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    • Dr. Elaine Cook M.D.
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    How to choose dermal filler vs skin tightening

    Which Dermal Filler is Best—Juvederm, Restylane, Sculptra, Radiesse or Fat?

    At Advanced Skin Treatment Center, we specialize in non-invasive anti-aging skin rejuvenation. One of the most popular and most effective methods to help patients look younger, while still looking natural, is to restore volume loss and treat wrinkles with soft-tissue dermal fillers. Some of the questions patients ask me every day:

    Q. Why should I consider dermal fillers instead of just tightening the skin?

    A. Over time, we all lose volume in the upper layers of the skin of the face. This volume loss includes loss of collagen, and hyaluronic acid. Hyaluronic acid is a sugar molecule that naturally occurs in skin providing youthful plumpness, cushioning and stimulates the skin’s fibroblast cells to make new collagen. Elastic fibers damaged from chronic sun exposure and aging, crumble and result in loss of elasticity. Beneath this layer, fat, muscle and supporting bone structure are also lost with aging. Naturally occurring fat pads that normally provide youthful contours flatten and drop. The result of these processes is flattening of the face, sagging and wrinkling. In short, as some people say “my face is falling.”

    Volume loss results in more flattening and a gaunt took, whereas the effect of elastic fiber and collagen breakdown is skin that's lax, droopy and susceptible to more lines. Both volume loss and the breakdown of elastic fibers and collagen within the skin may occur at the same time, and each requires different solutions to tackle the problem.

    In patients with loss of volume, if skin is tightened without replacing the lost volume, an abnormal “pulled” appearance results. Patients who have sagging without loss of volume, may only need tightening and or suspension of falling structures. Some patients need volume replacement only, some need tightening, and some need both for best results.

    Q. It seems like there are so many dermal fillers, how do I know which one I want?

    A: You are right; there are multiple injectable dermal fillers available to restore lost volume. The choice of which dermal filler injection is best for you depends on which specific problem needs improvement, the area of the face treated, whether you are looking for immediate improvement, and desired duration of improvement. In addition, each physician has a preferred group of dermal fillers that he or she feels works best.

    The main groups of dermal fillers include the hyaluronic acid fillers (Juvederm Ultra XC, Juvederm Ultra Plus XC, Juvederm Voluma XC, Restylane-L, Perlane-L and Belotero Balance), poly-L-lactic acid (Sculptra Aesthetic), calcium hydroxylapatite (Radiesse) and fat. Each of these fillers has advantages and disadvantages. My personal preferences are the hyaluronic acid family and poly-L-lactic acid. Hyaluronic acid fillers give immediate, soft, natural-looking, predictable results, and can be reversed if necessary. Poly-L lactic acid stimulates your own collagen production, and is often used for overall reshaping of the face. Results last for 2-3 years.

    Q. I have been reading about the new filler Voluma--what is it?

    A. Juvederm Voluma XC is the new dermal filler, used to give a subtle and natural-looking lift to the cheeks by adding a small amount of volume and contouring. Results appear to last longer than other hyaluronic acid fillers, with improvement seen for up to two years. We are impressed with the results.

    Q. I want to plump up my lips and reduce lipstick lines, but I don’t want them to look like Real Housewives of Beverly Hills. Is that possible?

    A. Yes, it is. Over the years, I have heard, in chronologic order: “I don’t want my lips to look like Goldie Hawn in First Wives Club”, “I don’t want to look like Angelia Jolie”, “I want to look like Angelina Jolie” and most recently “I don’t want to look like that woman on Real Housewives of Beverly Hills”. Interestingly, different parts of the country have different ideas on what looks desirable and the west coast (I am looking at you SoCal) evidently likes the “trout pout” look. In this part of the country…not so much. A subtle and natural looking lip augmentation is definitely doable, and we do it every day. See photos of real results with cosmetic lip injections performed at ASTC.

    For more information about Juvederm, Restylane or Sculptra, or to schedule an appointment with Dr. Elaine Cook at Advanced Skin Treatment Center in Amarillo, Texas, call us at 806-358-1117 or 800-417-SKIN today.


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