Injectable Fillers

Asymmetry is a challenge in facial plastic surgery. It is very difficult to achieve symmetry. That said, injectable filler with hyaluronic acid can address thin lips and may improve upon the asymmetry as well.

Injectable filler may result in bruising and/or swelling. If these occur, it may take approximately 3 days to resolve.

Yes, there can be some limitations when performing rhinoplasty on African Americans. First, the nasal skin is typically thicker and more sebaceous, thus limiting the amount of refinement of the nasal tip. Second, the nasal base is typically wider. In order to address this and flared nostrils, an excision is performed; however, there may be a risk of keloid formation. Third, there is typically a paucity of septal cartilage for structuring the nose in rhinoplasty; therefore, alternative sources of cartilage might be needed (ear or rib).

Posted by Rami K. Batniji, M.D., F.A.C.S.

I do not recommend silicone injections to the lips. Rather, I prefer a hyaluronic acid filler to achieve more shape to the lips.

Posted by Rami K. Batniji, M.D., F.A.C.S.

The chin implant I use is composed of silicone. It is well tolerated. For the individual who is hesitant to have an implant, you may consider an injectable filler, such as Radiesse, to provide chin augmentation.

Posted by Rami K. Batniji, M.D., F.A.C.S.

I recommend addressing your allergies first. You may find that the lower eyelids respond nicely to proper allergy treatment. If you still have hollowness of lower eyelids after proper allergy treatment, then you may benefit from injectable filler in the hollow areas to provide a smoother transition between the lower eyelids and cheeks.

Posted by Rami K. Batniji, M.D., F.A.C.S.

The most common complications associated with fillers include bruising and swelling. Certain medications can increase bruising, such as ibuprofen-containing products and aspirin. Therefore, we recommend patients stop these medicines approximately 10 days prior to injections. Also, some homeopathic medicines can increase bruising and swelling, such as Gingko Biloba. There are certain homeopathic medicines that minimize bruising, such as Arnica Montanta; we recommend patients consider this in an effort to decrease risk of bruising. If bruising and swelling occur, it is temporary. Other potential complications include a bumpy contour irregularity following injection. Massage usually alleviates the contour irregularity. However, if this "bump" persists and a hyaluronic acid filler was used (such as Juvederm), then I can inject an enzyme into that bump and it usually resolves within 24-48 hours.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Puffiness in the hollow tear troughs is a potential complication following injection of either Juvederm or Restylane. We minimize this risk by injecting a small amount of filler material within the tear trough. In doing so, we are able to improve the hollowness while significantly decreasing the puffy appearance. If you do experience puffiness following injection of hyaluronic acid in the hollow tear troughs, this is easily corrected with hyaluronidase.

Posted by Rami K. Batniji, M.D., F.A.C.S.

The temple region is an area that may lose volume over time, thus giving a sunken-in appearance to the temples. Radiesse is an excellent filler and I use it for a variety of purposes. However, I prefer a hyaluronic acid for the temples as this product is softer and, I believe, gives a more natural result in the temples.

Juvederm is an injectable filler. It is made of hyaluronic acid which is a substance that is found naturally in our bodies. Unlike collagen, which may require allergy testing, Juvederm does not require allergy testing. We use Juvederm to add volume to specific areas of the face depending upon what the patient's concerns are and what they would benefit most from. For example, the smile lines, also called the nasolabial folds, may become deeper over time. Juvederm is an excellent option for filling these lines and providing a more youthful appearance.

Another use for Juvederm is lip augmentation. Thin lips may result with time or may be due to hereditary causes. In either case, I use Juvederm to add volume to the lips. However, this volume is very natural in appearance. I do not inject too much volume into the lips, therefore I am able to achieve very natural results with natural volume and a natural appearance for the patient. Furthermore, we use a dental block so that the lip augmentation is virtually painless. Another area that I use Juvederm is for deep frown lines. While Botox can help minimize the frowning muscles and thus limit the depth of the line, if the line is very deep Botox alone will not treat this line effectively. Therefore, I use a combination of Botox and Juvederm to provide complete treatment of the frown lines.

I also use Juvederm for the hollowness beneath the lower eyelids. Over time we develop fullness in the lower eyelid region due to bulging of fat in the lower eyelid. At the same time, the cheek tissues descend and lose volume. Juxtaposed in between the fullness of the lower lid and the descent of the cheek is a hollowness that is sometimes called the tear trough deformity, nasojugal groove or infraorbital hollow. While I perform lower eyelid surgery for some patients to transpose or reposition the lower eyelid fat into the area of hollowness, some patients prefer a non-surgical option. In this case, I use Juvederm to fill the infraorbital hollows to provide a more youthful contour between the lower eyelid and the cheek.

While the FDA studies have shown Juvederm lasts approximately 12 months, I see in my patients a variety of lengths of duration for Juvederm. Some of this depends upon the location of augmentation. For example, in and around the areas of the mouth where there is a lot of muscle movement, Juvederm may last approximately four to six months. However, in the lower eyelids where there is less muscle movement, Juvederm may last approximately 12 to 18 months. Juvederm is not a permanent filler and if a patient develops a significant lump, Juvederm can be reversible with the use of an enzyme called hyaluronidase.