Filler replaces lost volume. It does not lift tissue, and it does not always leave when it seems to.
Dr. Kim sees Rochester patients for dermal filler consultations and treatment at his office at the Oliver Culver House, 70 East Boulevard. Every injection is performed personally by Dr. Kim, a double board-certified facial plastic surgeon whose practice is dedicated exclusively to the face, head and neck. Rochester patients do not need to travel to Syracuse for filler appointments; most leave the same day.
Aging removes volume in layers. Skin thins as collagen disappears. The deep fat compartments over the cheekbone and around the eye deflate; the ligaments that anchor soft tissue to bone weaken and tissue descends; and the underlying bone resorbs over decades. Significant weight loss produces the same hollowing at any age, sometimes quite rapidly in the midface.
Filler addresses deflation and part of the skeletal loss. A gel matched to the depleted layer restores the scaffolding that supported the skin above it, softening hollows and improving contour where volume has been lost. The product is injected into the tissue plane that corresponds to the loss: supraperiosteal for deep structural support, subcutaneous for the fat of the midface, dermal for very superficial lines.
Filler does not lift tissue that has descended. Jowls, a heavy neck and loose skin along the jawline represent descent, not deflation. Adding volume to a primarily descended face makes it fuller but not younger-looking, and can in some cases worsen the appearance of heaviness at the jawline. The separation of descent from deflation is made at the consultation; the outcome is sometimes a recommendation against filler and toward a facelift.
Filler also does not treat lines caused by muscle movement. The creases that appear when the brow furrows or the crow's feet that form when squinting are addressed by wrinkle relaxers, not volume. Filler and relaxers are often used together, but they act on different problems. A full account of the injectable options is in our dermal fillers overview.
Dr. Kim's Rochester office is located at the Oliver Culver House, 70 East Boulevard, in the Park Avenue neighborhood. The office is accessible from the I-490 corridor and has parking available. Patients traveling from Buffalo manage the trip in approximately 75 minutes on the I-90; those coming from the Finger Lakes communities -- Canandaigua, Victor, Geneva -- typically reach the East Boulevard office in 30 to 45 minutes.
Unlike surgical procedures, which are performed at the AAAHC-accredited suite in Syracuse, filler appointments take place entirely at the Rochester office. The consultation, photographs, treatment and any follow-up review are all conducted here. Most patients return home the same day without need for overnight accommodation.
At the consultation, Dr. Kim takes standardized photographs, reviews every prior injectable treatment you have had -- including work done elsewhere -- and examines the face to distinguish deflation from descent. The plan that follows is specific to your anatomy; some consultations conclude with a recommendation against filler and toward surgical restoration instead.
New patients may find it useful to write down the product names, areas treated and approximate dates of any prior fillers before the visit. If you have records or photographs from earlier treatments, bring them. Patients with a history of filler from multiple providers require particular care in planning; the consultation is the appropriate moment to surface that history fully.
HA gels -- the Restylane, Juvederm and Belotero families -- are the most widely used fillers and the only class that can be dissolved with hyaluronidase. Within the class, viscosity and cohesivity vary considerably: a firm, highly cohesive gel is suited to deep structural support at the cheekbone or jawline; a softer, lower-viscosity gel is better suited to fine lines near the surface or the delicate skin below the eye. Manufacturer duration figures are measured at specific endpoints and are not comparable across brands; visible correction typically ranges from several months to two years depending on site, depth and the individual.
MRI studies have detected HA in some patients 8 to 15 years after injection, well after any clinical effect has resolved. The material persists in the tissue, and a surgeon operating in those planes later needs to know it is there.
Calcium hydroxylapatite (RADIESSE) is a thicker gel suited to areas with more substantial soft tissue; it stimulates collagen over time and tends to last longer than most HA products in the areas where it is used. It cannot be dissolved. Poly-L-lactic acid (Sculptra) is a collagen stimulator rather than a space-filler; it is injected in dilute suspension and builds gradually over a series of sessions, making it suited to thin skin where a distributed, progressive result is preferable to an immediate volume depot. It also cannot be dissolved.
The irreversibility of these products is relevant to surgical planning. A patient who may want a facelift in the coming years should disclose all prior filler, including product class, because non-HA material in the deep planes may affect the approach. Dr. Kim addresses this directly at the surgical consultation.
Vascular occlusion occurs when filler enters a blood vessel -- or compresses it from outside -- and interrupts flow to the skin or deeper structures. In the face, the most dangerous areas are those supplied by the ophthalmic artery and its branches: the nose, glabella and forehead. Filler injected into the nasal dorsum, glabellar region or forehead can travel retrograde through the angular or supratrochlear arteries and reach the central retinal artery, causing permanent blindness.
Of 318 reported cases of filler-related vision loss with documented outcomes, 68.2% had no recovery. No reliable denominator exists for the overall rate, because most filler injections are not tracked in a registry. Hyaluronidase has not been shown to restore vision once lost; animal data are mixed, and the window in which it might help is almost certainly too short to be clinically actionable.
Skin necrosis from vascular occlusion is less catastrophic but produces lasting scarring if not recognised and treated early. The nasal ala, the glabella and the perioral area are the sites most commonly reported. The earliest signs -- blanching, livedo reticularis, disproportionate pain -- require immediate attention. This is why treatment is performed by a physician who can recognize the complication, has hyaluronidase available and can act without delay.
In a prospective series of 20,399 filler procedures, the overall adverse event rate was 0.24% and no serious events were recorded -- a figure that reflects the frequency of minor complications in expert hands, not the rate in aggregate clinical practice. The injector's anatomy knowledge and experience bear directly on risk; the largest available dataset found that more than five years of experience was associated with 70.7% lower odds of vascular occlusion.
Most patients return to normal activity the same day. The timeline below reflects typical experience; individual variation is substantial.
Swelling peaks in the first few hours. Some bruising may appear; this is expected. Avoid strenuous activity, alcohol and lying fully flat. Keep the face cool if comfortable. The area feels firm; that is the gel, and it softens as the tissue accommodates.
Swelling begins to reduce but is still visible. Bruising, if present, may deepen in colour before it fades. Avoid facial massage, steam and anything that significantly raises your heart rate. Makeup is generally permitted after the first 24 hours unless subcision was performed.
Most of the swelling has resolved. The result is closer to its final character. Any lump that is growing, warm or tender during this window should be reported promptly at 315-471-8404; a lump that is stable and not uncomfortable can be assessed at the follow-up visit.
A lump still present at two weeks is reassessed. Hyaluronic acid material can be dissolved with hyaluronidase at this point if the result is not satisfactory. A bluish tint visible through the skin (Tyndall effect) indicates superficial placement and is addressed at the review visit.
When subcision precedes filler placement, a firm, irregular feel beneath the skin is common for up to two weeks as the connective tissue heals. Surface appearance may look uneven during this period. This is the expected course and is not a sign of a problem unless accompanied by redness, warmth or increasing pain.
If at any point -- days or months after treatment -- you notice skin discoloration, an enlarging nodule, persistent redness or any change in vision, call 315-471-8404 immediately. Vision change after any facial injection is a medical emergency requiring an emergency department at once.
Yes. Dr. Kim holds consultations and performs filler treatments at his Rochester office, located at the Oliver Culver House, 70 East Boulevard. Unlike surgical procedures, which require the Syracuse suite, filler appointments take place in Rochester, and most patients return home the same day. Patients driving from Buffalo, the Finger Lakes or Canandaigua typically find the Rochester location the most practical entry point.
Dr. Kim performs every injection himself. Filler remains in tissue long after its visible effect fades and lies in the planes a surgeon later works in; having one person hold that record means knowing what was placed, where and when. The largest dataset to date found that more than five years of injector experience was associated with 70.7% lower odds of vascular occlusion.
Deflation is volume loss: fat compartments over the cheekbone and around the eye flatten with age or significant weight loss, and filler addresses this by restoring support in the depleted layer. Descent is tissue that has moved downward as retaining ligaments weaken; jowls, a heavy neck and loose skin are examples. Filler does not lift descended tissue. Adding volume to a primarily descended face makes it fuller but not necessarily younger, and the consultation is where this distinction is made.
None is best across the whole face. A firm hyaluronic acid gel suits deep structural support; a soft gel suits fine lines near the surface; calcium hydroxylapatite suits thicker skin and areas needing lift; poly-L-lactic acid builds gradually over several months and suits thin skin where a softer, distributed result is preferred. Manufacturer durability figures are measured differently and are not comparable across brands. Dr. Kim matches the product to the tissue layer and the goal.
Product, site, depth, volume placed and individual metabolism all affect duration. Labeled durations typically range from 6 to 24 months and measure clinical correction; the material often persists well beyond that point. MRI imaging has detected hyaluronic acid in some patients 8 to 15 years after injection, long after the visible effect resolved. Calcium hydroxylapatite and poly-L-lactic acid cannot be dissolved; hyaluronic acid can be reversed with hyaluronidase.
Yes, rarely. Filler injected into an artery can travel retrograde and reach the ophthalmic artery, most commonly when injected in the nose, forehead or glabella. Of 318 reported cases with documented outcomes, 68.2% had no recovery of vision. No reliable denominator exists for the overall rate. Hyaluronidase has not been shown to restore vision once lost. Any change in vision after an injection is a medical emergency.
The most common events are not serious: swelling, bruising, redness and small lumps that settle within days to two weeks. In a prospective study of 20,399 filler procedures the overall adverse event rate was 0.24% and no serious events were recorded. Serious events -- vascular occlusion, skin necrosis, vision loss -- are rare in absolute terms but can be permanent, which is why the injector's training, experience and knowledge of anatomy bear directly on risk.
Smaller deposits allow the face to be reassessed after swelling has fully resolved, and the plan can stop where the result looks right without having placed too much. The cost is more visits and more injection events, each carrying its own small risk. No controlled trial directly compares staged to single-session correction; the practice rests on indirect evidence and clinical judgment.
Fairly often. When the examination shows that the primary change is descent rather than deflation, filler adds volume to tissue that is already low -- heavier, not higher. When a patient has had multiple rounds from different providers and the planes are crowded, adding more creates risk without clear benefit. When the goal is correction of a line caused by muscle movement, wrinkle relaxers are the first answer, not filler. The consultation is where these determinations are made.
Write down every prior injectable treatment: product name, area, approximate date and the provider, including treatments done elsewhere. Disclose any earlier reactions, autoimmune conditions, recent infection or dental work, blood thinners, and any planned surgery. Bring photographs from prior treatments if available. Timing between filler and any planned surgery is determined case by case at the consultation.
Yes, in principle, though the timing depends on what was placed and where. Filler in the deep planes of the face is in the same tissue the surgeon will work in during a facelift; the surgeon needs to know what is present. Hyaluronic acid can be dissolved before surgery if needed. Calcium hydroxylapatite and poly-L-lactic acid cannot be dissolved, and their presence may affect the surgical plan. This is addressed directly at the surgical consultation.
Most Rochester patients return to normal activity the same day. Swelling, bruising and mild tenderness are expected and typically resolve within one to two weeks. Avoid strenuous exercise, alcohol and heavy facial massage for the first 24 hours. Patients who have subcision in addition to filler may notice a firm, uneven feel beneath the skin for up to two weeks as the tissue heals.
Individual results vary. This page is for informational purposes and does not constitute medical advice.
Oliver Culver House
70 East Boulevard
Rochester, NY 14620
Consultations and filler treatment. Park Avenue neighborhood; accessible from I-490. Serving Buffalo, the Finger Lakes and western New York.
4939 Brittonfield Pkwy
Bldg B, Suite 208
East Syracuse, NY 13057
Main office and AAAHC-accredited surgical suite. All surgical procedures are performed here. Filler consultations available.
Carnegie Hill
New York, NY
Consultations for New York City patients. Surgical procedures are performed in Syracuse; travel logistics are addressed at the consultation.
"Dr. Kim explained exactly what filler could and could not do for my face before anything was decided. He was honest that part of what I was seeing was not something filler would fix. I appreciated that more than I can say."
"The Rochester office is easy to get to from Canandaigua. I was in and out in under two hours and drove home myself. The result was subtle and natural -- exactly what I wanted."
"I had seen other providers before coming to Dr. Kim. He took a careful history of everything I had previously had done. That thoroughness made me feel I was in the right place."
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