Aging causes loss of deep Dermal fat pockets in the face leading to loss of volume in the midface among other areas of the face. The loss of volume in midface area tends to be more noticeable than other areas and comes to the attention of our clients as nasolabial folds, marionette lines and jowls and sagging of the midface. They don’t realize that all these signs of aging are happening due to the loss of deep fat pockets in the face. Before dermal fillers were invented, facelifts, laser resurfacing, cheek implants and fat transfers were the only ways to restore volume to the face and get rid of wrinkles. Dermal Fillers have revolutionized the cosmetic surgery practice because they have prevented a lot of surgical procedures on the face plus producing good results from minimum downtime. In 2016, over 2.6 million dermal filler procedures were done in the USA. Dermal Fillers can be used in every part of the body where soft tissue defect appears unaesthetic or unattractive on the surface. They can be used to enhance some features of the face like the lips or cheeks or chins in younger clients or restore the age-related volume loss in different areas of the face in older clients. Dermal Fillers can also be used to fill up depressed scars, acne scars or change the form of a bone such as the nasal bridge. We at Orion Aesthetics also use fillers like Radiesse and Sculptra for breast augmentation or breast lifts, buttock augmentations and butt lifts. The ideal filler to use for breast and buttock augmentation is fat. However, in athletic women or in women who don’t have enough fat on their bodies to move it to the breast or buttock, Sculptra can be considered as a volumizing agent. Sculptra is the most volumizing filler in the market. Radiesse can also be used for wrinkles anywhere on the body, particularly on the abdomen, thighs and upper arms.
There are over 2 dozen different types of Dermal Fillers in the market. How do you choose the best facial filler or the best lip filler or best cheek filler or filler for a hollow under the eyes also called sunken eyes? How do you find the best cosmetic surgeon who can produce the best results? Dr. Uppal who has been voted as the best Cosmetic Dermatologist in Rocklin, Roseville, Lincoln, Granite Bay, and Greater Sacramento area, uses the rheological properties of a filler to decide if it goes for lip injections or cheek augmentation or for treating static wrinkles. Radiesse has the highest Elastic Modulus G’ and viscosity of all the fillers in the market. That’s why Dr. Uppal uses Radiesse as the go-to filler if any volumizing effect is needed in the face. Radiesse is very unique among all the fillers that it produces an immediate lifting effect which lasts for months and this effect is continued by sustained production of collagen-induced by the Calcium Hydroxylapatite crystals. The effect of Radiesse can last 18-24 months.
Radiesse is a gel composed of 30% Calcium Hydroxylapatite crystals suspended in Carboxymethylcellulose gel which is 70% by volume. Calcium Hydroxylapatite is suspended in the gel as spherules of 25 microns to 45 microns in diameter. After sub-dermal and supra-periosteal deposit, the Calcium Hydroxylapatite spherules are slowly broken down into Calcium Phosphate molecules over 12 months. Interestingly the Calcium Hydroxylapatite crystals are not swallowed by macrophages or fibroblasts. They are never found intracellularly but induce the fibroblasts to produce collagen and ground substance. Elastin and proteoglycan production is also increased by these crystals. Radiesse can be used for thickening the skin in any part of the body, hence it can be used in high dilution as a non-volumizing but skin thickening agent. In Dr Uppal’s experience, it takes about 3 syringes on each side if someone in their 50s desires their cheek volume to be like that when they were in their 20s. The Radiesse injections are done in 2-3 sessions 1 month apart so that the cheek volumes are gradually increased.
We at Orion Aesthetics use the rheological properties of different fillers to reach different goals. Out of all the physical properties, G* is the most important property we look at for volumizing the midface. G* is called complex modulus which is the total energy needed to deform material using shear stress. This term is commonly referred to as filler “hardness,” representing how difficult it is to alter the shape of an individual cross-linked unit of filler. G* reflects the hardness of multiple units of cross-linked HA, not the hardness of the whole gel deposit. It is determined by the following formula:
in which G′ and G″ are derived from experimental testing with a rheometer
Radiesse has the highest G* followed by Restylane, Perlane followed by Voluma. In addition to the G*, viscosity is also an important property determining how the filler will get used. High G* values will produce low cohesiveness and the filler will tend to disperse in the tissues as small globular deposits whereas fillers with lower G* will have more cohesiveness and appear as single deposit spread over a wide area. Fillers in lips or lower eyelid or intradermal injections will need higher cohesiveness whereas fillers used for volume restoration in mid-cheek should have high G* to produce a lifting effect.
Dr Uppal performs all the filler procedures at Orion Aesthetics un-like other Cosmetic Surgery and Dermatology practices which use Nurses and Nurse Practitioners/Physician Assistants. Most of us want beautiful faces but have slightly different interpretations of beauty. Dr. Uppal wants to understand what his clients desire keeping in mind the cross-cultural universally accepted norms of beauty. Dr Uppal is a student of human attractiveness and believes there are universally accepted norms of beauty and then there are individual variations of that norm that Cosmetic Dermatologists have to know about to be able to individualize the treatments to each client. Orion Aesthetics is a Cosmetic Dermatology office near California Family Fitness. We at Orion Aesthetics help our clients reach their beauty goals and also guide them about the beauty goals because Dr. Uppal has a special interest in cross-cultural beauty trends. Our office sees clients from Rocklin, Roseville, Lincoln, Granite Bay, and the Greater Sacramento area.