Focus on Dermal Fillers (For Scarring, and Wrinkles): Part I

Dr. Hema Sundaram Health Guide
  • One of the defining moments of my career as a cosmetic surgeon is the first time I treated a patient with a dermal filler, over fifteen years ago during my dermatology residency at the University of Chicago. The patient was a woman who had been plagued with acne throughout her adolescence, and the resultant scarring had ravaged both her face and her psyche.


    She had passed through her formative years defined by herself and others as "the girl with bad skin." Now in her late 30's, her acne had cleared, but the scarring had become more noticeable as her skin lost elasticity. The filler that I used was collagen purified from cows' skin (bovine collagen) - the only filler approved for use in the U.S. at that time. I was immensely moved that a few teaspoons of filler injected in a few short minutes could produce such amazing results.

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    The visible improvement in this woman's skin was impressive, but it paled in comparison to her psychological transformation, as I could see from her newly confident stride and the shift in her wardrobe from demure, earth-toned dresses to snappy separates in bright primary colors.


    As filler options have expanded in the past few years, so too have the treatment possibilities. I get the best results from Restylane, Perlane and Juvederm, which are biosynthetic forms of the sugar-based hyaluronic acid that is naturally present in your skin. I often combine these treatments with injections of the patient's own natural fat, removed from where it is not wanted and replaced where it is needed.


    There has been a paradigm shift in how expert cosmetic surgeons are using fillers: no longer just for wrinkles and scars, but for targeted volume replacement that directly addresses the aging process and when skillfully performed, produces a non-surgical face lift. Re-volumization with dermal fillers reflects today's deeper understanding of the aging process and how to reverse it.


    To use a musical analogy, if my transition from collagen to Restylane and Juvederm was like switching a one-note piano for a baby grand, then I have found the addition of deeper volumizers, such as Perlane, akin to adding a full symphony orchestra. Lest this sound like mere hyperbole, please note that I hail from England, where hype is considered-well-a four-letter word!


    Besides filling lines around your mouth, nose and elsewhere on your face, dermal fillers can be injected just beneath the surface of your skin to fill under-eye hollows, to restore youthful fullness to flattened cheeks and eyebrows, to lift a downturned mouth and to make thinning lips full again.


    With gentle, expert technique, all that is needed is a little numbing cream beforehand on the areas to be treated, and you can return to regular activities immediately after treatment. Fillers such as Perlane and your own natural fat are also very useful for rejuvenation of bony, veined or wrinkled hands; they are injected beneath the skin to restore lost volume so that your hands look smooth and youthful again. This technique is growing in popularity, as we recognize that your hands can betray your age even when your face doesn't.


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    Patients are often surprised that non-surgical treatment with dermal fillers can produce such a dramatic yet natural-looking rejuvenation, while preserving their own individuality. They look years younger but without the telltale signs of invasive plastic surgery such as too-tight skin, a look of permanent surprise or a cookie-cutter "done" look.


    These days, when I'm treating patients in my offices in suburban Washington, DC and training other cosmetic surgeons in expert techniques, I often think of Albert Einstein, who said that true art is characterized by an irresistible urge in the creative artist. I think this statement applies equally well, whether the artist's canvas is paper or the human face. You will obtain the best results from dermal filler treatment if you select an experienced surgeon with a thorough understanding of ideal facial anatomy, an artistic eye, and the skill to use dermal fillers for true non-surgical face lifting, rather than mere wrinkle-filling.

Published On: April 07, 2008