Dermal Fillers
REPLACE VOLUME LOST WITH AGE
What are they and how and where are they used?

All fillers serve one primary function. They replace volume (fat) that everyone loses as we age. Generally fat loss begins to occur in our early 30’s but environment (sun exposure) and health habits (smoking, drinking & drug use) can cause a faster onset of fat/volume loss.
The more fat we lose the more the face begins to take on a less youthful look. The face typically loses the largest amount of fat in four primary areas. The areas at the sides of the nose called Nasolabial folds which develop lines that can be very deep, the cheek & temple areas, lips and the areas under & to the side of the lower lip which cause a person to look a bit unhappy.
Other areas can also be injected as every person ages differently and we can lose fat in other areas as well. The picture below depicts the most common areas treated on the face with fillers

If patients desire the longest lasting correction and want to rebuild the most Collagen & Elastin possible, we use Platelet Rich Plasma (PRP) in conjunction with fillers. Another popular media term is “The Vampire Face-lift”. Well, that’s what this is… PRP contains large amounts of different types of growth factors which when injected and over time, rebuild Collagen & Elastin fibers. By combining PRP & fillers you receive the best of both world in an immediate correction as you use your own bodies natural ability (with PRP) to re-build the most Collagen & Elastin possible.
Fillers come in two primary classifications.
Hyaluronic Acid (HA) based fillers which include Restylane, Juvederm, Perlane and Belotero which on average last 6 months to a year and Calcium hydroxylapatite (CaHA) filler which is known as Radiesse which last 12–18 months.
Let’s examine HA based fillers first. The two most common are Restylane and Juvederm are both excellent and offer about equal results. They are used primarily for lip augmentations and to round out the volume below the lips as well.
- Belotero is an excellent new FDA HA filler that is different than both Restylane and Juvederm.
- Belotero allows us to inject much closer to the skins surface so we can now inject in areas that we could only use Collagen before. The other huge advantage of Belotero is that unlike Restylane and Juvederm, it does not have the Tyndall Effect which causes superficially treated areas to take on a blue tint. This is why Belotero is now the best filler for treating under eyes in the tear trough area.
- Radiesse is used where deeper corrections are needed such as temples, cheeks and jawline and provides both the longest lasting corrections and studies prove that Radiesse also promotes more collagen production than any other filler. Now that we’ve discussed the different fillers let’s find out how they are used together to provide even better results.
A common question is how many syringes of fillers will I need? The answer as you would suspect varies greatly patient to patient. One patient may just need a few syringes to correct the Nasolabial fold areas while another patient may need that plus their cheeks, jawline & temples.
We have many tools at our disposal but like all tools they need to be used by someone who knows best how to use them. Cheryl Giangrante, ARNP, is an outstanding injector that has received numerous complements from her patients she has injected over the years. Yes you can probably find someone less qualified to inject Botox and fillers but what will you get back when looking in the mirror.
We don’t just dabble in medical aesthetics. It’s all we do each and every day of the year. Many physician & dental practices have added Botox & fillers to augment their practice incomes. Injecting Botox and Fillers is a medical art form that should be done by properly licensed, dedicated, trained and skilled practitioners.
When you do something full time, all the time you tend to get very good at it. Settling for anything less could result in poor results or even facial deformity and injury.
Call to schedule your complimentary consultation (941) 753-0600
The diagram below shows a deep fold that extends deepest into the face followed by a wrinkle which is not as deep followed by a line which is closest to the surface of the skin.

Providing for fat loss is not a one size fits all equation which is why we need different fillers.
We use an advanced injection technique called layering in which we use Radiesse in the deeper folds & Restylane or Juvederm on top of that correction.
This technique allows for a fuller more natural correction and longer lasting results. If any very fine lines remain we can then add Belotero.
The terms non-surgical face lift, liquid face lift have received a lot of media coverage. These terms all mean the same thing. Its’ the use of a combination of Botox and different fillers to provide a correction that was not possible without a facelift until very recently.
This does not mean however that a patient who truly needs a face-lift can get a facelift type of result using Botox and fillers. This type of procedure can however delay the need for a face-lift for years especially when combined with the Exilis for skin laxity.