By Dr. David Kirn


Dermal fillers are injectable medications which are used to improve facial contours and treat wrinkles. The modern era of dermal fillers began with the hyaluronic acid fillers Restylane® and Juvederm®. These products last much longer and have very few side effects compared to the first dermal filler, bovine collagen. Both Restylane® and Juvederm® continue to enjoy huge popularity and remain clinically useful. With time, the manufacturers have expanded the treatment options by introducing products targeted to specific facial areas such as the lips and upper cheek.

Dermal filler treatment is one of the most common non-surgical cosmetic procedures and its popularity continues to grow.

Recently, two new products specifically designed for enhancement and rejuvenation of the lips have come to market. Both of these products have FDA clearance for use in the lips. The newest of these is Juvederm Volbella®. We have observed very minimal swelling and a natural appearance in our initial experience with this product. Company literature indicates that Volbella® effectively increases lip fullness and softens the appearance of lines around the mouth in a majority of patients through one year. Similarly, Restylane® Silk was released about a year ago and has proven to be very effective for lip enhancement in our experience. Both Volbella® and Silk® are useful for fine lines around the mouth, frequently called “smoker’s lines.” Our lips tend to lose some plumpness over time and these fillers allow us to restore lost volume for lip rejuvenation. Both fillers may be used for lip enhancement to add volume and improve shape of lips that are less full than desired.

Although fat grafting remains my first choice for “volumizing” the face, our use of Sculptra® as a deep tissue filler has increased dramatically over time. The effect of Sculptra® is not instant. Instead, it builds fullness in the treated areas over several weeks after injection. As with fat grafting, multiple treatment sessions may be required. Sculptra® is useful for filling out hollow areas of the face and enhancing contours. For example, the temples sometimes take on a sunken appearance over time and may be restored to a youthful contour with Sculptra®. Other good areas for Sculptra® include the cheek and jawline.

Can fillers provide the mythical non-surgical facelift? There is no filler, nor any amount of filler, which can take up extra skin or reposition tissues like the surgical procedure. However, use of fillers may help delay the need for surgery. Similarly, fillers may also be used after surgery to enhance and maintain the result.

Dermal filler treatment is usually accompanied by some degree of swelling and occasionally bruising. Our practice uses a chilling device during the injection process to improve patient comfort  and decrease  the risk of bruising. Where possible, special cannulas designed for filler injection are used. These are very small blunt needles which are less traumatic to the tissues than  a sharp  needle.  They allow injection of a broad area through a single access point. Smoother deposition of the filler with less risk of bruising are additional benefits of a cannula.

There is no special certification needed to inject fillers, therefore anyone legally authorized to perform injections in Kentucky, may inject fillers. However, as with most cosmetic procedures, the quality of the result and safety of the process are strongly dependent on the skill of the injector. We have three injectors in our practice; myself, and two highly skilled nurse injectors. All three of us have significant experience using these products and have taken the opportunity for advanced training in the use of dermal fillers. Our patients always have the choice of who injects them. Over-treatment is a common error by inexperienced injectors and should be avoided. As with surgical results, the best dermal filler treatments should look completely natural.

Dr. David Kirn is a Board Certified Plastic Surgeon who is devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body. In private practice since 1998, he is located in a state of the art facility which includes a full service skin care center. The practice is focused on personalized patient care and attention to detail. Where possible, Dr. Kirn utilizes minimally invasive procedures. The goal is to deliver quality clinical results while minimizing patient recovery time. Examples of this include a no-drain tummy tuck, armpit incision breast augmentation with gel or saline implants, fat grafting, and a short scar facelift. In addition, Dr. Kirn and nurse-injectors Carey Sanders, RN and Shirley Ramsey DNP, APRN, offer a full spectrum of non-surgical treatments such as Botox®, Dysport®, Dermal Fillers, Kybella®, & Laser.