Loss of facial volume is a common trait of aging. These changes produce loss of definition of the cheek, deflation of the lips, and pronunciation of skin lines and wrinkles. Luckily, these can be quickly treated in the office with the use of facial filler injections, also known as dermal fillers. The main objective of a dermal filler is to fill hollow and deflated areas of the face and body, and subsequently soften skin folds and wrinkles. Although dermal fillers are not a substitute for a surgical facial rejuvenation, it is an essential tool that helps individuals amplify or maintain their facial aesthetic beauty without the need undergoing surgery.
Dr. Couto is a board-certified, Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
Dr. Couto specializes in both surgical and non-surgical aesthetic treatments. Therefore, an objective and unbiased recommendation will always be provided during your consultation. The ability to know firsthand what can be accomplished non-surgically and when a surgical intervention is required is a unique and essential quality in the field of aesthetic surgery and aesthetic medicine.
Facial fillers or dermal filler injections is an office-based treatment designed to treat those areas of the face and body affected by the loss of volume associated with aging. In addition, some of these products have intrinsic capacity to stimulate collagen production and hydrate the skin & soft tissue.
Dermal fillers are made of biological synthetic materials that are present in our skin and soft tissue, and thus it is typically compatible with the human body. There are numerous classes of dermal fillers (e.g. hyaluronic acid, calcium hydroxyapatite, poly-L-lactic acid). However, hyaluronic acid-based fillers, such as Restylane® and Juvederm® are the most popular dermal fillers in the market. This is because it is a product that can be easily degraded with hyaluronidase and it blends well with the soft tissue.
Dermal fillers can benefit both, young and older patients. Dermal fillers are excellent for patients interested in enhancing the shape of certain parts of their body, such as the lips, chin, buttock. It is also indicated for individuals exhibiting early or advanced aging changes where volume restoration is required.
On the other hand, patients exhibiting gravitational changes, such as a saggy skin, prominent jowls, and loss of definitions of the jawline and neck, may require a surgical intervention. Facial rejuvenation surgery are procedures designed to specifically achieve those things that dermal fillers cannot: remove excess skin and lift descended soft tissue into an aesthetic pleasing position.
The number of commercially available injectable dermal fillers has increased dramatically worldwide over the past decade. However, there are just a handful of dermal fillers brands that are approved by the US Food & Drug Administration (FDA). Knowing the type and brand of dermal filler being used is crucial, since a non-medical grade dermal filler can result in catastrophic complications. In our practice, we only offer FDA approved dermal fillers, this includes:
Hyaluronic Acid-Based:
Restylane
Restylane Lyft
Restylane Defyne
Restylane Refyne
Restylane Contour
Restylane Kysse
Juvederm Ultra XC
Juvederm Ultra Plus
Juvederm Vollure
Juvederm Volbella
Juvederm Voluma
Calcium Hydroxylapatite Fillers:
Radiesse
Poly-L-Lactic Acid
Sculptra
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the treatment. It is important to tell Dr. Couto if you have recently taken blood thinning medications such as aspirin, ibuprofen, or anti-coagulants, as this can lead to greater bruising. Furthermore, it is important to specify if you have experienced any allergic reactions or complications to filler injections in the past.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a global face and neck rejuvenation.
3) Physical Exam
A complete systematic analysis of the face and neck is performed. Dr. Couto treats the face and neck as whole, not by areas. A youthful appearance is marked by harmonious transitions between different areas of the face. Consequently, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Treatment Plan
Following the physical exam, Dr. Couto develops a personalized treatment plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient if she if dermal fillers will achieve the desired aesthetic looks or if a surgical procedure is required. Dr. Couto will explain in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved to book the procedure with us.
Filler injection treatment is a straightforward and painless procedure that is usually performed in the office following your consultation. First, the area to be treated is numb with topical anesthesia. Once the skin is numb, we remove all the makeup and we clean and sterilize the area. Then we proceed to perform the injections. The entire procedure usually takes a few minutes. Afterward, the nurse will apply cold compression to the site and help scheduling any follow-up appointments or treatments, as necessary.
In order to minimize bruising, we recommend our patients to avoid taking blood thinning medications such as aspirin, ibuprofen, or anti-coagulants, as this can lead to greater bruising.
Recovery time is not required! You can continue with your normal daily living activities following dermal fillers injection. After your treatment, we do recommend applying cold compression to the area to minimize swelling and bruising. We also encourage patients to use Arnica products, as this may help resolve unwanted bruising much faster.
Facial filler injections is only a safe treatment when an experienced and certified injector is performing the procedure. With the increasing worldwide demand of dermal fillers, we are observing a significant amount of uncredentialed personnel performing this procedure. As a result, every week we have patients showing up to our clinic with complications. Some patients have a bad aesthetic result, while others have catastrophic complications, such as skin necrosis due to intravascular injections. The problem with these uncertified injectors is that they lack proper training. This lack of experience not only increases your risk of complications, but they are less likely to know what it needs to immediately do to treat these adverse events. Furthermore, many of these non-certified injectors do not have access to FDA-approved dermal fillers;instead, they commonly use non-medical grade filler materials acquired through the black market.
We recommend to our patient to always do your research before undergoing a dermal filler injection. Enquire about the injector’s credentialing and experience doing dermal fillers. Also, ask about the origin of the product and ensure that FDA-approved dermal fillers are being used.
This is a controversial topic in the field of facial aesthetics, since there is conflicting scientific data. Based on the existing scientific evidence, we can say that the main mechanism of action of a filler injection is to volumize those areas affected with age-related volume loss. Recent studies suggest that facial fillers might provide a minimal lifting effect when used on the lateral aspects of the face. However, it is important to note that this study emphasizes that this lifting effect is minimal and facial filler treatment should never be used to treat saggy, descended saggy skin.
Advantages:
1)Filler injection treatment does not require harvesting fat from your body; thus is a quick, non-invasive procedure that is performed in the office.
2) Recovery time is not required following filler injection treatment.
3) In case of an unwanted result, filler injections can be easily reversed with a degradation reagent called hyaluronidase.
Disadvantages:
1) Although filler injections are made of safe biological materials, these are synthetically produced. During facial fat transfer, fat harvested from your own body is being used to restore volume.
2) Fat is more cost-effective than facial fillers injections.3) Fat provides a permanent volume restoration. On the other hand, filler injections are temporary as they typically last 8-12 months.
4) Fat volume is readily available
