What are facial fillers (aka injectables)?

Fillers, or facial injectables, are a general category of injectable medications that are designed to increase volume in specific parts of the face. They are gelatinous in consistency and are based on naturally occurring skin proteins such as collagen and hyaluronic acid. Volume is increased by drawing water into injected areas. The typical problems treated with fillers are deep wrinkles and other areas lacking fullness. Some commonly used fillers are Juvederm®, Restylane®, Belotero®, and Perlane®. Newer generation of fillers typically last up to 12 months. Radiesse and Sculptra are non-hyaluronic acid fillers and typically last longer than the HA fillers mentioned above. Their indications for use are for deeper wrinkle filling and for general volumizing.


Schematic diagram of skin injection of dermal or facial fillers.

There are other substances that serve as fillers.  The most popular of these options is using one’s own fat (fat injection or fat grafting).  By suctioning fat from the abdominal region and purifying it, fat injection can achieve similar results to other fillers.  Although fat injection is considered a permanent type of filler, there are advantages and disadvantages is that the effect can be permanent.


When should I use fillers?

Fillers are used when deep wrinkles set in or the effects of aging and gravity have unmasked volume deficiencies in the face. Permanent wrinkles such as those occurring in the forehead, laugh lines, and crow’s feet are common areas. Even smaller wrinkles such as those occurring between the eyes or around the lips can be filled. Fillers are also helpful for enhancing certain facial features by increasing their volume. These areas can include the lips or cheekbone areas.

Everyone’s genetics are different. Younger patients typically prefer volume enhancement, and older patients may also want to correct deep wrinkles. There is no specific age range to begin treatment. This is a personal choice, but many seek Dr. Panossian’s evaluation and recommendations to guide them in their decision.

One other popular indication for fillers is liquid rhinoplasty. For patients who have small nasal imperfections, fillers can even out problem areas to restore the aesthetics of the nose without the need for surgery. It is an excellent way to maintain a perfect nasal appearance for people who are not ready to undergo a rhinoplasty or revision rhinoplasty. Results last typically one year and must be repeated.


What are some risks of fillers?

Several issues can occur with injection of facial fillers. These mostly have to do with contour problems. Uneven injection of material may cause lumpiness in treated areas. Overcorrection is rare but may occur as well. Bruising can occur if blood thinning agents (eg, aspirin, Motrin, Advil, ibuprofen) have been used within 10-14 days of treatment. Allergic reactions are known to also occur very rarely. If you have had an allergic reaction to a specific filler, please bring it to Dr. Panossian’s attention at the time of your consultation.


What is Dr. Panossian’s technique for injection of fillers?

Injection of facial fillers is more art than science. It should not be taken lightly. Dr. Panossian does not believe in handing off these procedures to other staff members to perform. He performs all injections with an eye for artistry and a deep knowledge of facial anatomy. This is as vital to the safety and comfort of his patients as well as for the final results.

Dr. Panossian is an advocate of the conservative approach to administering facial fillers. While other physicians in the cosmetic world may elect to use large quantities of these products, Dr. Panossian believes in injecting only as much as necessary for achieving the intended results. This not only limits complications but makes these treatments more affordable for patients. His approach to filler injection involves using a blunt cannula to perform injections which reduces the risk of bruising substantially. The success of fillers rests on the experience and knowledge of the person performing the injections. It is important to vary the depth and direction of injections to avoid over- or undercorrection. Dr. Panossian’s passion and extensive experience in this area stands out. Trust your face only to the best!