Anatomic Guide and Products We Use

Facial Fillers Guide & Products We Use

An Anatomic Guide to Facial Fillers

Fillers We Use and GuideExperienced injectors know that certain fillers are particularly suited for specific areas of the face. Through extensive experience with thousands of treatments, Dr. Greene learned the unique handling characteristics of all of the facial fillers. This led to an understanding that patients are often best treated using a combination of different fillers in order to achieve the best result. Dr. Greene evaluates each patient’s anatomy and their concerns in order to determine the areas to treat and the best fillers to utilize.

For each anatomic area of the face, there are specific fillers that can be used. However, the particular filler to choose varies depending on the patient and other factors, that may include skin quality and thickness, volume deficit, and aesthetic goals. Below is a fairly generalized list that includes most of the fillers that are currently available in the U.S.

  1. Glabella: Not recommended due to high risk of vascular complication
  2. Temple: Juvederm Voluma, Restylane Lyft, Sculptra
  3. Tear trough: Restylane, Belotero
  4. Cheekbones: Juvederm Voluma, Restylane Lyft, Radiesse
  5. Nasolabial folds: Juvederm Ultra Plus, Juvederm Vollure, Revanesse Versa, Restylane Lyft, Restylane Refyne, Restylane Defyne
  6. Lips: Juvederm Ultra, Revanesse Versa, Restylane Refyne, Juvederm Volbella
  7. Perioral Rhytids (Smokers lines): Juvederm Volbella, Juvederm Ultra, Restylane Silk 
  8. Marionette lines and oral commissure: all fillers
  9. Lower cheek: Juvederm Vollure, Restylane Refyne, Sculptra
  10. Chin/Jawline: Juvederm Voluma, Radiesse, Restylane Lyft
  11. Pre-jowl sulcus: Juvederm Voluma, Radiesse, Restylane Lyft
  12. Earlobe: Juvederm Ultra, Restylane

LEARN MORE ABOUT FACIAL FILLERS WE USE

There are a number of fillers available, each with its own strengths and unique characteristics.

To understand these fillers, it is best to group them according to the portfolio.

Also known as the Hylacross fillers, which refers to their manufacturing and cross-linking.

  1. Juvederm Ultra: This is an excellent filler for lip enhancement and augmentation, due to its soft plumping nature. It creates very natural results if used properly. It can also be used in other areas of the face, most notably for fine rhytids. It is not well-suited for deeper folds or areas where there is significant volume loss.
  2. Juvederm Ultra Plus: Much more structured and ‘thicker’ than Juvederm Ultra, this filler is an ideal choice for deep nasolabial folds and areas of significant volume loss. While it can be used for lip augmentation, this must be done only for patients who desire more dramatic results. This filler requires more expert judgment in the lips to keep them looking natural.
  3. Juvederm Fillers

Also known as the Vycross fillers, which refers to their tighter cross-linking than the Hylacross fillers. It is believed that this is what may lead to more longevity, though a comparison has not been made with the Hylacross fillers.

  1. Juvederm Voluma: One of the most ideal structural fillers, this is most often used in the cheeks and midface. This filler is very moldable and can create very natural contour. Voluma is one of the longest-lasting hyaluronic acid fillers available. Meant for deeper injections, its structural characteristics make it well-suited for the chin and jawline as well. This is a poor choice for lip augmentation.
  2. Voluma
  3. Juvederm Vollure: This filler was FDA-approved for use in the lower face rhytids and folds. This is where is best-suited, though it works well in the lower cheeks as well. Not as structured as Juvederm Ultra Plus.
  4. Vollure
  5. Juvederm Volbella: This filler is an excellent choice for patients who desire lip enhancement and have perioral rhytids. It is a very soft filler and can create natural results in the perioral region. Used for lip augmentation, it creates among the most subtle enhancements of all of the fillers.
  6. Volbella
  1. Restylane: The most versatile of all of the fillers, it can be used in essentially any area of the face. It is an ideal choice for the tear trough (under eye hollows), where is provides excellent longevity. It is also an excellent choice for lip augmentation and for lower face rhytids. Not as structured as Restylane Lyft, so it is not designed to be used in the midface or chin/jawline.
  2. Restylane Lyft: Like Restylane, this filler offers excellent versatility. It is an excellent choice for deep nasolabial folds and rhytids, as well as for cheek and chin augmentation. This filler can be used in the temples as well.
  3. Restylane Silk: Similar to Volbella, in that it creates very subtle lip enhancement and also is an excellent choice for addressing perioral rhytids.
  1. Restylane Refyne: This has similar handling characteristics to Juvederm Vollure. Refyne is an ideal choice for the lower cheek rhytids and for patient with hollows below the cheekbones. It is also an excellent choice for nasolabial folds and marionette lines. Due to its soft but structured consistency, it can produce excellent lip enhancement results as well.
  2. Restylane Defyne: This filler is designed for deeper folds and rhytids than Refyne. Also it isn’t as structural as Restylane Lyft or Juvederm Voluma, it can be used in the midface and jawline.
  3. Restylane

Revanesse Versa: This filler is one of the ideal choices for lip augmentation, as it creates excellent definition while keeping the lips soft and natural. Some patients report less swelling with Versa compared to other hyaluronic acid fillers. Versa is also an excellent choice for nasolabial folds and marionette lines. Versa comes in both 1.0cc and 1.2cc syringes. The 1.2cc syringe is ideal for patients who desire lip augmentation in conjugation with treatment of the nasolabial folds.

  1. Radiesse: Rather than hyaluronic acid, this filler is composed of calcium hydroxyapatite. It has been shown to lead to collagen formation, but its true impact on the clinical outcome is unknown. Radiesse creates very structured results, and is well-suited to areas such as the cheeks and chin/jawline. Some injectors may use Radiesse in the nasolabial folds and for lower face rhytids.
  2. Radiesse
  3. Belotero Balance: This filler is a great choice for fine rhytids throughout the face. It has been used for the tear trough, due to its decreased risk of Tyndell effect (i.e. filler visible with a bluish hue under thin skin). In some patients, Belotero can be injected superficially to the neck and chest area to smooth rhytids.

Sculptra: Comprised of poly-L-lactic acid, Sculptra is actually not a filler. Instead, it is considered to be a volumizer, as it creates the formation of new collagen in the skin and soft tissue. Many patients find Sculptra to be an attractive option, since it is very long-lasting (many patients report improvement that lasts over two years). Treatment with Sculptra does require patience, as the results gradually appear over 4-6 weeks. Multiple treatments are also usually necessary. While Sculptra can be used in most areas of the face, it seems to work particularly well in the temples, midface, and jawline.

Sculptra