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Dermal Fillers

Dermal Fillers


Facial fillers is a broad term which refers to temporary or possibly permanent injectable materials which are added to the face to erase some of the signs of aging. There are many on the market today.


Restylane® and Juvéderm® are composed of hyaluronic acid. Hyaluronic acid is a component of all connective tissues, especially abundant in the deep layers of skin, and is the same chemical composition across species. Three different formulations of Juvéderm® were approved by the FDA in 2006 for injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). The formulations differed in the size of the hyaluronic acid particle. Adverse side effects of Juvéderm® treatment are rare, and usually go away in less than a week without any intervention. Side effects of Juvéderm® usually result from the injection itself and may include redness, tenderness, swelling, firmness, and bruising. Since your body already contains hyaluronic acid, and the ingredient in Juvéderm® is created through biosynthesis in a laboratory and is designed for biocompatibility, there is very little risk of an allergic reaction after Juvéderm® treatment. Juvéderm® is estimated to last approximately 6 months though individual results may vary and it is the only hyaluronic acid product which has FDA approval to indicate it lasts up to a year.

Restylane® is another hyaluronic acid, similar to Juvéderm®. It is also synthetically created and technically has less hyaluronic acid per volume, though the significance of this clinically has not been determined. In theory it lasts less time than Juvéderm® though the actual results in clinical practice have yet to be directly tested. Restylane® too is said to last about 6 months though individual results may vary.

All of these hyaluronic acid products will last about the same amount of time, usually around 6 months though individual results may vary from one month to 9 months or more. The one execption is Juvederm Voluma which is said to last 2 years. The products are synthetically manufactured which means that the risk of allergic reaction is minimal. The major difference in the products is the size of the particle which will determine their effectiveness in various situations. Smaller particle sizes are useful for fine lines and wrinkles, such as those around the lips. Larger particle sizes are more useful for deeper folds, such as the nasolabial folds. The good thing is – if you don’t like what you see it will be gone without a trace in about 6 months. The bad thing is – if you like what you see it will be gone without a trace in about 6 months.

For patients who received hyaluronic acid injections and are not happy with the results, injection of hyaluronidase, an enzyme, will dissolve the hyaluronic acid.


For a product which lasts for about a year, think about Radiesse®Radiesse® consists of calcium hydroxylapatite microspheres suspended in gel (carboxymethylcellulose). Because calcium hydroxylapatite is a normal constituent of bone, it should not elicit a chronic inflammatory or immune response. Additionally, Radiesse does not require allergy testing. Radiesse® is a safe, effective and non-surgical treatment, which provides immediate smoothing out of wrinkles and most scars. Radiesse® is approved by the FDA for the long-lasting correction of moderate to severe facial wrinkles and folds such as nasolabial folds. Radiesse® also received a second FDA approval for the long-lasting correction of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (HIV). Radiesse® is the only filler that has received FDA approval for hand augmentation to correct volume loss in the back of the hands.

With all of these facial fillers, injections are performed in the office by Dr. Verret. Local anesthesia is used, similar to injections received when visiting the dentist. Mild bruising does occur in some people but can usually be covered in a day or two. Results are immediate though some local swelling does occur which resolves in a couple of days. The longevity of each product is different and individual results will vary.


Dr. Verret performs all facial filler injections himself. This is important for several reasons. While injectible fillers are safe, they are medications which are injected into the body. As with any medication, serious allergic reaction is possible, even if you have not had a reaction before. Should this occur, Dr. Verret is certified in advanced cardiac life support and has all of the equipment necessary in the office to treat severe allergic reaction. Unilke other nurse injectors and some physicians, Dr. Verret is a surgeon who specializes only in head and neck surgery. This means that he regularly sees the anatomy which is being affected by the fillers and has a keen understanding of the relationship of various structures of the head and neck. Dr. Verret regularly treats patients who have undergone injections at other locations with less than optimal results.

Dr. Verret is committed to getting you results which meet your goals. With that in mind, he does not have a minimum number of syringes to buy and he will always present all of the options for rejuvenation. While no results are guaranteed, Dr. Verret does guarantee that he will do everything possible to help you attain your desired results.

D.J. Verret, MD, FACS

Double Board Certified Facial Plastic Surgeon