Dermal Facial Fillers


What are Dermal Fillers?

As our face ages, the skin, underlying muscles and soft tissue descend, and with the loss of fat volume, the resulting deep lines and hollows can create a sunken or tired look.  Today’s dermal fillers can quickly and easily address these conditions.  These simple in-office injections can help men and women maintain their youthful appearance without surgery.  When used in conjunction with BOTOX® and PRP they provide a “liquid facelift.”

Customized Filler Treatments to Address Your Needs

Specializing in plastic and facial surgery and board-certified in Ophthalmology, Dr. Kimberly Cockerham and Dr. Ethan Tittler’s knowledge of skin and facial musculature and her skilled aesthetic approach have helped thousands achieve a natural, more youthful appearance with fillers. In recognition of her expertise in the most advanced facial filler techniques, she has been selected to be in the Liquid Face Lift Association.

The most popular fillers are natural products found in your own body’s tissues: hyaluronic acid (Juvéderm® and Perlane®) and calcium hydroxyapatite (Restlyane® and Radiesse®). After discussing your cosmetic goals and assessing your facial structure, Dr. Cockerham or Dr. Tittler will recommend the most appropriate dermal filler treatments for your desired outcome.

Dermal fillers are able to address your following needs:

  • Deep lines around the sides of the nose to the mouth (nasolabial folds)
  • Loss of volume and fine lines on our around the lips
  • Hollowing below the eyes or along the eyebrows
  • Loss of cheek volume
  • Lip, nose, or chin augmentation and shaping
  • Facial deformities or scarring

What is Juvéderm®?, Restylane®, and Belotero®?


Juvéderm®, Restylane®, and Belotero® are three brands of dermal fillers (like Ford, Chrysler, and GM are three brands of cars). Dermal fillers are injectable products that are placed under the skin to fill indentations or to provide additional volume in areas that need augmentation. For example, permanent wrinkles and creases can be decreased by careful placement at the base of these problem areas. Another common use of these products is over the cheekbones, providing a subtle lift or projection of the mid-face, which decreases the drooping of the cheeks.

Each brand has a range of fillers that have different characteristics, each optimized for different situations. Thicker, stiffer fillers are generally used where more support and lift are needed, and where mobility is less important, such as over the cheekbones. Thinner, more flexible fillers are used where maintaining maximum mobility is important or where indentations are very superficial, such as in the lips.

Dermal fillers, such as Juvéderm, Restylane, and Belotero, take effect immediately and generally last about 9 months. Frequently, touch-up treatments do not require as much product as the initial treatment.

Possible unintended effects of fillers are very rare, but include a subtle change in the skin tone in areas of thin skin, blockage of skin blood vessels, and lumps that can be felt under the skin.

What exactly is in dermal fillers?

Dermal fillers are either categorized as “natural” or “synthetic.” Natural fillers, such as the Juvéderm and Restylane families, and Belotero Balance, are made primarily from hyaluronic acid. This naturally occurring sugar in the body is responsible for hydrating, plumping, and firming the skin. It does this by binding with nearby water molecules. Hyaluronic acid is so good at this function that it can bind with 1000 times its weight in water.

Synthetic fillers such as Radiesse are made from calcium hydroxyapatite microspheres suspended in an aqueous gel. This is the same material that dissolvable sutures are made from. While the body does not reject these microspheres, they do not naturally form, hence the synthetic moniker.

Can dermal fillers be used in other areas of the body?

Really the only area other than the face where Dr. Cockerham or Dr. Tittler injects dermal fillers is the back of the hands. Fillers such as Restylane Lyft have been approved by the FDA for use on the backs of the hands. This is to return volume to cover blood vessels and tendons that become more and more prominent due to the thinning of the skin on the backs of our hands.

Dermal fillers have not been approved on any other areas of the body, and they wouldn’t have much effect. To eliminate wrinkles on a body area such as the backs of the elbows would require such large amounts of filler that it would be unrealistic as a treatment.

Am I a good candidate for Dermal Filler injections?

Whether or not fillers such as Juvéderm and Restylane would be right for you depends on what type of wrinkles you are trying to address and where they are on the face.

Dermal fillers are true to their name. When injected they instantly fill in the area of volume loss and push the skin back upward. Fillers are used to treat the form of wrinkles known as “static” wrinkles. These wrinkles are due to sun damage, declining collagen production, personal habits, and the effects of aging on our skin. Static wrinkles show themselves at all times and don’t involve muscle contractions. Dermal fillers are injected beneath these areas where volume has decreased and they return volume, pushing the skin back upward. These areas are from the mid-face down around the mouth area. 

If your lines are on the upper third of your face, the expressive area, they are likely caused by muscle contractions under the skin when you make various typical expressions. Over time and hundreds of thousands of these contractions a wrinkle begins to form on the surface skin when you make an expression such as forming a frown. This is where you need a neuromodulator. We carry Botox, Dysport and Xeomin at Central Valley.

Neuromodulators work by relaxing a muscle that forms a wrinkle on the surface skin when the muscle contracts. These are known as “dynamic” wrinkles and they occur on the upper third of the face. When you form an expression, such as showing surprise or forming a squint, you can feel the muscles around your eyes, between your eyebrows, and on your forehead engage. When injected into these muscles, the neuromodulator relaxes them for about four months, so the wrinkles they form are erased. Dermal fillers don’t work on dynamic wrinkles.

Do Dermal Fillers look natural?

Dr. Cockerham and Dr. Tittler are both board-certified oculofacial plastic surgeons. As such, they have extensive training, expertise, and experience both with facial anatomy and with the use of dermal fillers to return volume to areas of the face and hands. That’s another reason why you wouldn’t want to have dermal fillers injected at a dentist or nail salon, as the injector may not have the training and experience to ensure your best results. Dr. Cockerham and Dr. Tittler have been trained specifically with all of the dermal fillers we offer at Central Valley Eye Medical, and she knows how to inject the correct amount to erase the lines, creases, or areas of volume loss, while at the same time keeping the patient’s appearance completely natural-looking.

How do I know which Dermal Filler would be right for me?

Different dermal fillers have been created for different areas of the face. For instance, Juvéderm Voluma is meant to return volume to the cheeks. Restylane Silk and Kysse, and Juvéderm Ultra and Volbella have all been created (and have FDA approval) for adding volume and definition to the lips.

As mentioned above, Dr. Cockerham and Dr. Tittler are both board-certified in ophthalmology, and have a detailed understanding of the skin and underlying musculature of the face. With that expertise, she is able to match the dermal filler she uses to the specific aging issues you’re seeking to address.

Are there any risks associated with dermal fillers? 

Because most of the dermal fillers we offer at Central Valley are made with hyaluronic acid, which occurs naturally in the human body, allergic reactions are almost unheard of, so pre-testing isn’t necessary. The most commonly observed side effects are swelling, redness, pain, bruising, headaches, tenderness, lump formation, and itching at the injection sites. These are typically mild in severity and usually resolve themselves in two or three days. 

Occasionally, lumps or granulomas can form near the injection sites. This side effect can be reversed with an injection of hyaluronidase, an enzyme that speeds up the natural degradation of the hyaluronic acid in the filler.

As for the synthetic fillers we offer, such as Radiesse, they are made with the same material used to create dissolvable medical sutures. They are completely compatible with the body. The risks are basically the same as those with hyaluronic acid fillers.

Are dermal filler injections painful?

Dr. Cockerham or Dr. Tittler injects these dermal fillers with a very fine needle. Plus, the entire Restylane line now includes some Lidocaine in each formulation to help keep these injections comfortable. Otherwise, we can apply some topical numbing cream prior to your injections to alleviate any discomfort. These are not painful treatments.

Is there any downtime after receiving filler injections?

There isn’t any downtime. As mentioned above, you can have some slight swelling or redness at the injection sites, just as you do with any injection. But this generally passes in just a few hours. Immediately after you leave our Central Valley offices you can get right back to work or your other normal activities. These are great lunchtime procedures, as you can fit them in over your lunch hour and still have time left to grab a sandwich.

How Long Do Results From Dermal Fillers Last?

Dermal facial fillers result in immediate visible effects. Fillers are injected in the office following topical anesthetic, and they result in immediate visible effects. Bruising or swelling is possible, so icing is recommended immediately following the procedure. Dermal fillers can stimulate collagen production and provide long-lasting enhancements that can last from months to years, depending on the product used and the site of injection.

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If you would like to learn more about Dermal Facial Fillers call 1-800-244-9907 to make an appointment at Central Valley Eye Medical Group.

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