Dermal Fillers

The use of dermal fillers such as Juvederm, Restylane, Voluma, Belotero, Radiesse, and Sculptra, has revolutionized cosmetic dermatology. The old thinking was that tighter was better. Facelifts were overdone, leaving unnatural results with tight but still hollow faces. The fresh thinking is that in order to truly look younger, you need to RESTORE VOLUME. Pulling the skin tighter can help, but only up to a point. VOLUME is needed to hide shadows and concavities, reduce wrinkles and folds, and lift sagging skin. Fillers can accomplish this without invasive surgery and best of all, with a NATURAL appearance

Look at a young person and notice that their face appears smooth without shadows or harsh transitions. Then observe an elderly person with flat cheeks, deep folds, bony ridges, a down-turned smile, under-eye hollows, and sagging jowls. The main difference between old and young is LOSS OF VOLUME. Unfortunately, this occurs to all of us as we age due to gradual loss of collagen, fat, muscle, and bone. The good news is that fillers can replenish the lost volume and turn back the hands of time!

Fillers are most commonly used to fill and lift the cheeks, temples, under eye hollows, lips, jowls, jawline, and corners of the mouth. Individual areas can also be filled, such as the nasolabial folds, marionette folds, and vertical lip lines. Filler also work well to rejuvenate the hands.

• Hyaluronic Acid (HA) Fillers – Hyaluronic acid is a natural substance produced in our skin which binds to water and adds firmness to the skin. HA fillers are the most widely used around the world. Typical duration of HA fillers is 6-12 months or longer. There are many different HA fillers available, including the following brands:
  – Restylane
  – Juvederm
  – Belotero
  – Teoxane RHA

Some HA fillers such as Restylane Lyft are thicker with larger particle size and are injected deeper to provide more robust volume. Others such as Belotero are thinner and are injected into superficial lines and wrinkles. Our favorite filler for the tear trough (under eye hollows) is Restylane Eyelight. For the cheeks, our favorite fillers are Restylane Lyft, Restylane Contour, and Juvederm Voluma. Our preferred filler for the lips is Restylane Kysse. One advantage of HA fillers is that they can be dissolved or reversed with injections of hyaluronidase. This is rarely used but is a welcome safety feature. We always carry hyaluronidase in our office. Some lower end clinics don’t stock this expensive medicine.

• Sculptra – Sculptra is a unique, long-lasting filler which consists of poly-L-lactic acid (PLLA). Sculptra is a biostimulatory filler which facilitates the production of the patient’s own collagen. It is used to restore lost volume, particularly in the cheeks. Results from Sculptra can last for up to 2 years or longer! It can also be used to rejuvenate the chest. Multiple treatment sessions are recommended for best results. Sculptra is gaining popularity because of its natural-appearing and long-lasting results.

• Radiesse – Radiesse consists of calcium hydroxylapatite. It is a robust, long-lasting filler for deeper folds and hollows and for cheek augmentation. It is also used for rejuvenation of the hands. Radiesse can be blended with saline (hyperdilute Radiesse) and used for skin tightening in the face, neck, chest, and on the body. Radiesse comes in a larger syringe size which makes it an excellent value.

• Botox – Botox is not a filler, but it is also an injectable and works very well in combination with fillers. Botox can actually make fillers last longer. Botox smooths the skin by relaxing the muscles which cause wrinkles.

The person who injects you is much more important than the actual brand of filler used. Many offices employ a nurse or assistant to inject fillers. Many injectors have been trained to treat all patients the same. This leads to over-emphasis of certain areas and results that do not appear natural.

All filler injections in our office are performed by Dr. Richard Ort, M.D., a board-certified, Harvard-trained dermatologist. Dr. Ort has a reputation in Lone Tree, Highlands Ranch, and Denver as an expert in the use of fillers. To be a great injector, one must be an artist and appreciate the ideal human form as well as the changes that occur with age. Dr. Ort is an expert in facial anatomy and advanced injection techniques. He takes his time and does not rush his filler treatments. He formulates a treatment plan specific to each patient to bring out their natural beauty.

Dr. Ort is one of the few doctors in Lone Tree and Denver who has advanced training and expertise in the use of cannulas to inject fillers. Unlike a needle, a cannula is not sharp and has a lower risk of causing a bruise or other side effects. Cannulas are especially useful in the tear trough (under the eyes) where there is a higher risk for bruising. Compared to using a needle, a cannula requires more training, experience, and patience on the part of the injector, but the potential benefits to patients are undeniable.

Our goal is to make filler injections a pain-free experience. We offer numbing creams, dental blocks, local anesthetic, and ice to make our patients comfortable. Our patients who have been treated elsewhere often note the difference.

Fillers have been used in millions of patients over the last 25 years. We use only FDA-approved products with a long track record of safety. Minor problems such as bruising can occur after treatment but typically resolve on their own. More serious complications can rarely occur but are less likely in expert hands. Dr. Ort has a conservative philosophy and takes special precautions to reduce the risk of any complications. We recommend that you review our consent form prior to your treatment.

To reduce the risk of bruising, please follow these instructions:

• If you take ASPIRIN, stop it two weeks prior to treatment. (Do NOT stop aspirin if you are taking it for medical reasons on the order of your doctor).
• Stop taking anti-inflammatory medicines such as ibuprofen, naproxen, etc three days prior to treatment. (It is OK to continue Tylenol or acetaminophen).
• Stop taking Vitamin E, fish oil, and herbal medicines (including gingko, garlic, ginger, ginseng, ephedra & feverfew) two weeks prior to treatment.
• Do not schedule your filler treatment within one week of any important event.
• We do not recommend that you have any dental procedures for two weeks after a filler treatment.