Dermal Fillers in NYC
Dermal fillers are injectable gels used to replace volume that has been lost and to change the shape of specific features. They are not a treatment for movement lines, which is what neuromodulators address. Leah Corredora, PA-C performs dermal filler injections at the Manhattan practice. Most are temporary, and the hyaluronic acid fillers can be dissolved if a result is not what you wanted.
What dermal fillers do
A dermal filler is a gel placed under the skin to add volume where volume is missing, or to build projection where a feature is small or set back. The face loses fat and bone volume with age, and skin loses elasticity, which is why the midface flattens, the folds around the mouth deepen and the jawline blurs.
Filler is one of two things that happen with a needle in aesthetic practice, and it is worth keeping them apart. A neuromodulator such as Botox or Dysport relaxes a muscle so it stops creasing the skin above it. A filler adds volume. They treat different problems, and patients often need both for different parts of the same face.
Filler does not tighten skin and it does not lift a face that has descended. Beyond a certain point, adding volume to compensate for laxity produces a heavier face rather than a younger one. Where laxity is the main finding, surgery or an energy-based treatment is the honest answer, and Dr. Smith will say so.
The main types of filler
Hyaluronic acid fillers
Hyaluronic acid is a sugar molecule found naturally in skin, where it binds water. The fillers in this family are cross-linked gels made from it, and they make up the large majority of filler used in aesthetic practice. Juvederm and Restylane are the two best known families.
Their practical advantages are that they can be placed precisely, they come in different thicknesses for different jobs, and they can be dissolved with an enzyme called hyaluronidase if the result is not right. That reversibility is the main reason they are preferred for most work.
Collagen-stimulating fillers
Poly-L-lactic acid, sold as Sculptra, works differently. Rather than filling a space directly, it prompts the body to lay down its own collagen over the months after treatment. The change is gradual, it is given as a series of sessions, and it suits diffuse volume loss better than it suits a defined feature. It cannot be dissolved.
Which product for which job
There is no single best filler. A thin gel that sits well in the lip is wrong for building a jawline, and a firm gel that holds projection in the cheek is wrong for fine lines. Your clinician selects the product after examining you, and will tell you which one she is using and why.
Areas commonly treated
Cheeks and midface
Volume in the cheek supports the skin below it. Restoring it is often what makes the difference to the folds beside the mouth, which is why the midface is frequently treated before the folds themselves.
Nasolabial folds and marionette lines
The folds running from the nose to the corners of the mouth, and from the corners of the mouth downward, are softened by placing filler along them. They are softened rather than erased, and treating them in isolation without addressing the midface tends to look heavy.
Lips
Lip treatment is about shape, border definition and balance between the upper and lower lip as much as it is about volume. This is covered in more detail on the lip filler page.
Chin and jawline
Filler can add projection to a small chin and definition along the jaw. Where the deficiency is significant, a chin implant gives a more reliable and more durable result, and Dr. Smith will say which he thinks is the better answer for you.
Under the eye
Hollowing under the eye is one of the most commonly requested filler treatments and one of the least forgiving. Most hyaluronic acid fillers are used in this area off-label, and your clinician will tell you whether the proposed product carries an approved indication for it. The skin is thin, the space is small, product placed poorly can look puffy or bluish and can persist, and the blood vessels of the region make this the highest-risk area on the face for injection. Whether your anatomy suits it is a judgment made in person, and some patients are better served by lower eyelid surgery.
Hands and temples
Volume loss in the back of the hand and hollowing at the temple are both treated with filler in appropriate patients.
The consultation
The consultation is an assessment of the whole face, not of the line you came in about. What produces a natural result is usually treating the cause of a change rather than the change itself.
- An examination of volume, skin quality, laxity and facial proportion
- A review of your medical history, medicines and allergies, including any history of autoimmune disease
- A record of any filler you have had before, what was used and where, since old product affects planning
- A plan setting out which areas would be treated, with what, and in what order
- A clear statement of what filler will not fix
A medical aesthetics consultation with Leah Corredora, PA-C is $100, collected to reserve your time and credited toward any procedure.
What the treatment is like
Most filler appointments take between fifteen and forty-five minutes depending on how many areas are treated.
- The skin is cleaned and the treatment plan is marked out
- A topical numbing cream is applied; many fillers also contain lidocaine
- The filler is placed with a fine needle or a blunt cannula, depending on the area
- The area is shaped and checked as the work proceeds, with you sitting up so it is assessed the way it will be seen
Your clinician uses a blunt cannula rather than a needle in some regions. A cannula is less likely to enter a blood vessel, which is the complication that matters most.
Dermal filler recovery and how long results last
There is no real downtime, but expect swelling and the possibility of bruising for several days.
- Swelling is usual for two to three days and is most obvious in the lips
- Bruises can take a week to ten days to fade and can be covered with makeup after the first day
- Avoid strenuous exercise, alcohol and heat for the first day
- Use acetaminophen rather than an NSAID for discomfort
- Leave two weeks before judging the final shape
How long a result lasts depends on the product and the area. Hyaluronic acid fillers generally last from several months to a couple of years, with areas that move a great deal, such as the lips, going first. Collagen-stimulating treatment builds gradually and lasts longer, but takes months to appear.
Safety, side effects and risks
Common side effects are local: swelling, bruising, redness, tenderness and lumpiness in the first days after treatment.
The serious risk with any filler is injection into or compression of a blood vessel. If the blood supply to an area of skin is interrupted, that skin can be damaged. In rare cases involving vessels around the eye and nose, injection has caused vision loss or stroke. This is uncommon, and it is the reason injection technique, knowledge of facial vascular anatomy and the ability to recognize and treat the problem immediately matter more than any other factor in this treatment.
Hyaluronic acid fillers can be dissolved with hyaluronidase, which is both a safety measure in an emergency and a way to reverse a result you are unhappy with. Fillers that are not hyaluronic acid cannot be dissolved, which is worth weighing before choosing one.
Lumps or nodules can appear at the time or months later. Delayed nodules sometimes follow an illness, a vaccination or dental work. Tell your clinician about any autoimmune condition, any bleeding problem, any medicine acting as a blood thinner, any active infection or skin condition at the site, and if you are pregnant or breastfeeding. Filler is not given during pregnancy or breastfeeding.
What determines the cost of dermal filler
Filler is priced by the amount of product used, so the cost of a treatment depends on how much is needed rather than on how long the appointment takes.
- How many syringes the plan calls for
- Which product is used, since the families are priced differently
- How many areas are treated
- Whether a neuromodulator or another treatment is combined at the same visit
- Whether the plan is staged over more than one appointment
You are given an exact figure at consultation before anything is booked. Dr. Smith is out of network with all insurance plans, and the practice helps patients use out-of-network benefits toward care; cosmetic treatment is not covered. Financing is available through CareCredit and Alphaeon Credit. A medical aesthetics consultation with Leah Corredora, PA-C is $100, collected to reserve your time and credited toward any procedure.
Common questions about dermal fillers
How long do dermal fillers last?
It depends on the product and where it is placed. Hyaluronic acid fillers generally last from several months to a couple of years. Areas that move constantly, such as the lips, lose volume soonest.
Can filler be removed if I do not like it?
Hyaluronic acid fillers can be dissolved with hyaluronidase, usually within a day or two of the injection. Fillers that are not hyaluronic acid cannot be dissolved, which is a reason to be more conservative with them.
Does it hurt?
There is some discomfort. Topical numbing is used, many fillers contain lidocaine, and local anesthetic can be added for sensitive areas such as the lips.
How much bruising should I expect?
Some patients bruise and some do not. Bruises typically fade over a week to ten days. Avoiding alcohol and anything acting as a blood thinner beforehand reduces the chance, and any decision to hold a prescribed medicine is made with the physician who prescribed it.
What is the difference between filler and Botox?
Filler adds volume. Botox relaxes a muscle so it stops creasing the skin. They address different problems, and many treatment plans include both.
Will filler make me look overdone?
That comes from the amount used and where it is placed, not from filler as such. Your clinician treats conservatively and prefers to stage a plan over more than one appointment rather than place a large volume at once.
Is filler under the eye safe?
It is the most technically demanding and highest-risk area on the face, and most hyaluronic acid fillers are used there off-label. Whether it is appropriate depends on your anatomy, and some patients are better served by lower eyelid surgery.
What happens when filler wears off?
The area gradually returns toward how it looked before. Filler does not cause the tissue to sag when it goes.
Can I have filler if I have had it elsewhere before?
Yes, and it helps to know what was used, how much and when, because old product changes what is appropriate now.
Can filler and a facelift be combined?
They address different problems and are often used together, though usually at different points in time. Your clinician will explain the sequence that makes sense for your case.
Who performs the injections?
Leah Corredora, PA-C performs medical aesthetics injections at the Manhattan practice.