Artefill is a filler that is effectively permanent due to the fact that the body cannot degrade it. It is composed of tiny microspheres in a suspension of bovine collagen. The collagen gets degraded over time but the microspheres remain and induce an inflammatory response by the body which deposits new collagen around it.

Because the results of Artefill depend on each individual's response to it, there is a certain amount of unpredictability. It is therefore prudent to initially under correct with artefill and use it in stages until the desired outcome is achieved.

Like most of the other fillers, Artefill is only FDA approved for injection into the nasolabial folds. Like all the other fillers, practitioners can use it in off label ways and inject it anywhere else they deem to be safe. That is where different doctors might have varying viewpoints as to where it is safe to inject.

The only places I would inject Artefill are in the nasolabial folds, bridge of the nose, high cheek bone area, and prejawl sulcus. All these places are conducive to deep injections on or close to the bone. The deeper the material is injected the less likely it is to cause troublesome lumps or other issues.

Because Artefill contains bovine collagen, a skin test is needed about a month prior to administration of Artefill to make sure you do not have an allergy to it. This is done for free in our office.

By Dr. Gal Aharonov

It is not typical for our brow bone itself to get bigger as we age, but it does tend to look bigger and more prominent in some people. Why is that? Usually the reason is loss of fat around the bone including in our temples and the fat under the brow bone in our upper eyelid. As the padding around the bone goes away with age, the bone seems more prominent.

Is it possible to shave down the brow bone? It might be but I would not recommend it. Instead the way to fix this is by adding padding back again around the brow bone. Either by using filler or fat injections. By giving more volume to the temple, forehead, and/or upper eyelid, the brow bone will appear less prominent.

Hollowing of our facial features is a main contributor to looking older and more tired. This could happen due to weight loss, genetics, having a very low body fat composition, or certain diseases. There are several good options for someone with your issue:

Fillers: Fillers can be used to target the hollowing features. They can be directly injected and you see an immediate result. This group includes injectables like Restylane, Juvederm, and Perlane.

Collagen Stimulators: These include Sculptra and Radiesse. Sculptra is an injectable but is not a filler. It causes your body to build collagen in reaction to it. It slowly works over several weeks and has a very gradual effect. It is usually done gradually over 2 to 3 treatment sessions to achieve an optimal result. Radiesse is a hybrid between fillers and Sculptra. It has an immediate filling component which you will see right away, and a collagen stimulatory effect that is also gradual like Sculptra.

Fat Injections: Fat can be harvested from other parts of your body, purified, and then gently injected back into your face. This is closer to being a surgical procedure but can also be done with you awake in our treatment room.

Non Surgical Rhinoplasty or Non Surgical Nose Job usually entails using a filler such as radiesse or juvederm or perlane to augment or change the shape of your nose. In the bridge, the filler tends to last a fair amount of time. I err on conservative estimates and tell patients it will need to be redone every 6 months or so, but I have had many patients for whom it has lasted for over a year.

Initially, there is some swelling associated with the injection, especially if it is your first time. You might need a small touch up once the swelling subsides about 14 days after the first injection.

You can read more about non surgical rhinoplasty by visiting our non surgical rhinoplasty page

As we age we loose facial volume and fat in a nonuniform manner. Our cheeks loose volume as well as the area around our eye, temples, and jaw line. This contributes greatly to the aging process. When you were younger you probably had decent facial volume which blended better with the cheek implants. Since you are now loosing more volume around the cheeks, such as in your temples, under eyes, and lower cheek and jawline area, it makes the cheek implants appear more obvious and fake.

You have a couple of choices: one would be to enhance your facial volume around the cheek area, including your temples, under eye area, and brows. This will put your face into greater balance and harmony again.

Your other option is to take out the cheek implants, but then you will be faced with more hollowness and a more aged appearance. Your cheeks will no longer look fake, but instead might look deflated and older. At that point you can decide whether you want to enhance your facial volume. Your choices for doing that include fillers such as Radiesse, Restylane, and Juvederm, or your own fat.

The answer to this question depends on many variables. The same goes for Juvederm and some of the other fillers. They tend to last longer in parts of the face that do not have excessive movement. For example, restylane will last longer around the eyes than around the mouth, because there is more movement of the muscles around the mouth which promotes the breakdown of the filler.

The real question is how often you will have to have the procedure done in order to maintain the result. Restylane gets slowly degraded over time. When you feel that the restylane has broken down completely, it could still mean that there is some restylane still present, but just not enough for you to tell. At this point you will need to inject less restylane than the first time you had the procedure done, because there is still some residual amount left.

So although even after more than a year there is still some restylane present (especially around the eyes) you will probably need to have the procedure done every 6-9 months to maintain optimal results. Around the lips it might even be every 4-6 months.

As an example, if you had your under eye hollows injected with restylane 7 or 8 months ago, you might only need half as much this time to get to the same result. This is extremely variable; some people might not need a refill for over a year, and some people might need it every 6 months. There are other factors, such as your own metabolism for the product, smoking, and a few other factors.

In theory, it is possible to cause a very slight brow lift by injecting a filler, such as juvederm, restylane, perlane, or radiesse, into the scalp and upper forehead. A very large amount of filler needs to be injected to cause this slight effect--we are talking about at least 3-4 syringes. The question is whether it is worth spending that much money to achieve such a slight effect... that depends on the patient's means and desires.

In my hands, it is possible to create a much more dramatic, yet natural, brow lifting result using fillers in the brows and temples. If a patient has unlimited means, I would also consider injecting the fillers into the hairline and scalp, but again, for most people this will not be worth the cost.

Certainly I would consider it really rare to need a facelift before age 40 something. I can imagine a rare case If there was a large degree of weight loss--as in over 150 lbs of weight loss. For younger people (and I consider anyone younger than mid 40's pretty young) the main issue tends to be loss of facial volume. The hollowness that you are speaking of is not sagging skin, just loss of facial fat. Some people have a genetic predisposition to loss their facial volume at a young age. A facelift will not make you look like your old face--it will make you look weird and different. For those patients volume replacement is of much greater importance. Using either fillers or fat grafting to the face will not only reverse the hollowness, but will also take up the laxity in your skin and make it more firm.

As we age, we loose facial fat and volume. With time, our temples become very hollow and sunken in. This also happens to young healthy people, usually who are very athletic and lean with a very low body fat percentage.

The hollowness in the temples make us look more gaunt and older. It also helps shift the harmony in out faces and draws more attention to our lower cheeks as opposed to keeping attention at our eyes.

Fortunately, this is a very simple problem to treat quickly and effectively.

The two main options include fillers such as radiesse and perlane, or fat injections. I would suggest fat injections to people who have a high degree of facial fat loss who would benefit from volume augmentation that would otherwise necessitate a very large quantity of fillers.

Otherwise, fillers such as radiesse or perlane work great to reverse the changes in our temple. It is a quick and simple in office treatment that takes no more than 5 minutes to complete with virtually NO PAIN.

Typical upper eyelid surgery, also known as upper eyelid blepharoplasty, or a lid lift, consists of cutting away loose skin and underlying muscle and fat. This is a classic teaching that most plastic surgeons still, unfortunately, subscribe to.

The aging process in the eyelid area mostly consists of loss of volume of fat around our eye, as well as some loss in elasticity of the skin. We do not form "extra" skin. Cutting away the seemingly extra skin is the equivalent of cutting away the wrinkled skin of a raison and expecting to have it look like a grape again.

Restoration of the upper and lower eyelids is more complicated than most surgeons realize. to make your eyes look like they used to you need to understand the aging process.

The way I usually restore the upper eyelids is to cut away a little bit of skin, but to also inject either fat or fillers into the upper eyelid and brow to restore the lost volume.

This gives you a more natural result. It also leads to less hollowness and a HIGHER eyebrow, NOT lower. The fullness of your youth will be restored.

learn more about eyelid surgery by visiting: the eyelid surgery page at www.draharonov.com/eyelidsurgery.html