Question: When I first had Juvederm, I looked nice. Now after several years of filler injections, the Juvederm looks puffy. When I skip the filler, my puffiness settles but I look tired and older. Is there a filler that can soften my deep smile lines and cheek hollows without making me look over-plumped?
Answer by Dr. Anita Mandal:
Not all fillers are the same. Injectables like Juvederm
, and Belatero fall into the category of hyaluronic acid (HA) fillers. HA fillers work differently in your body compared to Bellafill
or Renuva which are in the group of biostimulatory and regenerative fillers.
Many patients don’t realize that HA fillers are prone to fluid retention after repeated treatments. HA fillers work by attracting your body’s own water to restore volume. Initially, you may see a nicely hydrated appearance. But because HA fillers only last 6-12 months and you must continue to refill frequently, the continued water attraction over the long term can result in a puffy, overly smooth, and/or unnatural appearance to your face.
Another aspect of HA fillers rarely discussed is the layer of scar tissue that forms along the pathway of injection. While having HA filler treatments 2-3 times in one’s lifetime won’t necessarily contribute to a significant amount of scar tissue, serial treatments over a period of years every 6-12 months can cause significant buildup of scar tissue and slow down your lymphatic system in the area of treatment. Since your lymphatic vessels drain fluid and toxins from the face, any blockage can contribute to fluid build-up and puffiness.
If you are only having HA fillers placed in the superficial tissues in smaller amounts, you don’t need to be as concerned. However, HA filler treatments into deep tissues requiring higher volumes can become an issue.
Long-term fillers - Bellafill which can last 5 years or even longer as well as Renuva which is permanent - are not injected frequently compared to temporary HA fillers. For this reason, long-term fillers don’t result in the kind of scar tissue buildup seen with HA fillers.
Additionally, Bellafill is a biostimulatory filler which stimulates your body’s own collagen. Renuva is a regenerative filler which causes regeneration of your own natural fat. Both Bellafill and Renuva can restore volume to the face. However, since they do not attract water like HA fillers do, Bellafill and Renuva are much less prone to puffiness when treatments are performed by a highly skilled injector.
Dr. Anita Mandal is a Board Certified Facial Plastic Surgeon of 26 years and a specialist in the face, eyes, and neck, Dr. Anita Mandal’s philosophy is to reverse the signs of aging without making you look different, unnatural or distorted. She believes that after a cosmetic procedure, the patient should appear rested, refreshed, more youthful but look as they are simply aging beautifully on their own without obvious signs of a cosmetic procedure being performed.