Dermal Fillers: Juvederm, Restylane, Perlane and Radiesse

As we age, our faces begin to show the effects of gravity, exposure to the sun and many years of facial muscle movement such as smiling, chewing and squinting our eyes. The underlying tissues that keep our skin looking youthful begin to break down, often leaving laugh lines, smile lines, crow’s feet or facial creases over the areas where muscle movement occurs.

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Dermal fillers such as Juvederm, Restylane, Perlane, Radiesse, Collagen and Fat can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these wrinkle fillers plum up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers can be used alone or in conjunction with a resurfacing procedure, such as laser treatment, or a recontouring procedure, such as a facelift.

Injected collagen and fat are primarily used to improve the appearance of the skin’s texture. Dermal fillers can help fill out deep facial wrinkles, creases and furrows, sunken cheeks, skin depressions and some types of scars. Fillers are also used to add a fuller, more sensuous look to the lips.

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Dermal fillers are not intended to treat severe surface wrinkles on the face, such as vertical “lipstick lines” that sometimes form around the mouth. Dermal fillers, or fillers for the face, are sometimes use in conjunction with facial surgery procedures; however, fillers alone cannot change facial contour the way surgery can.

Types of Cosmetic Dermal Fillers

Facial wrinkles and creases begin to appear in your lips and skin as the underlying collagen and elastin fibers begin to break down and wear out. Dermal Fillers can be used to counteract these aging effects. Dr Azizzadeh can use dermal fillers to treat problems such as:

  • Smile lines (nasolabial folds)
  • Jowls (marionette lines)
  • Vertical lines above the lip
  • Cheek definition
  • Nose shaping
  • Lip border and volume
  • Under eye circles, tear troughs
  • Temples
  • Chin lines (mental crease)
  • Facial symmetry

Advanced Injection Techniques

Dr Azizzadeh uses a blunt-tip cannula to inject the filler. The blunt-tip cannula is a new, advanced injection technique that improves the procedure, as well as the results. The cannula has a blunt tip with a hollow bore and is flexible. This cannula allows Dr Azizzadeh to have more precision when placing the fillers and he is able to treat a larger surface area with just one injection site. The flexible cannula also offers great results for delicate areas, like around the eyes, because it does not cause as much trauma to the tissue as a needle. Less trauma means less pain during the procedure and less swelling after the procedure. Another great advantage of the blunt-tip cannula is that since their is less trauma to the facial tissue, recovery time and social downtime are nearly eliminated.

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Trust Your Face to an Expert!
Dr Azizzadeh, a double-board certified facial plastic surgeon, is an expert with dermal fillers and has trained doctors nationwide in his techniques. His strong skills as a Radiesse injector led him to be selected as a member of the elite Medical Education Faculty for Radiesse’s developer, Bioform Medical and Merz Aesthetics. With this role, he is responsible for providing dermal fillers training and mentoring other physicians in the correct and effective injection of Radiesse.

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Dermal Filler Before and After Photos

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filler photo - beverly hills - azizzadehView more before and after photos

Dr Azizzadeh’s Philosophy for Dermal Fillers:
We have to listen to our patients and we have to educate our patients so that we can explain the procedures and products that will give them the best results. Balance is very important. I think that we usually under treat patients, and as a result they’re not happy with the results. It’s always important to make sure that we achieve the correction that will give the patient a great result.

On the other hand, we should also recognize that the face should not be overfilled or overstuffed; there should still be contours and shadows that preserve a natural-looking face. We sometimes see people whose buccal spaces have been overfilled, so they get an unattractive round face when they started out with an oval face. Make sure that the zygomatic arch, lips and cheeks aren’t overfilled.

The injection techniques and the injection protocol are very important so that too much — or too little — product isn’t injected. Balance is very important.

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What to Expect
One of the most important facts to remember about fillers for the face is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some, the result may last only a few weeks; in others, the result may be maintained indefinitely. Age, genetic background, skin quality and lifestyle all play a role in the filler’s staying power.


When dermal fillers are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with dermal fillers is never completely predictable.

Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to our office. Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

If you are like most patients, you’ll be very satisfied with the results of your injectable treatments.

Read more from Dr Azizzadeh’s interview with WebMD/Medscape on Fillers

Non-Surgical Rhinoplasty can also be performed with dermal fillers such as Restylane of Radiesse. It takes about thirty minutes to perform, and can be used to fill depressions, smooth out sharp angles, change the angle of the tip of the nose, restore symmetry and make the nose appear more attractive and in better harmony with your face. Read more about non-surgical rhinoplasty with dermal fillers.

Radiesse Hand Rejuvenation is a fast and simple procedure to convert older-looking hands to younger-looking hands in minutes. Because the skin on the back of the hands is extremely thin, the loss of fat padding allows tendons, bones and veins to show through. Although a Radiesse injection to the hand may seem painful, most of our patients find it very tolerable and the results are well worth it. Dr Azizzadeh injects several areas on the tops of your hands and then spreads the Radiesse filler to form a smooth even surface. Results can last 18 months or longer.

Botox/Dysort work differently than dermal fillers, as they work to reduce muscle contractions in the face causing lines and wrinkles to become smoother and less prominant. Read more about Botox and Dysport.

Multi-Level Fat Grafting or FAMI is a new non invasive restorative approach to aesthetic surgery which facilitates correction of facial volume deficiencies to provide a more youthful appearance. Fat grafting is an outpatient procedure which removes and refines fat tissues from the lower part of the body, with Liposuction. This refined fat is then injected into the 30 main facial muscles with the use of 10 specific cannulae. This procedure restores the facial volume loss that is associated with aging and prior face lifting procedures. Fat grafting significantly improves the skeletonization of the face which is a hallmark of aging; hence restoring a more youthful facial appearance. Dr. Azizzadeh often utilizes fat grafting simultaneously with facelifts to improve the overall result. Read more about multi-level fat grafting.

Lip Augmentation Improvement and enlargement of lip contour is commonly desired by many of our patients, and there are multiple ways to approach lip augmentation. Treatment options include dermal fillers such as Restylane and Juvederm, lip implants, Gore-text (soft-form) and Saline filler implants. Each options has its advantages and disadvantages. In your consultation, Dr Azizzadeh will carefully go through each option and together pick what is right for you.

Pre-Treatment Guidelines for Dermal Fillers:

Medications to Discontinue 7 Days Before Treatment to Avoid Bruising

  • Aspirin
  • Ibuprofen (Motrin, Advil, Aleve)
  • St. John’s Wort
  • Omega 3 fatty acids
  • Vitamin E
  • Ginger
  • Ginkgo Biloba
  • Ginseng

Cold Sores: If you have a history of cold sores, ask us about pre-care instructions so we can prescribe you with an anti-viral medication.

Post-Treatment Guidelines for Dermal Fillers:

Side Effects
The intensity and duration of your side effects depends on the treatment aggressiveness and your individual healing characteristics, but usually can last up to a week after treatment.

  • Swelling: You will notice most of the swelling the first morning after treatment, particularly under the eyes. Swelling usually lasts 2-3 days. To minimize swelling:
    • Apply cold compresses to the treatment area for 10 minutes every hour
    • Sleep elevated the first night. Use as many pillows as you can tolerate.
    • Take Arnica Montana and/or Bromelain supplements, which can be found at your local pharmacy or herbal supplement store.
    • The initial swelling after treatment to the lips may last longer. Some patients experience swelling for up to a week and the lips can look somewhat ‘uneven’ during this time. After the swelling has subsided, you will be able to see your true results.
  • Redness: You may apply makeup immediately after treatment to minimize the redness.
  • Tenderness/Pain: You may take Tylenol if necessary.

After Treatment Skin Care

  • Avoid Excessive Sun and Heat: Until any initial swelling and redness has resolved.. This includes aggressive exercise.
  • Avoid squeezing or massaging the treated areas for several hours after treatment, as this may subtly change the shape we are trying to achieve. If you were also treated with the injectable Sculptra Aesthetic, please disregard this and massage as you were instructed.
  • Sunscreen: Proper and frequent application of sunscreen is always important. The sunscreen should offer broadband protection (UVA and UVB) and have a sun protection factor (SPF) of 30 or more. You should apply sunscreen 20 minutes before going outside, and again, immediately before. After that, reapply your sunscreen every 2 hours. If direct sun exposure is necessary, wear a hat and clothing that covers the treated area. Use this regimen during the healing period and always.

Read real patient testimonials

Learn more about Cosmetic Dermal Fillers
Dermal injectable fillers are one of the most popular non-surgical treatments being performed today, but it is important to have dermal fillers performed by an experienced cosmetic surgeon, not just any one. Contact Dr. Azizzadeh today if you live in the Beverly Hills or Los Angeles, California area and would like to schedule an initial consultation. During your initial consultation Dr Azizzadeh will perform a throughout facial assessment and find the right filler or combination of fillers to fit your unique needs.

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