Miki will inject additional fillers as needed. Depending on the number of areas to be treated, the whole process may be as short as 15 minutes.

AFTER YOUR DERMAL FILLER PROCEDURE

Once we have achieved the best results for your face, any markings will be cleansed off and you may be offered an ice pack to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.

Recovery time varies for each patient and for each type of filler injected, but you can resume most activities right away. However, we recommend that you avoid intense physical activity for the first 24-48 hours to minimize swelling and bruising.

When your own fat is the injected filler, the healing process is longer and may take a few weeks. That said, the results of soft tissue augmentation using dermal fillers are apparent immediately and, depending on the filler used and the patient injected, will last from several months to several years. Maintaining good overall health and caring for your skin with appropriate products and skin treatments will improve the results and longevity.

MAKE SURE TO CHECK BEFORE YOU INJECT!!! ASK THE FOLLOWING QUESTIONS:

• Are you certified by the American Board of Plastic Surgery?
• Are you a member of the American Society of Plastic Surgeons?
• Were you trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• How long of a recovery period can I expect and what kind of help will I need during my recovery?
• What are the risks and complications associated with dermal fillers?
• How are complications handled?
• How can I expect my skin to look overtime?
• What are my options if I am dissatisfied with the cosmetic outcome of my procedure?
• Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?

ARE YOU READY FOR A CONSULTATION?

If you’re considering dermal fillers to help combat your aging process or if you have questions about your options, don’t hesitate to contact us or schedule a consultation with Dr. Zelken. We’re located at 1617 Westcliff Drive in Newport Beach, CA, and we can be reached at (949) 432-4730. We serve patients from across the world — we have a Mandarin Chinese-speaking physician — along with clients in Newport Beach, Huntington Beach, Irvine and Laguna Beach, California.

FAQ

SHOULD YOU CONSIDER FAT INJECTIONS?

Fat injections use fat harvested from your own body that can then be re-injected to enhance facial fullness, fill creases or build up shallow contours. They require a more extensive procedure than the "off-the-shelf" soft tissue fillers listed above. First, a "donor area" must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft. The grafted fat then has to redevelop a blood supply in order to survive. About 50% of the fat injected will survive, and the surviving fat will last forever. Typically, multiple fat transfer procedures will be needed to achieve the best results. The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure, but you will have to decide if the benefits will achieve your goals and if the risks and potential complications of dermal fillers are acceptable.

WHO MAY INJECT BOTOX, FILLERS, AND THE SORT?

A skilled RN, NP or PA, under the supervision of an MD, may inject Botox or Fillers in the State of California. If your injector does not have these letters after their name, they are not qualified to inject you. Many providers are called “nurse”, but this does not necessarily mean RN or NP.

WHAT CAN I EXPECT DURING A DERMAL FILLER PROCEDURE?

First we assess what areas you are looking to have treated such as softening smile lines, plumping up the lips, or raising cheeks. We then use a topical numbing if you desire for extra comfort. While the topical numbing sets in, we will determine what dermal filler will be best for you. Dermal fillers are then administered by injection. You can expect to have minimal discomfort and the procedure takes a few minutes!

WHAT IS THE DOWNTIME FOR DERMAL FILLERS?

Dermal filler placement is done by injections using a very fine needle. As a result, you may have slight bruising but nothing that some cover-up can’t fix! If you bruise easily or end up with a bruise, you can take some Arnica and eat some pineapples so the bruising subsides faster. Other than the slight bruising that you may or may not obtain, there is zero downtime!

HOW ARE DERMAL FILLERS DIFFER FROM NEUROTOXINS SUCH AS BOTOX?

Both dermal fillers and neurotoxins are used for aesthetic treatments to combat aging due to the appearance of fine lines and wrinkles but they do indeed work differently. Dermal fillers are injected and fill areas of the face that have lost volume overtime which can cause wrinkling. Neurotoxins, on the other hand are injected into the facial muscles to decrease the amount of muscle movement to prevent wrinkles from forming or further deepening.