Many patients who are interested in rhinoplasty (nose job surgery) are often anxious and scared. Some would like to change the shape of their nose without surgery. This can be sometimes achieved using fillers. HA type fillers can be injected to mold and shape the nasal bridge and sidewalls without the surgery and the result can last up to a year.

There are different types of fillers for your facial lines and wrinkles. The most common type is a hyaluronic acid type (HA) filler. These include fillers such as Juvederm, Restylane, and Perlane. They are similar but not identical. For example, Juvederm has a gel like consistency, which gives great results for lips and fine lines. I find that I can inject Juvederm much more superficially than Restylane or Perlane.  For smile lines, called nasolabial folds, Restylane and Perlane work just as well. Radiesse is a calcium-based filler for deeper lines and wrinkles. It can also be used for augmentation purposes on the face, such as your cheeks. I prefer to inject this filler deeper than the HA type and will sometimes place an HA filler on top of it (a layering technique) for further improvement. Both men and women should get equally good results.

There are more permanent and semi-permanent fillers available. I prefer not to use these types of fillers because if a patient is not satisfied with the result it takes many months to years for the filler to dissipate.

Lastly, there is Sculptra. This is not necessarily a filler, but a volume enhancer. It is injected into sunken areas of the face where fat loss has occurred. It is great for temples and cheeks that have lost volume and is an excellent alternative to fat grafting. I hope this answers any questions about which filler may be right for you.

Many patients have a poor understanding of how and when botox or fillers should be used. The facial lines can be divided into either dynamic or resting lines. Dynamic lines are lines that can be seen when you animate or move your face. Examples of such lines are forehead lines, glabellar lines, and crow’s feet. Dynamic lines occur because the underlying muscle moves and contracts. Botox is used to relax these muscles by disrupting muscle-to-muscle communication. Resting lines are lines that can still be seen when your face is at rest. Smile lines (nasolababial folds) and marionette lines are good examples. These lines occur due to loss of volume and sagging cheek tissue. As you inject Juvederm (or Restylane, Perlane, Radiesse) into these lines, you are making them less noticeable by decreasing the depth. For patients with deep nasolabial folds, an endoscopic mid-facelift or a layering technique of fillers may be a better option. Botox and fillers are simple office procedures that require little or no downtime.