Fillers – Juvederm

Fillers For Wrinkle Lines, Furrows, Lipstick Lines and Thin Lips

Fillers have been successfully used for decades to reduce the appearance of Wrinkle Lines and Facial Expression Lines. Fillers are also effective for plumping thin lips and improving ‘lipstick lines’ (that is, vertical lines around the upper lip in which lipstick seems to run). Within the past few years, several new fillers have been introduced that provide for a greater variety of treatment options.

What are Fillers?

Fillers are products that are used to reduce the appearance of Wrinkle Lines by adding volume to the skin. Some Fillers have been used for decades or longer. Their effect is achieved by plumping and elevating the skin where lines, grooves or depressions have appeared. The Fillers that are used are FDA approved and considered safe and well tolerated in the skin. A variety of products can be used depending upon the type of lines that are present.

What Filler materials are most commonly used?

There are several biocompatible materials that are used as Fillers. Those most commonly used are Hyaluronans (JUVÉDERM® XC Ultra Plus XC, JUVÉDERM VOLLURE™ XC, JUVÉDERM® VOLUME XC, JUVÉDERM® VOLBELLA XC) among others and transplanted fat. Both Collagen and Hyaluronans are normal constituents of the skin (that is, the dermis), while Fat is a normal constituent of the subdermis (that is, the tissue directly underneath the dermis).

What is the cause of Facial Expression Lines and Wrinkle Lines?

Facial Expression Lines develop from the movement of the underlying muscles on the overlying skin. Although these lines help us to convey to others a range of emotional states, some facial expression lines always seem to connote fatigue or anger, even if those appearances do not represent how we are feeling. This is especially true of lines of the forehead and between the eyebrows. Other lines, such as crow’s feet, may make us appear older than our chronological age. By the time we are in our 3rd or 4th decade and sometimes younger, permanent creases and furrows, known as Wrinkle Lines, develop in the skin along these Facial Expression Lines.

How do Fillers work?

Fillers provide bulk to the skin. They elevate and plump up at-rest Wrinkle Lines, grooves, furrows and depressions under which they are placed. Their effect is different than that provided by Botox®, which targets the muscles that produce Facial Expression Lines. It is the repeated movement of these muscles that results in the development of at-rest Wrinkle Lines and furrows.

What kind of facial lines do Fillers treat?

Prominent, deep Wrinkle Lines and furrows respond best to fillers. Most commonly, these include the Nasolabial lines, which run between the sides of the nose and the angle of the mouth; Mentolabial lines, also referred to as “Marionette lines”, which run between the angle of the mouth and the jawline; Glabella lines, which appear as vertical lines between the Eyebrows; and horizontal Forehead lines. However, other at-rest lines and furrows and depressed scars can be treated with fillers as well. In addition, Fillers are used to plump up Thin Lips. Fillers can also reduce ‘lipstick lines’, that is, those vertical lines around the upper lip in which lipstick may ‘run’.

How does Botox® compare to Fillers?

Botox® and Fillers are used for different purposes. Botox® reduces the activity of the muscles that produce Facial Expression Lines. However, it may not significantly affect those wrinkles and furrows that have already developed and are present in the absence of active facial expression. Fillers treat these at-rest Wrinkles Lines and furrows by plumping up the skin.

How do I know whether I will benefit from Botox® or a Filler for expression lines?

This will depend upon whether you want to treat Facial Expression Lines or Wrinkle Lines. That is, are your lines present at rest (Wrinkle Lines) or only with facial expression (Facial Expression Lines)? Some people benefit more from Botox® than Fillers while others more from Fillers than Botox®. However, many benefit from a combination of Botox® and a Filler. During a consultation, it will be determined whether Botox®, a Filler or a combination will provide the most benefit to you.

How is treatment administered?

The filler material is injected directly under the Wrinkle Line or furrow that you would like to elevate. To plump up thin lips or to reduce ‘lipstick lines’, the Filler is injected into the lips. Filler treatments take just a few minutes.

Is there any discomfort with treatment?

There is mild discomfort with Filler treatment, such as Juvederm®, Volbella® or Voluma®.  That’s because these Fillers have an anesthetic – Lidocaine – incorporated in them.  For that reason, discomfort only lasts for the duration of each injection, which is usually a several seconds. The entire treatment usually takes just a few minutes.

How long do the results of Fillers persist?

All of the naturally occurring Fillers provide temporary improvement in the appearance of at-rest wrinkle line, furrows, scars, lipstick lines and thin lips. The results vary widely – from 6 to 24 months depending on the specific Filler used, the site of treatment and your individual response. In addition, the presence of Botox® may enhance the duration of Fillers. For example, if the Glabella lines (those lines between the eyebrows) are being treated with a Filler, the duration of benefit may persist longer if Botox® was administered as well. When the effect of the Filler wears off another treatment can be administered. There is no limit to the number of Filler treatments that one can receive.

Which Filler is best for me?

There is an array of Fillers that can be used including JUVÉDERM® XC Ultra Plus XC, JUVÉDERM VOLLURE™ XC, JUVÉDERM® VOLUME XC, JUVÉDERM® VOLBELLA XC. The one selected will depend upon the site to be treated, the depth of the Wrinkle Line or scar and the duration of benefit you are looking to achieve.  During a consultation, it will be determined which Filler would be most appropriate for you.

When can I expect to see any results after treatment?

Immediately after the Filler has been placed, the Wrinkle Line, furrow or scar should be reduced in appearance. During the next few weeks there is usually further reduction in the appearance of these lines and depressions in the skin.

How does the skin appear after Fillers?

Immediately after treatment with Filler the skin may appear pink with mild swelling. This usually fades within a few hours to a few days – although sometimes longer – after treatment. Rarely mild bruising can develop. Initially, the skin feels numb for a short time – because of the anesthetic that is incorporated into the Filler – but there is, otherwise, no unusual sensation.

Are there any limitations after treatment?

No. Immediately after treatment with a Filler you may resume all normal activities, including strenuous exercise.

Are there any risks or side effects?

Side effects such as an allergic reaction are rarely or never seen. The Hyaluronans (JUVÉDERM® XC Ultra Plus XC, JUVÉDERM VOLLURE™ XC, JUVÉDERM® VOLUME XC, JUVÉDERM® VOLBELLA XC) are fully compatible with the naturally occurring Hyaluronans in the skin. They are considered safe and non-allergenic that no prior skin-testing is recommended or required.


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10.32.09: Delegation and Assignment of Performance of Cosmetic Medical Procedures and Use of Cosmetic Medical Devices. This is a Maryland safety regulation which governs who can legally perform medical cosmetic procedures.  Dr. Green administers all injectable treatments (including Botox™, Juvederm™, Voluma™ , Kyblella™ and other fillers & Sclerotherapy) and laser treatments.

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