By Dermatology & Dermatologic Surgery, Ltd.
February 07, 2017
Category: Dermatology
Tags: fillers  

When patients come to a dermatologist’s office, frustrated with a line or fold, they often want to plump the offending crease with filler. fillersThey see a wrinkle, and want to directly fill in a wrinkle.  In his Willowbrook and S. Barrington practice, Dr. Jeffrey Berti, a board certified cosmetic dermatologist, sees many people for fillers every month. For some of those patients, his filler technique is surprising, yet very effective.

“One woman came to me with jowls,” Dr. Berti said. “I explained I’d start injecting the cheek area to correct the sagging in the lower face. She questioned me: ‘Why would you inject up there when the problem is down at my jawline?’ I asked, “How did you look when the last surgeon injected you with many syringes of product in your lower face?’ She answered, “Like a bulldog.”

He filled the cheeks and the area he discussed. She left happy.

Dr. Berti’s approach is sometimes called anatomic filling: replacing volume (with injectables like Restylane, Juvéderm, and Sculptra) where it has been lost to restore the overall youthfulness of the face. Doctors have stopped looking at wrinkles and sagging skin in isolation and are considering how volume loss in one area affects other.

A young face has the “triangle of youth,” meaning it is broadest at the cheeks just under the eyes and narrower at the chin. But over time, tissue and bone is lost midface. With a deflated support system, skin starts to sag, and the face slowly transforms from triangle to trapezoid. Jowls form.

Fillers counteract that aging process by adding fullness to the cheeks, which restores skin to its original position, softening nasolabial folds (smile lines), marionette lines (creases running from the corner of the mouth to the chin) and jowls.

“When you inject on top of the outer cheekbone, it has a lifting effect that tightens up the droopiness in the lower face. That’s how we do things now.”

Doctors will note that in some patients, nasolabial folds still require direct injections. “But I start in the midface,” Dr. Berti said. “That’s where most of the work happens.” Using the principles he learned in physics, Dr. Berti can utilize vectors within the skin to tighten skin beautifully.

Of course, there are limits to what fillers can do. Think of the neck as a litmus test. If it’s very loose or banded, fillers won’t help. Also prohibitive: inelastic skin. For fillers to work, they must have some structure to push against. Skin lacking collagen and elasticity, like severely sun-damaged skin, won’t lift.

“In my experience, using filler to correct drooping skin in somebody who already has prominent cheekbones is reasonable,” said Dr. Berti. “After that, the pocket where the filler was placed stretches. Then to achieve the same look, doctors will inject more product. You start seeing cheeks that are very prominent compared to the lower face and more youthful.”

If you would like to learn more, or if you would like to come in for a complimentary consultation contact Dr. Jeffrey Berti at Dermatology & Dermatologic Surgery, Ltd., in South Barrington and Willowbrook, IL. Call our Willowbrook office at 630.321.0303 and our South Barrington office at 847.304.0303.

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