Filling agents are substances that are injected into deeper creases and lines that are not normally improved by creams, peels, laser treatments, or Botox injections. As patient safety and comfort are paramount to the dermatologists of DCW, we carefully research and investigate new fillers and technologies until we are confident that they are appropriate to offer to our patients. While it is tempting to contemplate using filling agents that are deemed "permanent", long term filling substances tend to be less studied, more risky and may cause lumps, scar tissue formation, and other complications following treatment. However, some of the newer filling agents are now able to last a long time without the risks of permanent problems. The most commonly observed side effects are temporary redness and swelling or bruising at the injection site which typically resolve in less than seven days.

Some of our favorite fillers include:

Restylane® and Restylane-L™
Restylane®, a clear non-animal source, hyaluronic acid gel, has become one of the most popular filling agents approved by the FDA for cosmetic uses. Hyaluronic acid is a natural polysaccharide that is highly bio-compatible. No pre-treatment testing is required since it is of extremely low allergenicity. The most common areas to be treated are the nasolabial folds (creases from the nose to mouth), the nasomental creases (corners of the mouth) and around the lips, as well as cheek and chin contours. Topical anesthetic is generally used to minimize the discomfort of the procedure. Restylane-L™, newly formulated, combines lidocaine, an anesthetic, with Restylane® to further insure your comfort. The duration of Restylane® appears to be approximately 6 months or longer, in most cases, making it an easy improvement to maintain. We often combine Restylane® with BOTOX® for best results. The BOTOX® relaxes the muscle so that the Restylane® that is filling up the lines may last longer.

Perlane® and Perlane-L™
Perlane® is the newest member of the Restylane® family of products. Like Restylane®, Perlane® is composed of hyaluronic acid, a natural substance that already exists in the body. It is used to smooth moderate to severe wrinkles and folds, such as the lines from the nose to the corners of the mouth (nasolabial folds). The primary difference between Restylane® and Perlane® is that the hyaluronic acid gel particles in Perlane® are larger than those found in Restylane®, thereby making Perlane® an excellent treatment for deeper folds and wrinkles. The hyaluronic acid in Perlane® is a crystal clear gel that is chemically cross-linked (the long chemical strands are tied together) to delay breakdown by skin enzymes for long lasting results. Perlane® is non-animal based and free from animal protein. Allergy testing is not necessary. To help maximize your comfort, numbing medications may be used before treatment. Perlane-L™, a new formulation, combines lidocaine, an anesthetic, with Perlane® to futher maximize comfort during your procedure. With an ultra fine needle, Perlane® is injected into the deeper layers of the skin to add volume and plump the skin. This can restore facial contour and smooth away those moderate to severe facial wrinkles and folds. Perlane®’s three-dimentional water-loving gel particles attract and bind with water molecules helping to maintain volume as they degrade, maintaining volume augmentation for at least six months or longer. Perlane® gradually disappears from the body without a trace. Perlane® has been used safely by dermatologists and plastic surgeons since 2000 outside the U.S.

Juvederm™ Ultra, Juvederm™ Ultra Plus and JUVÉDERM® XC
Juvederm™ is a smooth consistency gel made of cross-linked hyaluronic acid that bolsters skin elasticity, providing a smooth and supple appearance. It supplements the body’s own natural hyaluronic acid, which age has depleted. Allergy testing is not necessary. Approved by the FDA in 2006, Juvederm™ dermal filler has a smooth and malleable consistency which helps to instantly restore your skin’s volume and smooth away wrinkles and folds. Topical anesthetic is generally applied to minimize the discomfort of the procedure. The transparent gel is injected into the mid- to deep dermis of the face to provide a smooth, natural look and feel. In the majority of patients, a single treatment of Juvederm delivers sustained results for up to 6 months or longer after which the biocompatible compound is naturally absorbed into the body. Juvederm™ injectable gel is available in two formulations to allow your physician to tailor treatment to your unique needs. Juvederm™ Ultra provides versatility in correcting superficial facial lines and folds. Juvederm™ Ultra Plus is a more robust formulation for volumizing and correcting deeper folds and wrinkles. JUVÉDERM® XC is formulated with lidocaine, an anesthetic, for a more relaxing patient experience. JUVÉDERM® XC provides smooth and natural looking results and now a more comfortable experience. In fact, studies show results of JUVÉDERM® last up to one year. In addition, Juvederm™ injectable gel is the first FDA approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

Zyderm® & Zyplast®
Zyderm® and Zyplast® are two types of highly purified bovine dermal collagen that have been used to correct facial contour defects since the early 1980's. The bovine collagen is processed to create a product that is similar to human collagen. Six weeks prior to the procedure, a test dose is administered intradermally in the forearm to determine if a patient has sensitivity to the implant material. Three percent of people tested may have sensitivities. A second test dose is administered after four weeks. Collagen is most commonly used to fill in superficial wrinkles, skin depressions, and some scars. The duration of the effect is approximately 4 months. Because the product contains lidocaine, an anesthetic, the injection only causes minimal discomfort.

CosmoDerm® & CosmoPlast®
CosmoDerm® and CosmoPlast® are very similar to Zyderm and Zyplast . The source of the collagen in them, however, is from a single human fibroblast cell culture which has been in use for many years. No skin test is required because this is fashioned from human cells rather than an animal source. CosmoDerm® and CosmoPlast® are injected just below the surface of the skin to fill in folds, superficial lines and wrinkles, and can be used to define the border of the lips. The duration is similar to bovine collagen, approximately 3-4 months.

Restylane
Juvederm

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Before	After

Peels
Botulinum Toxin (BOTOX®)
FDA Approved Fillers
Leg Vein Treatments
Color Cosmetics and Camouflage Techniques
Photodynamic Therapy (PDT) for Acne
Photorejuvenation (IPL)