Injectables and Dermal Fillers

Dr. Kim performs every neuromodulator and filler treatment in the practice, and has done so since he began practicing over a decade ago. Facial surgery is the core of the practice, and he treats injectables and surgery as points along one continuum of facial aging.

Repeated treatment provides a longitudinal record of each patient's anatomy: the pattern of volume loss, changes in the underlying bone, and changes in skin and soft tissue. Facial aging is individual, and patients of the same age can differ considerably. This view is difficult to obtain any other way.

A bespoke, individualized treatment plan depends on an understanding of the subtle and diverse anatomy of the face and of how it moves with expression. As a facial surgeon, Dr. Kim has an intimate knowledge of facial anatomy and its variations. That knowledge guides where and how each product is placed and helps minimize the risk of complications. Following each patient over time allows the plan to be adjusted as the face changes.

When a patient followed over several years considers surgery, Dr. Kim evaluates a face he already understands, and the surgical plan is tailored to how that face has changed. The same continuity applies to patients who have had surgery and continue with injectable maintenance.

Dr. Kim treats in a series of smaller sessions. Each session adds a measured amount, and the response of the face and the patient's feedback guide the next one.

Hyaluronic acid fillers continue to interact with the skin in the weeks after injection, as collagen is deposited around the filler, so the result continues to develop between sessions. Staging allows that response to be assessed before more product is placed. The goal is a natural result built in layers.

Treatment is planned one session at a time, without bundled packages. Facial aging continues, and ongoing follow-up allows the plan to be adjusted as the face changes.

Dr. Kim uses three families of dermal filler, each with a different role. The choice depends on the layer, the area and the result you want.

Hyaluronic acid (HA) fillers, such as Restylane, Juvéderm and Belotero, restore volume and soften creases and lines. They differ in cross-linking. Lighter products suit fine lines and delicate areas. More highly cross-linked products suit deeper volume.

Calcium hydroxylapatite (CaHA), sold as RADIESSE, restores volume in deeper layers and stimulates the skin to produce its own collagen.

Poly-L-lactic acid (PLLA), sold as Sculptra, rebuilds volume gradually through collagen stimulation, usually over a series of sessions.

New fillers come to market regularly. Dr. Kim relies on products that have been used and studied over the long term.

Dr. Kim selects among the three according to your anatomy and goals, and often combines them in a staged plan.

Folds and creases result from several changes of aging: loss of skin elasticity, years of repetitive movement with expression, and loss of volume. The loss of elasticity allows a crease to form and deepen, and volume loss adds to it. The areas treated most often are the nasolabial folds (from the nose to the corners of the mouth), the marionette lines (from the corners of the mouth toward the chin), the lips and the tear trough (the groove beneath the lower eyelid).

Dr. Kim plans each area according to the anatomy of your face and how it moves with expression, and this determines the product and the depth. Subcision, a fanning motion of the needle beneath the crease, releases the fibrous connections that tether the skin to the tissue below. Hyaluronic acid placed in the deeper dermis or just beneath the skin (intradermal and subdermal placement) then lifts the crease. The filler also stimulates the skin to remodel, with new collagen forming around it to support the skin's elasticity over time.

Results last different lengths of time in different areas, and the lips typically need retreatment sooner than the folds around the mouth.

Fine lines can remain etched in the skin when the dermis has thinned and sun exposure has damaged its elastic fibers (atrophic rhytids and solar elastosis). These lines arise in the skin itself and are treated at a more superficial level than folds.

Superficial subcision releases the tethering directly beneath the line, and hyaluronic acid is then placed in the same shallow plane to smooth it. The treatment is repeated in stages as the skin responds, and each session is planned according to the pattern and depth of the lines in your face.

A facelift or neck lift repositions the deeper tissues and tightens the skin. Fine lines within the skin itself can remain afterward. Fractionated CO2 laser resurfacing, performed at the time of surgery, tightens the skin and improves its texture.

Discrete creases that persist after healing are treated afterward with subcision and hyaluronic acid, as described above. Dr. Kim plans this sequence for each patient, and both the surgery and the injections remain in one practice.

Volume loss in the midface, the cheeks (including the hollow below the cheekbone) and the temples is treated with fillers placed in the deeper layers. These include highly cross-linked hyaluronic acid formulated for deep volume and, more commonly, RADIESSE or Sculptra.

Volume is the limiting factor in these areas, so restoration is completed over multiple sessions. Each session is planned according to the anatomy of your face and how your face has changed.

RADIESSE is generally advised for patients in their later years, whose metabolism is slower. Sculptra is generally advised for younger patients, whose metabolism is more robust.

The reasoning concerns how the body responds. Sculptra builds volume gradually, through the collagen the body produces in response to it over a series of sessions, and a younger, more metabolically active body mounts that response readily. Collagen production declines with age, so RADIESSE, which restores volume and also stimulates collagen, is better matched to older skin. Skin thickness and your goals also guide the choice.

Fat grafting is an alternative for patients who want a more lasting correction of volume loss. It is a procedure, performed under twilight sedation, and it is minimally invasive with minimal downtime. Fat is gently removed by liposuction, most often from the abdomen, and injected into the face in small portions.

Its strengths are supply and durability. The supply of donor fat is practically unlimited, so the volume that can be restored does not depend on the amount of product. Because the fat is your own tissue, the portion that survives the first months is long lasting, and it may also improve the quality of the overlying skin.

Patients who wish to consider fat grafting can learn more on our Facial Fat Transfer page.