Damian G. McNamara

SAN FRANCISCO — Although changes to the aging face are often complex, knowing filler basics will help optimize results, Dr. Jason R. Michaels said.

“When I approach patients, I try to keep it as basic as possible: who, what, where, why, and when?” Dr. Michaels said. “It is almost back to the grammar lessons we had as kids.”

Even so, pairing the appropriate filler to each patient remains an art form. “Think of [fillers] as different types of paint brushes; and I choose depending on whether I want a broader effect or to treat more detail,” he said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation (SDEF).

“I tend to look at faces in four different categories: furrows, folds, shaping, and volume,” said Dr. Michaels, associate clinical professor of dermatology at the University of Nevada, Las Vegas.

For correction of furrows, for example, options include finer-gauge fillers such as CosmoDerm (INAMED Aesthetics), Prevelle Silk (Mentor), Juvéderm Ultra (Allergan), and Restylane (Medicis Aesthetics). These products are generally safe for injections higher up in the skin. “My ideal choice is CosmoDerm because it works great on fine lines and wrinkles, but the downside is it does not last as long as some others,” Dr. Michaels said. He is a consultant for Allergan and a consultant and speaker for Medicis.

For treating folds, “the world is your oyster,” Dr. Michaels said. Examples include CosmoPlast (INAMED Aesthetics), Elevess (Anika Therapeutics), and Evolence (Ortho Dermatologics). The majority of his patients are aged 25–55 years and filler studies typically include 18- to 65-year-olds. However, “I inject patients well into their 70s and beyond and some teenagers.” Juvéderm UltraPlus, Perlane (Medicis), and Radiesse (BioForm Medical) are among his preferred products for folds, particularly in older patients.

Like other enhancements, shaping with fillers is technique dependent. “This is the art of doing fillers—you are creating a shape, defining some characteristic the patient has,” said Dr. Michaels. He prefers CosmoPlast, Juvéderm Ultra, or Restylane for shaping.

Volume replacement “is about quantity, and you need lots of product,” Dr. Michaels said. “Think of volume fillers as the rug pad under a rug.” Evolence, Perlane, Radiesse, and Sculptra (Sanofi-Aventis) are among the options for volume. “The problem with Sculptra is delayed gratification, which is not necessary a bad thing—some patients do not want their friends to know they used a filler,” Dr. Michaels said.

Filler products can be used in combination, which “is taking this to a new level,” Dr. Michaels said. “It is not uncommon for me to use two or three different fillers on the same patient.” An example of a combination is Perlane injected into the low dermis, Restylane in the mid-dermis, and CosmoDerm in the high dermis.

“Its limitation, of course, is going to be cost. Not everyone can afford that,” Dr. Michaels said.

Dr. Michaels urged caution with injection of fillers superficially “unless you have a lot of experience.” Even with the best intentions, fillers do not always end up at the level a physician perceives, “although the outcomes are fine,” according to a histologic study of hyaluronic filler injections in 16 patients (Dermatol. Surg. 2008;34:S56–62).

SDEF and this news organization are owned by Elsevier.

Click here to see a video of Dr. Michaels explaining his strategy for patients on a budget and for use of filler combinations.

SAN FRANCISCO — Although changes to the aging face are often complex, knowing filler basics will help optimize results, Dr. Jason R. Michaels said.

“When I approach patients, I try to keep it as basic as possible: who, what, where, why, and when?” Dr. Michaels said. “It is almost back to the grammar lessons we had as kids.”

Even so, pairing the appropriate filler to each patient remains an art form. “Think of [fillers] as different types of paint brushes; and I choose depending on whether I want a broader effect or to treat more detail,” he said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation (SDEF).

“I tend to look at faces in four different categories: furrows, folds, shaping, and volume,” said Dr. Michaels, associate clinical professor of dermatology at the University of Nevada, Las Vegas.

For correction of furrows, for example, options include finer-gauge fillers such as CosmoDerm (INAMED Aesthetics), Prevelle Silk (Mentor), Juvéderm Ultra (Allergan), and Restylane (Medicis Aesthetics). These products are generally safe for injections higher up in the skin. “My ideal choice is CosmoDerm because it works great on fine lines and wrinkles, but the downside is it does not last as long as some others,” Dr. Michaels said. He is a consultant for Allergan and a consultant and speaker for Medicis.

For treating folds, “the world is your oyster,” Dr. Michaels said. Examples include CosmoPlast (INAMED Aesthetics), Elevess (Anika Therapeutics), and Evolence (Ortho Dermatologics). The majority of his patients are aged 25–55 years and filler studies typically include 18- to 65-year-olds. However, “I inject patients well into their 70s and beyond and some teenagers.” Juvéderm UltraPlus, Perlane (Medicis), and Radiesse (BioForm Medical) are among his preferred products for folds, particularly in older patients.

Like other enhancements, shaping with fillers is technique dependent. “This is the art of doing fillers—you are creating a shape, defining some characteristic the patient has,” said Dr. Michaels. He prefers CosmoPlast, Juvéderm Ultra, or Restylane for shaping.

Volume replacement “is about quantity, and you need lots of product,” Dr. Michaels said. “Think of volume fillers as the rug pad under a rug.” Evolence, Perlane, Radiesse, and Sculptra (Sanofi-Aventis) are among the options for volume. “The problem with Sculptra is delayed gratification, which is not necessary a bad thing—some patients do not want their friends to know they used a filler,” Dr. Michaels said.

Filler products can be used in combination, which “is taking this to a new level,” Dr. Michaels said. “It is not uncommon for me to use two or three different fillers on the same patient.” An example of a combination is Perlane injected into the low dermis, Restylane in the mid-dermis, and CosmoDerm in the high dermis.

“Its limitation, of course, is going to be cost. Not everyone can afford that,” Dr. Michaels said.

Dr. Michaels urged caution with injection of fillers superficially “unless you have a lot of experience.” Even with the best intentions, fillers do not always end up at the level a physician perceives, “although the outcomes are fine,” according to a histologic study of hyaluronic filler injections in 16 patients (Dermatol. Surg. 2008;34:S56–62).

SDEF and this news organization are owned by Elsevier.

Click here to see a video of Dr. Michaels explaining his strategy for patients on a budget and for use of filler combinations.

SAN FRANCISCO — Although changes to the aging face are often complex, knowing filler basics will help optimize results, Dr. Jason R. Michaels said.

“When I approach patients, I try to keep it as basic as possible: who, what, where, why, and when?” Dr. Michaels said. “It is almost back to the grammar lessons we had as kids.”

Even so, pairing the appropriate filler to each patient remains an art form. “Think of [fillers] as different types of paint brushes; and I choose depending on whether I want a broader effect or to treat more detail,” he said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation (SDEF).

“I tend to look at faces in four different categories: furrows, folds, shaping, and volume,” said Dr. Michaels, associate clinical professor of dermatology at the University of Nevada, Las Vegas.

For correction of furrows, for example, options include finer-gauge fillers such as CosmoDerm (INAMED Aesthetics), Prevelle Silk (Mentor), Juvéderm Ultra (Allergan), and Restylane (Medicis Aesthetics). These products are generally safe for injections higher up in the skin. “My ideal choice is CosmoDerm because it works great on fine lines and wrinkles, but the downside is it does not last as long as some others,” Dr. Michaels said. He is a consultant for Allergan and a consultant and speaker for Medicis.

For treating folds, “the world is your oyster,” Dr. Michaels said. Examples include CosmoPlast (INAMED Aesthetics), Elevess (Anika Therapeutics), and Evolence (Ortho Dermatologics). The majority of his patients are aged 25–55 years and filler studies typically include 18- to 65-year-olds. However, “I inject patients well into their 70s and beyond and some teenagers.” Juvéderm UltraPlus, Perlane (Medicis), and Radiesse (BioForm Medical) are among his preferred products for folds, particularly in older patients.

Like other enhancements, shaping with fillers is technique dependent. “This is the art of doing fillers—you are creating a shape, defining some characteristic the patient has,” said Dr. Michaels. He prefers CosmoPlast, Juvéderm Ultra, or Restylane for shaping.

Volume replacement “is about quantity, and you need lots of product,” Dr. Michaels said. “Think of volume fillers as the rug pad under a rug.” Evolence, Perlane, Radiesse, and Sculptra (Sanofi-Aventis) are among the options for volume. “The problem with Sculptra is delayed gratification, which is not necessary a bad thing—some patients do not want their friends to know they used a filler,” Dr. Michaels said.

Filler products can be used in combination, which “is taking this to a new level,” Dr. Michaels said. “It is not uncommon for me to use two or three different fillers on the same patient.” An example of a combination is Perlane injected into the low dermis, Restylane in the mid-dermis, and CosmoDerm in the high dermis.

“Its limitation, of course, is going to be cost. Not everyone can afford that,” Dr. Michaels said.

Dr. Michaels urged caution with injection of fillers superficially “unless you have a lot of experience.” Even with the best intentions, fillers do not always end up at the level a physician perceives, “although the outcomes are fine,” according to a histologic study of hyaluronic filler injections in 16 patients (Dermatol. Surg. 2008;34:S56–62).

SDEF and this news organization are owned by Elsevier.

Click here to see a video of Dr. Michaels explaining his strategy for patients on a budget and for use of filler combinations.