Dermal Filler New York City

Injectables such as Fillers and Botox are frequently used by plastic surgeons for facial rejuvenation. To understand how these products may be useful to you requires some understanding of the facial aging process.

As we age our skin gets damaged by the sun or through environmental exposures. We develop wrinkles that can range from fine lines to deeper creases. Most commonly, these wrinkles or creases can be found running horizontally along the forehead or vertically between the eyebrows (frown lines) in the area we refer to as the glabella. They can also be found extending outward from the outer corner of the eyes ( “Crow’s Feet” ).

In addition to developing wrinkles and fine lines, we also tend to lose volume in our face. The loss of volume can lead to dark shadows on the face. It is the appearance of shadows and the loss of the smooth facial contour of youth that makes us appear tired or aged. The shadows are most frequently seen in the cheek bone area, at the junction between the lower eyelid and the cheek (known as the “teartrough” and “orbital malar hollow”), in the area of the temples or along the skin fold that runs from the nose down to the corner of the mouth (the nasolabial fold).

Skin excess and sagging in the face and neck are also hallmarks of the aging process and information on the surgical treatment of these issues can be found in the face/necklift section of Dr. Cangello’s website.

Botox and fillers can be used to smooth wrinkles and replenish volume in the face in order to restore its youthful contour. These are temporary treatments which require maintenance. They can be used in conjunction with other modalities such as laser resurfacing or surgery when appropriate. During your consultation Dr. Cangello will ask you what your aesthetic goals are and what you hope to achieve. After examining you, Dr. Cangello will then provide you with a thorough and thoughtful explanation as to what he feels is the best treatment plan for you given your desires and acceptable “downtime. “ We recommend that if you have a big event planned and are worried about potential downtime that you ask for advice from our staff before you schedule a treatment.

Injectable Fillers

How do fillers work? Fillers work in one of two ways: There are certain fillers in the class referred to as Hyaluronic Acids or “HA’s” and these fillers essentially act as “space occupying” fillers. When they are injected they fill up space in the face that was once filled with fat. They have their volumizing effect only by occupying the space they fill. So once they are metabolized by the body they disappear and retreatment is required as the volumizing effect is lost. Hyaluronic acid fillers do not stimulate collagen production. Other fillers work in a different way by stimulating collagen production. These fillers are usually metabolized by the body relatively rapidly (within a few weeks) however they stimulate collagen production which in turn increases volume.

There are numerous injectable fillers available today. Dr. Cangello has extensive experience with all facial injectables and his goal is to help you make the right decision regarding the appropriate type of filler for you. The value of having a Board Certified Plastic Surgeon such as Dr. Cangello perform your facial injectables cannot be underestimated. He understands the facial anatomy from the surface of the skin to the underlying nerves, muscles and blood vessels. In addition, choosing a plastic surgeon who has a demonstrated understanding of facial aesthetics is essential so that facial balance and proportions are maintained and a “fake” or “done” look is not achieved after treatment with fillers.

Fillers Used By Dr. Cangello:

RESTYLANE– Restylane is an HA filler so it is a “space occupying” filler and does not stimulate collagen production. In general its effects last around 6 months. In certain areas (such as the hollow under the eyes) it can last up to 9 months or a year. It can also be used anywhere else in the face that facial fillers are used such as the lips, temples, nasolabial folds, marionette lines, cheeks, etc. Restylane also comes as “Restylane Lyft” (formerly known as Perlane) and Restylane Silk. Restylane Lyft is frequently used by Dr. Cangello in the cheeks and nasolabial folds. At this time, Dr. Cangello minimally uses Restylane Silk. Like all of the HA fillers, they can be dissolved with an enzyme called Hyaluronidase if that is necessary for some reason. As is the case with all of the fillers mentioned in this section, the combination of your preference and Dr. Cangello’s expertise will help determine which is/are right for you.

JUVEDERM– Juvederm is an HA filler and does not stimulate collagen production. Most of its properties are very similar to Restylane. Like Restylane it lasts around 6-9 months. It can be used in exactly the same areas as Restylane with the one exception of the lower eyelids where Dr. Cangello prefers to use Restylane.

VOLUMA– is an HA filler made by Allergan, the same manufacturer as Juvederm, and is a more highly crosslinked version of it. Because of this it lasts longer than Juvederm, around twelve to eighteen months. It is FDA approved for the cheek bone area and this is primarily where Dr. Cangello uses it. He may also use it to create skeletal augmentation for areas such as the angle of the jaw or chin.

BELOTERO– Belotero is an HA filler. It is a very fine filler with much less viscosity as compared to the above mentioned HA’s. It is best used for the filling of stubborn wrinkles that are not effectively treated with Botox. It also works well in the under eye area.

RADIESSE– Radiesse is Calcium Hyroxapatite. It is not an HA filler. It dissolves in the few weeks following injection. However, it has its volumizing effect through the stimulation of collagen production. This is a very versatile filler and is used throughout the face by Dr. Cangello as well as for rejuvenation of the back of the hands. In fact, Dr. Cangello is one of a few physicians in the country that participated in the study conducted by Merz Aesthetics (the manufacturer of Radiesse) to gain FDA approval for its use in hand rejuvenation. In the face, it often lasts around 9 months and in the back of the hands it can last around one year.


SCULPTRA– Sculptra is poly-L-lactic acid. It is not an HA filler. It is made of the same material found in absorbable sutures (stitches). Like Radiesse it has its effect by stimulating collagen production. Usually multiple (two to three) treatments are required about four weeks apart. Dr. Cangello most frequently uses this in the cheek area. It cannot be reversed or dissolved.

FAT GRAFTING– Fat grafting is a more permanent solution as compared to injectable fillers for facial filling. Fat is taken from a donor area such as the abdomen or inner thighs and is transferred or grafted to the area of the face that filler would be used. It is extremely versatile and can be used in almost any area of the face. It is permanent because the fat is actually “grafted” which means the fat cells take up new blood supply and live in the area they are transferred to. It is a surgical procedure and usually requires some downtime as bruising and swelling of the grafted areas are likely to occur. Dr. Cangello has been trained by and works extensively with the pioneer of fat grafting, Dr. Sydney Coleman.

How to prepare before Fillers/Injectables with Dr. Cangello:

Dr. Cangello recommends that you do not consume any products that can cause thinning of the blood and lead to bruising for one to two weeks prior to injection. Medications that can thin the blood include anything containing Aspirin or Ibuprofen such as Advil, Motrin, Alleve, etc. Certain homeopathic and herbal medicines can thin the blood as well. If you are taking any of these you should inquire as to whether the ones you are taking should be stopped. Alcohol intake, particularly red wine can also thin the blood and is best avoided.

All filler and Botox procedures are performed by Dr. Cangello himself in his New York City Plastic Surgery Practice located in Tribeca.

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