Which Filler to choose?

For those who are new to fillers, it can be a very daunting and arduous task to figure out what is the best filler for what you are trying to accomplish and at the same time making sure the practice is not just selecting a product based on what best lines their pocket book.   At Ageless MD, Dr. TJ Tsay is very experienced with ALL the different filler manufacturers and ranked top 250 accounts in the entire country for Allergan, one of the top tier accounts with Galderma, makers of the Restylane family of fillers and Sculptra Aesthetics.   He is an artist and sees the face as not just a grid and product not as just a pipet in a laboratory.    He utilizes ALL the fillers in different ways to arrive at the look you are trying to achieve.   An artist that just carries 2 paintbrushes and 3 colors will not be able to maximize their creativity as one that has a spectrum of colors and a myriad of tools to use to create his or her masterpiece.  This is where the science of medicine meets with art of medicine.  We will discuss the different parts of the face and which product best suits those needs.

If you were to divide the face into 3 horizontal segments you would have:   upper third, mid face, and lower face.   

Upper third:  The upper third of the face includes the forehead and temples and maybe even the under eye  area or tear trough deformity.  Fore many individuals their forehead is a source of concern because of hollowness which can give a “neanderthal” look with a prominent brow bone.     The temples can also become more hollow after the third decade of life or from other causes such as accelerated weight loss or stress or illness.    This can be filled in with a number of different fillers including any of the Juvederm family of fillers blended with saline, or any of the softer Restylane fillers such as Restylane Silk or Restylane L, or Restylane Refyne.     Sculptra Aesthetics as well as autologous (from your own body)  fat  transfer can also be used to fill theses areas for a longer lasting and more natural result.  

The tear trough or under eye hollowness (also called “dark circles” or “eye bags”)  is a very delicate area that needs special attention.   This area is one of the most satisfying areas to treat because when you meet someone for the first time, eye contact is the most primal and immediate form of communication and the other person usually looks at your eye and the  area immediately surrounding the eye.  Dr. Tsay prefers a very soft, non hydrophilic (does not like water) and low cohesively filler for this area such as blended Juvederm Voluma XC,  Juvederm Volbella, Juvederm Vollure, Restylane L, or Restylane Refyne.

Mid Face. In the mid face fillers are used to restore volume, give projection, and give 3-dimensional contouring.   In order to accomplish this you want a filler that will withstand shear deformation and compression.  It must be pretty viscous and have high rigidity.  The desired filler should be able to have minimal displacement and keep and maintain the original shape as that when injected.  In scientific terms this translates into high viscosity, low elasticity, and high cohesiveness.  The fillers one would want to use in this area would include Juvederm Voluma XC, Restylane Lyft, Juvederm Vollure, Restylane Defyne, Radiesse, Sculptra Aesthetics, or autologous fat.

For the lower face, there is a lot of movement such as laughing, smiling, talking, yawning, eating a large burger, etc.  You want to use a filler that can integrate and stretch with movement, has minimal projection (no lumps and bumps), and can be easily moldable.   Some good fillers in this area include Restylane Defyne, Restylane Refyne, Juvederm Ultra, Juvederm Vollure.     Part of the lower face includes the chin and Jawline.   Dr. Tsay prefers to use a filler that is structurally rigid and can maintain the shape after injection such as Radiesse, Juvederm Voluma XC, Restylane Lyft,  Sculptra Aesthetics, or Bellafil deposited along the jawline.    Both men and women desire to have a more defined jawline versus a nebulous and indistinct one.    Dermal fillers and/or thread lifting can be used to accomplish this effect.