Seattle, Bellevue Facial Fillers: Restylane, Perlane, Radiesse, Sculptra, and Bellafill®

• Fillers and Volumizers
• Why Fillers?
• Maximizing Comfort!
• Fillers in a Nutshell
• Versa
• Restylane
• Juvederm & Voluma
• Teoxane
• Radiesse
• Sculptra
• PRF
• Fat Injection
• Voluma vs Juvederm
• FAQ

Fillers and Volumizers

These volume enhancing substances answer the popular desire for non-invasive, minimal downtime rejuvenation. Filling agents replace the age-related loss of the skin’s natural components such as fat, water, collagen, and hyaluronic acid.

In Dr. Zemplenyi’s practice, fillers including Restylane®, Versa®, Teoxane®, Juvederm®, Radiesse®, and Voluma® are each used to best effect. Each of these substances has its own advantages for wrinkle reduction and plumping treatment in various areas of the face.

Fat injection using a patient’s own fat transferred from one area of the body to another is an alternative to replace lost facial volume. Dr. Zemplenyi also uses PRF, a platelet-rich gel matrix, to stimulate the body’s natural collagen production.

Additionally, injection of any of these fillers may be combined with neuromodulators such as Botox®, Xeomin®, Daxxify® and Dysport® to relax muscles for further rejuvenation.

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Why Fillers?

Most fillers consist of the naturally occurring skin component hyaluronic acid, with volumizing effects apparent immediately after injection. Fillers can be injected into multiple areas of the face where they are ideal for smoothing wrinkles, deeper valleys and restoring lost volume. In recent years, augmentation of lips in younger patients has become very common and popular. This can be comfortably performed using topical anesthetic cream that Dr. Zemplenyi uses for all lip augmentations and also selectively in other areas for maximum patient comfort. Undesirable effects such as the “duck lip” look are minimized by judicious use of small amounts of fillers. Dr. Zemplenyi always solicits patient input during the injection for maximizing patient satisfaction and aesthetic effect.

Depressed scars, including some acne and traumatic scars, as well as hollowed or sagging tissues, can be remodeled with non-invasive volume replacement using a variety of fillers.

The duration of fillers’ effects depends on several variables including the site of injection, the natural rate of degradation and absorption, and the patient’s metabolism. All of these substances are absorbable by the body and therefore require periodic re-injection.

At the Bel-Red Center for Aesthetics in Bellevue, Dr. Zemplenyi performs the injections himself, carefully considering the patient’s facial contours and areas of concern. The specific filler selected depends on the treatment area, the patient’s goals, and budget.

The amount of filler injected depends on the amount of correction required. Because volume loss increases with age, patients in their thirties typically require less filler than someone in their fifties or later.

Maximizing Comfort!

In addition to careful selection and placement of the volumizing substance, Dr. Zemplenyi uses modern techniques to maximize patient comfort. He uses specially compounded numbing cream for more sensitive patients. He uses the smallest and thinnest needles and sometimes cannulas, combined with topical anesthesia and skin cooling. Technique using low injection pressure and small caliber needles provides safety and precision. In Dr. Zemplenyi’s many years of experience the use of vibratory device effectively blocks pain receptors in many patients.

Some bruising can occur after treatment. Dr. Zemplenyi often recommends Arnica Montana tablets one day prior to injection and advises avoiding aspirin and other non-steroidal medications such as Ibuprofen (Motrin), naprosyn (Aleve) for one week before treatment.

Results are visible immediately, and Dr. Zemplenyi works closely with patients to achieve results that align with their aesthetic goals.

Fillers in a Nutshell

Restylane®, Versa®, Teoxane RH1-4®, Juvederm® and Voluma® are hyaluronic acid fillers. Because hyaluronic acid occurs naturally in the body, the risk of allergic reaction is extremely low. These substances are especially useful for patients who have not previously received fillers because their effects can be reversed using a special enzyme hyalorunidase if necessary.

Fillers such as Voluma®, Teoxane® RH4 and Restylane® Lyft & Contour contain thicker versions of hyaluronic acid and are especially useful for cheek augmentation. Their effect may last longer than one year, especially if used in a larger volume.

Radiesse® contains hydroxyl apatite and provides an excellent filler option for areas near bone, such as the mid-cheek and jawline, where it helps offset jowls and restore facial structure. When used diluted, it produces both volume and collagen stimulation. Dr. Zemplenyi prefers use of dilute Radiesse compared to Sculptra®.

Neuromodulators

Neuromodulators such as Botox®, Xeomin®, Daxxify® and Dysport® have become the most commonly performed non-surgical cosmetic procedure in the world including the United States. Neuromodulators work by reduction of muscle activity that then softens wrinkles in multiple facial areas, and especially in the forehead and around the eyes (crow’s feet). The “frozen look” is avoided by judicious weakening of selected groups of muscles without involvement of too many muscles. Gentle technique using low pressure improves the results and decreases the chance of bruising. Eyebrows and corners of the mouth may also be elevated by redistribution of forces of depressor groups of muscles compared to the elevator groups of muscles.

Studies have found that all of the neuromodulators available in the United States are equally effective when used in univalent, comparable units. As with fillers, when a facial area is treated with a higher number of units, the neuromodulator muscle relaxation effect tends to last longer. Once the neuromodulator effect wears off the muscle contraction returns to the pre-existing level without any long-term side effects. For best results re-injections need to be repeated regularly every four to six months. In Dr. Zemplenyi’s many years of experience, some patients who undergo regular treatments with neuromodulators experience more lasting effects and need re-treatments only twice per year. Any filler treatment can at the same time be combined with neuromodulators.

Versa®

Versa® is a hyaluronic acid dermal filler made in Canada and approved in the United States in 2017. It is packaged in a 1.2 mL syringe, a higher volume syringe than either Restylane or Juvederm. It is very well hydrated and causes less swelling upon injection compared to other hyaluronic acid fillers. These properties of Versa make it a versatile filler. Dr. Zemplenyi was among the first users of Versa in the United States and has been using it very successfully since 2017. Versa is specifically FDA approved for augmentation of lips and nasolabial folds, but it can be used in many other facial areas. As with other hyaluronic acid fillers, duration is variable and depends on the patient’s metabolism and areas injected. In Dr. Zemplenyi’s experience Versa compares favorably to both the original Restylane® and Juvederm XC®.

Restylane®

Restylane®, used successfully in Canada and Europe since the late 1990s, was approved by the FDA in the United States in 2004. It is a clear gel made of hyaluronic acid that injects smoothly into the skin.

Because hyaluronic acid occurs naturally in the body, the risk of allergic reaction is extremely low. Restylane is commonly used to treat nasolabial folds, tear troughs beneath the eyes, and to enhance lip volume.

Results typically last around six months before the filler is gradually broken down by the body. Other Restylane products have joined the Restylane family over years, each having specific properties such as elasticity and variable firmness that are useful for adding volume to the cheeks and lips, correcting hollow areas around the eyes and temples, and improving the jaw line and treatment of fine wrinkles.

Juvederm® Family of Fillers

Juvederm® is another hyaluronic acid filler approved by the FDA in 2007. Its formulation attracts water into the skin (is hydrophilic) and helps to restore a smoother, more youthful appearance.

Because of its soft texture, Juvederm is effective for enhancing thinning lips and smoothing smile lines around the mouth but it causes more swelling as it becomes hydrated once injected into the tissues. Juvederm is available in a thinner and thicker version—Juvederm Voluma®. This is a hyaluronic acid filler that was introduced in the United States at the end of 2013. It was the first filler in the United States that was specifically approved by the FDA for restoration of the cheek volume for creation of a fuller, more youthful facial contour. If used in a larger volume and in some patients, results can last up to two years. Voluma and other Allergan fillers that begin with the letter “V” contain the proprietary Vycross cross-linking. In rare patients, these fillers have been associated with delayed swelling reactions. In Dr. Zemplenyi’s practice other hyaluronic fillers such as Teoxane RH-4 and Restylane Contour have been used for augmentation of cheeks with similar effects to Voluma, and the latter, more modern fillers are preferred by Dr. Zemplenyi.

Teoxane® Family of Fillers

Teoxane® RH1 through RH4 Swiss-made dermal fillers are very popular in Europe but were FDA approved in the United States only in 2020. That is the reason why the name may not be as familiar to US patients as Restylane and Juvederm. The manufacturer and founder of Teoxane is the same person as was for Juvederm (prior to its sale to Allergan). Dr. Zemplenyi finds the RH1 soft filler particularly useful for treatment of very fine lines and it compares favorably to Restylane FineLine® and Merz Belotero®. Teoxane RH4 filler is very useful for augmentation of the cheek, very similar to Voluma and Restylane Contour. Like Versa and unlike other hyaluronic acid dermal fillers, RH4 is supplied in the larger, desirable 1.2 mL syringe.

Radiesse®

Radiesse® is a synthetic filler and collagen biostimulator made of calcium hydroxylapatite microspheres, a substance that naturally occurs in bone. Introduced in the United States in 2006, it typically lasts longer than many other fillers.

Radiesse is often injected deeper in areas near bone such as the cheeks and mid-face to provide structural support and volume. Because its components naturally occur in the body, allergic reactions are extremely rare. It is packaged in a larger syringe than most fillers, allowing for greater volumization when needed. Radiesse has the highest lifting property (called G prime) compared to other dermal fillers. This filler is especially useful when used for new collagen formation in a diluted form. Unlike hyaluronic acid fillers, Radiesse cannot be reversed.

Sculptra®

Sculptra®, known in Europe as Nufill, was approved in the United States in 2004. It was initially used to treat facial fat loss associated with HIV but is now widely used for cosmetic volume restoration.

Sculptra contains L-polylactic acid, a biodegradable substance that stimulates the body to produce its own collagen. This collagen production gradually restores lost facial volume and can provide results lasting two years or longer.

Treatment typically involves several sessions spaced about four weeks apart to achieve optimal collagen stimulation. Dr. Zemplenyi prefers to use diluted Radiesse for induction (stimulation) of collagen synthesis.

PRP and PRF

PRF is a platelet-rich gel matrix, also sometimes referred to as a “vampire filler” or “vampire facelift.” It uses the patient’s own blood to extract platelets that are then combined with a gel matrix and injected into targeted areas.

Platelets contain about seven natural growth factors that are released and stimulate collagen production as well as healing and increased vasculature. Improvement of skin texture and restoration of volume may occur when PRF is combined with hyaluronic acid fillers. PRF can also be applied using microneedling techniques to stimulate collagen production and improve skin texture.

Fat Injection (Lipo Transfer)

Fat injection transfers fat from one part of the body, such as the abdomen or thighs, to areas of the face where volume has been lost. The harvested fat is carefully processed and injected into areas such as the cheek tear troughs and deep facial folds.

Fat transfer provides a natural filler option using the patient’s own tissue. Results vary depending on the treatment area and transferred fat survival.

Some swelling and bruising may occur after treatment, but these effects typically improve within a week. In general, about fifty percent of the transferred fat volume will remain in the face. Augmentation of the face with adipose tissue (fat) uses micro-cannulas for injection. This technique differs from augmentation of breasts and buttocks (Brazilian butt lift) which use much larger volumes of fat and larger cannulas.

Voluma vs Juvederm — A Comparison of the Long-Lasting Facial Fillers

While we may not be able to turn the clock back to the squeezable chubby cheeks of a two year old, the panoply of volume enhancers and facial fillers available today can restore the fuller, plumper look of a younger you. Among the many dermal filler products available, the two described below are long lasting, not needing reinjection several times a year.
FAQ