As we age, our skin changes. Over time, the natural contours of youthful skin begin to change as wrinkles and folds form. Young faces are full of volume and look refreshed. Hollows and folds can make you look tired, worn, sad, and even angry.If you are looking to avoid the downtime of surgery and laser treatments, injectable fillers like Restylane, Juvéderm, Radiesse, and Sculptra can help restore your youthful contours. By adding volume to your face, these fillers can help you look as young as you feel.

Many physicians from a variety of fields inject facial fillers. However, there is an art to successful use of injectables. Standard applications of facial fillers can lead to flat results which do not create the desired visual impact.Many times, just finding the best price does not lead to the best deal.

With the appropriate application of facial fillers, the entire face appears younger, balanced, and more refreshed. Dr Kolstad is a highly trained, highly qualified Facial Plastic Surgeon.

Not all providers of injectable fillers have the same degree of skill. Merely filling in lines will lead to a mediocre result at best. Why would you trust your face to anyone who is not an expert?

Dr. Kolstad’s expertise in facial fillers comes from spending a year training with one of Allergan’s Black Diamond Providers. The prestigious Black Diamond is awarded to the top 1% of practices and medical spas using Allergan’s Botox and Juvederm products. It is through working and learning from the best that Dr. Kolstad is able to deliver such high quality care to his patients.

In his experience, Dr. Kolstad has often found that using multiple fillers together can produce better results than using just choosing one or another. As such, he adds volume throughout the face, so that the face is enhanced in a global and more attractive way. This unique way of injecting was learned from one of the world’s top injectors.

Facial fillers can be combined with BOTOX® Cosmetic and skin resurfacing procedures to provide the ultimate correction. Many times, a permanent improvement can be achieved through transfer of fat from your hip or belly. Only an expert in facial rejuvenation will know which combination is best for you.

WHAT FACIAL FILLERS CAN DO FOR YOU

1) Restore Lost Cheek Volume

Juvederm, Voluma, Radiesse and Sculptra can all be used to restore full, youthful appearing cheeks. The amount of volume needed will dictate which injectable filler is best.  Dr. Kolstad applies injectable fillers to three different areas of the midface to create a unique cheek appearance.    Depending on what look you are trying to achieve you may be a better candidate for central cheek, lateral cheek or infracheek augmentation.

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i) Central cheek augmentation: many patients are happy with their cheek bone structure and prefer to add volume to the central cheek. This restores the apple in the cheek and creates a youthful, round cheek mound. Adding volume to the central cheek can also improve under eye hollowing or eye bags.

Good filler options for central cheek augmentation:

Allergan products:  Juvederm, Voluma, Volbella, Vollure.

Galderma products:  Restylane, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk, Sculptra.

Merz aethetics products:  Radiesse.

Dr. Kolstad does not use the following products for central cheek augmentation:  None, all products work well for central cheek augmentation.

 

 

 

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ii) Lateral cheek augmentation: a second type of cheek augmentation is adding volume to the soft tissue above the cheek bone. This type of cheek augmentation is similar to cheek implants and is designed to create a sculpted look, most noticeable on oblique view.  People that have flat cheek bones or midface hypoplasia are good candidates for this type of cheek augmentation.  The highpoint of the cheek should be above the zygomaticomaxillary complex (ZMC) and creates a heart-shaped cheek of youth.

Good filler options for lateral cheek augmentation:

Allergan products:  Juvederm, Voluma, Volbella, Vollure.

Galderma products:  Restylane, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk.

Dr. Kolstad does not use the following products for lateral cheek augmentation: Sculptra and Radiesse.

 

 

 

 

 

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iii) Infracheek augmentation: as we age we lose volume and fat underneath the zygomatic (cheek) bone.  This can create a hollowed and gaunt appearance.  Sometimes a sculpted cheek appearance can look overdone if there is too much hollowing under the cheek bone.  To address lower cheek hollowing volume is added to the soft tissue above and under the zygomatic bone.  By adding roundness to a hollowed area the cheeks appear fuller and more youthful.  This type of cheek augmentation requires multiple syringes and is frequently best treated using in-office facial fat transfer.

Good filler options for infracheek cheek augmentation:

Allergan products:  Juvederm, Voluma, Volbella, Vollure.

Galderma products:  Restylane, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk, Sculptra.

Dr. Kolstad does not use the following products for infracheek augmentation:  Radiesse.

 Pictured: In-office nonsurgical facial fat transfer to infracheek hollows.

2) Smile Lines

Smile lines are a result of volume loss and shadowing in the nasolabial and melolabial folds. The nasolabial folds run from the corner of the nostril to the mouth in an oblique line.  Shadowing in the nasolabial folds can make the face appear drawn and tired. The melolabial folds as commonly called marionette lines. Deep melolabial folds create shadows at the corners of the mouth and can convey sadness or a negative emotional state. Smile lines respond to a number of different injectable fillers:filler for smile lines san diego

Good filler options for very superficial smile lines:

Allergan products: Volbella. Galderma products: Restylane Silk

Good filler options for moderate depth smile lines:

Allergan products: Juvederm, Vollure. Galderma products:  Restylane, Restylane Refine.

Good filler options for very deep smile lines:

Allergan products:  Voluma. Galderma products:  Restylane Lift, Restylane Define, Sculptra.

Dr. Kolstad does not use the following products for smile lines:  Radiesse.

 

 

 

3) Lip Augmentation

Easily our most popular injectable service is lip augmentation.  Full, luscious lips are a very flattering feature for many women. Conversely, having very fine, thin lips can artificially age the face. Achieving a perfectly natural result is the most important goal for every treatment Dr. Kolstad offers.  Lip enhancement requires an artistic application and an eye for detail. Uneven injection of fillers can lead to lumpy, palpable knots or an over-inflated appearance.  There are different types of lip implants or lip lift surgeries available for patients seeking longer lasting results.  For the majority of our patients injectable fillers offer a minimally invasive solution to achieve their ideal lip shape and volume.
 lip-augmentationGood filler options for lip augmentation: Allergan products:  Volbella, Juvederm.  Galderma products:  Restylane, Restylane Silk.
 Dr. Kolstad does not use the following products for lip augmentation:    Voluma,  Restylane Lift, Restylane Define, Sculptra and Radiesse.
 See our Lip Augmentation page or Lip Augmentation gallery for more information.

 

Dr. Kolstad – Double Board Certified Facial Plastic Surgeon

 4) Tear Troughs

Dr. Kolstad frequently comments “When the eyes look tired, everything looks tired”.  By far the most powerful feature on your face is your eyes.  Under eye bags, tired eyes, puffy eyes, dark circles under the eyes, all convey the same message: a tired, sleep-deprived appearance.

Are you tired of people asking you “Are you tired”?  Eyelid bags or puffiness are typically from lower eyelid fat.  As lower eyelid fat pushes outward it creates a bulge under they eyelid.  Underneath the bulge a depression is created casting a shadow.  Make-up and concealers do not cover shadows.

Volume correction to the tear trough, lateral orbit, central cheek and midface are required to blend in eye bags.   Volume must be added to a wide distribution for the eyes to look perfectly natural.  Focusing all of the volume in one area, the tear trough for example, leads to an unnatural, over-filled appearance.

For many of our patients requesting under eye filler Dr. Kostad advises them that correcting the central cheek is frequently required as well.  The nasjojugal groove (tear trough) runs inferiorly into a central cheek depression.  Sometimes by filling the central cheek the tear trough improves sufficiently without even needing filler.

 

 

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Many of our patients that present for lower eyelid surgery (blepharoplasty) are surprised to find out they are good candidates for under eye filler.  Dr. Kolstad is a Facial Plastic Surgeon specializing in both surgical and nonsurgical eyelid rejuvenation.  He will help guide you to determine if you are a better candidate for injectable fillers or surgery.

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Dr. Kolstad uses microcanulas to apply injectables to the eyelid and cheek areas.  Microcanulas are a new way of distributing filler in a significantly safer and less traumatic way.  After switching to microcanulas Dr. Kolstad has seen significantly less bruising around the eyes after treatments.  The results have improved so significantly that he rarely offers needle injections around the eyes.

Good filler options for tear troughs and under eyes: Allergan products:  Volbella.  Galderma products:  Restylane.

Dr. Kolstad does not use the following products for tear troughs and under eyes:   Juvederm, Voluma,  Vollure, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk, Sculptra and Radiesse.

5) Smokers Lines (fine creases around the mouth)

Fine wrinkling around the mouth is termed perioral rhytids. More commonly these wrinkles are referred to as lipstick lines or smoker lines. Dr. Kolstad typically advises his patients that lipstick lines tend to be some of the most challenging wrinkles on the face to correct.  For most patients a realistic goal is to make the lines softer or less deep rather than erasing them completely. The challenge and art of correcting lipstick lines is to improve the rhytids without adding too much volume to the upper lip and creating a “Marge Simpson look”.

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Newer HA fillers are thinner and tend to work best for the very superficial lines.  Dr. Kolstad’s filler preference is currently Volbella.  When placed appropriately a few units of Botox can improve the upper lip creasing as well.    Deep wrinkles around the mouth respond best to skin resurfacing methods like microneedling, CO2 lasers and dermabrasion.

Good filler options for very superficial lipstick  lines:

Allergan products: Volbella. Galderma products: Restylane Silk.

 Pictured: Combination of Botox and Juvederm to the upper lip wrinkles (lipstick lines).

Injectable Fillers Placed By A Board Certified Facial Plastic Surgeon

6) Liquid Rhinoplasty

One of the newest and most versatile applications of fillers is used for nasal contouring.   Injectable rhinoplasty is the ideal solution for someone looking to avoid the cost or downtime of surgery.  Unheard of only a decade ago liquid rhinoplasty has become an essential part of our practice.  Before jumping into liquid rhinoplasty it is important to know that the nose is one of the perilous places to inject facial fillers. Injectable rhinoplasty should only be performed by an expert. There are many arteries that supply blood to the nose and surrounding skin. Dr. Kolstad’s experience as a rhinoplasty surgeon helps him to achieve desired outcomes and avoid catastrophic complications.

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The following changes can frequently be achieved with injectable rhinoplasty:

  • Adding height to an underprojected bridge.
  • Straightening a bridge hump on profile view.
  • Straightening a crooked bridge on front view.
  • Filling an asymmetric nasal tip.
  • Filling a nasal tip cleft.

Features Dr. Kolstad believes are better changed with surgery:

  • Nasal tip rotation
  • Nasal tip projection.
  • Nasal tip narrowing and refinements.
  • Functional nasal breathing obstructions.

 

 

 

 

 

 

 

Good filler options for liquid rhinoplasty:

Allergan products:  Juvederm, Voluma, Volbella, Vollure.

Galderma products:  Restylane, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk.

Dr. Kolstad does not use the following products for injectable rhinoplasty:  Radiesse, Sculptra.

7) Liquid Chin Augmentation

Injectable chin augmentation is a nonsurgical way of adding volume and size to the chin.  Liquid chinplasty can achieve similar outcomes to chin implant surgery and in many cases actually lead to a more natural and superior result.  Liquid chin augmentation is performed in the office in a noninvasive way with minimal downtime.  Dr. Kolstad applies injectable fillers to three different areas of the chin and jawline. Depending on what look you are trying to achieve you may be a better candidate for central chin, lateral chin or chin dimple augmentation. The location, duration and amount of volume needed will dictate which injectable filler is best for you.

liquid-chin-augmentation-san-diego-50-copyi) Central chin augmentation: injectable fillers are added to the midline and central chin to increase chin projection: The changes are most noticeable on profile view. The goal is to bring the chin into balance with the lips, nose and forehead. The submental space (under the chin) appears longer and more feminine by increasing projection of the chin.  For some necks the combination of liposuction with liquid chin augmentation can create a beautiful neckline.

 

 

 

 

 

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ii) Lateral chin (prejowl) augmentation: fillers added to the soft tissue on either side of the chin can reverse signs of aging. Jowls are the result of facial soft tissue descending into the neck.  Heavy jowls require face lifting surgeries to correct. Early descent and small jowls can be camouflaged by filling the prejowl soft tissue.  Filling prejowl depressions straightens the jawline and makes the face appear tighter and more youthful.

 

 

 

 

 

 

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ii)  Chin dimple correction:  a strong dimple in the central chin can create a very masculine appearance.  Men can choose implants specifically designed to create a deep chin cleft.  Dimples are the result of a split in the mentalis muscles.  For people without chin dimples the right and left mentalis muscles attach midline creating a uniform appearance.  When the mentalis muscles do not meet in the middle a depression is created causing a chin dimple.  If you would like to fill erase your chin dimple injectable fillers are an ideal solution.  Easy to place, minimal downtime and improved symmetry are the results.

Good filler options for liquid chin augmentation:

Allergan products:  Juvederm, Voluma, Volbella, Vollure.

Galderma products:  Restylane, Restylane Lift, Restylane Refine, Restylane Define, Restylane Silk.

Dr. Kolstad does not use the following products for liquid chin augmentation:  Sculptra.

See our Chin Augmentation page or Chin Augmentation gallery for more information on surgical chin augmentation.

IN-OFFICE FAT TRANSFER

Most injectable fillers last one to two years.  Injectables are charged by syringe and for people requiring multiple syringes the cost adds up very quickly.  Facial fat grafting offers natural, from your own body volume replacement.  Rather than charging for each syringe facial fat transfer is billed per session.  Most of our facial fat transfers add 10-15 mLs (in-office small session) to 15-30 mLs (large volume surgical) of volume. For patients requiring more than 5 syringes of volume correction Dr. Kolstad recommends facial fat transfer as a more economical solution.

How does facial fat transfer work?  Unwanted fat is removed from the abdominal, thigh or hip areas. After cleaning and purifying the fat cells are grafted into facial areas deficient in volume. When expertly grafted into the lips, cheeks, temples and face, fat transfer creates a fuller, healthier, more youthful look. Because the fat is harvested from your own body it is naturally incorporated into the face producing long-lasting results.

Cheek Volume Correction: As we age the midface and cheeks lose volume creating a deflated and drawn appearance. Expensive lifting procedures and surgical implants can now be avoided by using nonsurgical fat transfer.

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Injectable Fillers Placed By A Board Certified Facial Plastic Surgeon

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To schedule an appointment call us at (858) 859-2563 or get in touch with the form below.