For deep “grooves” or “wrinkle lines” in the face, many patients have found that “Botox” injections are not enough, and facelifting is “too much”, so they are good candidates for the injection of “filler” materials into these sites. There are many filler materials available, which historically began with “collagen”, which was derived from bovine (cow) collagen, and required skin testing to be sure the person was not “allergic”. Fillers have now advanced to include perhaps as many as a dozen different pre-packaged products ready to be injected. And, of course, there is the use of one’s own fat, which can be harvested from an area of excess, and then re-inserted into the facial areas desired. The troubles with fat injection is that the process involves more “hands-on” time from the surgeon, which makes the use of this “filler” more costly than the pre-packaged “fillers”. Also, there is more variability in the result from fat “filling”; should this living tissue not get adequate blood supply, it may dissolve, leaving an uneven appearance.

Dr. Scheu has been using two “filler” materials (in addition to the patient’s fat) virtually since each product hit the market. The one with the longest “track record” is “Radiesse” (originally called “Radiance”), and the newer filler is “Juvederm”.

The two have different chemical structures, and the “Radiesse” is generally used for deeper deposition within the facial “grooves”, like in the naso-labial folds. It can also be used to correct contour deficits along the jaw lines or in the cheeks, to enhance the cheekbone prominence, and to even “smooth out” irregular contours in the forehead and nose. The “Juvederm” product is usually employed to fill finer lines with less depth, like in the upper lip in smokers, or to “plump up” the lips. Dr. Scheu usually uses a combination of these two filler products for the best contouring possible.

Since the two main “filler” products have different chemical composition, they react differently with the body’s tissues. “Juvederm” seems to “break down” much more quickly than the “Radiesse” product. Correction of contours with “Juvederm” seems to last only 6 or 8 months (occasionally up to a year), while “Radiesse” usually lasts longer (up to 2 years in some cases). And, since “Radiesse” is not much more costly than “Juvederm” (volume for volume), it is often the “filler” of choice, especially if the lines (“wrinkles” or “grooves”) are rather deep. Only a physical examination can determine what would be the best recommendation for the type and amount of the “filler” to be used, to assess the site(s) of interest for any given individual, and to estimate the cost of the treatment (as cost varies accordingly). Another advantage of “fillers” is that their use is cheaper than surgery or laser treatments, and recovery is typically quicker. Finally, when the benefit from “filler” injections begins to wane in a year or so, the areas can be re-injected easily.

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