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Real Patient Reviews!

David N. Sayah Plastic Surgery

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As of 05/19/2014

Injectable Fillers

injectable fillers

As we age, our faces begin to show the effects of gravity and sun exposure. Years of facial muscle movement, such as smiling, chewing and squinting lead to creases in our skin much like folding a piece of paper repeatedly along the same line. The collagen that keeps our skin looking youthful and plumped up begins to break down leading to laugh lines, smile lines, crow's feet or facial creases over the areas where muscle movements occur.

Administering soft tissue fillers, most commonly JUVÉDERM®, JUVÉDERM VOLUMA™ XC, and Restylane®, can help fill in these lines and creases, thereby restoring a smoother and more youthful appearance. Other frequently used soft tissue injectable fillers include Belotero Balance®, Radiesse®, Artefill®, and Sculptra®. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to sunken cheeks and lips, correct lipstick lines associated with thinning lips and advancing age, and improve hollowness between the lower eyelids and cheeks. It’s important to note that use of these fillers to correct some of the mentioned areas treated is considered “off label” by the FDA.

Soft tissue fillers may be used in conjunction with other plastic surgery procedures, such as skin rejuvenation with laser or chemical peels, or surgeries such as eyelid surgery and facelifts.

The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. In some individuals, the effects last only a few months, while in others the results may be maintained indefinitely. Researchers believe that age, genetic background and skin quality may all play a role in injected materials "staying power."

To discuss your wrinkle treatment options, request a consultation with Dr. Sayah today or call 310-385-0000.

JUVEDÉRM® & Voluma™ XC

One of our most popular treatments at our office in Beverly Hills, JUVÉDERM® is a smooth-consistency gel made of hyaluronic acid—a naturally occurring substance in your skin that helps to add volume and hydration. Dr. Sayah eases JUVÉDERM® injectable gel under the skin to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your "smile lines" or nasolabial folds.

JUVÉDERM® provides a smooth, natural look and feel that everyone will notice (but no one will know)! JUVÉDERM® can last up to one year but the results gradually diminish beginning one week after injection. The advantage of JUVÉDERM® is its malleability such that Dr. Sayah is able to sculpt it in your face after injection to achieve absolutely natural results. Another advantage is its clear color, making it possible for use in superficial wrinkles such as lipstick lines around the lips or crow’s feet around the eyes. The last advantage of JUVÉDERM® is the possibility to make it all go away by injecting an “antidote” called Hyaluronidase. JUVÉDERM® is approved for use in nasolabial folds. Injection of JUVÉDERM® into other sites is considered “off label” by the FDA. A thicker consistency version of JUVÉDERM® called “JUVÉDERM® Plus” is preferred for deeper lines.
We also offer JUVÉDERM VOLUMA™ XC, the only filler FDA-approved for instant volume enhancement to the cheek area. We also use it to accent the jaw line. It can achieve a fuller facial contour and more youthful profile for up to 2 years.

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Belotero Balance®

BELOTERO BALANCE® instantly smoothes the lines and wrinkles on your face. It is made of hyaluronic acid, the same material as many other injectable fillers and a naturally occurring substance in your skin that adds volume and hydration. BELOTERO BALANCE® is designed to adapt within the skin for soft and even correction, making it versatile enough to handle a range of treatment areas including smile lines around the mouth, smaller lip lines, and other areas where wrinkles occur due to facial volume loss. We find it to be particularly effective for superficial filling, for example adding volume under the eyes.


Restylane® is injected using a fine needle inserted at several points along the edge of the treatment site. Dr. Sayah prefers to administer some local anesthesia so the injections are not painful. Since part of the substance is saltwater that will be absorbed by the body within a few days, Dr. Sayah may slightly overfill the area. Along with injecting the soft tissue filling material, Dr. Sayah actually sculpts the injected material to produce perfectly smooth results every time. You may be asked to hold a hand mirror during the procedure to help Dr. Sayah decide when you feel he has achieved your preferred results. The FDA has approved Restylane® for correcting nasolabial folds. Injection of Restylane® into other areas is considered “off label.”


A sister product to Restylane® but with a thicker consistency, Perlane® restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). After your treatment, you might have some swelling, redness, pain and bruising. This will normally last less than seven days. Although rare, red or swollen small bumps may occur. If you have had herpes before, an injection can cause the herpes to return. In rare circumstances, the doctor may inject into a blood vessel, which can damage the skin. To avoid bruising and bleeding, you should not use Perlane® if you have recently used drugs that thin your blood or prevent clotting. If you are pregnant, breastfeeding or under 18, you shouldn't use Perlane®.


Radiesse® is essentially liquid bone or Calcium Hydroxylapatite microspheres which when injected lead to new collagen production. The results of Radiesse® are immediate and can last up to 2 years. Common areas treated with Radiesse® include cheeks and laugh lines. Given its composition, Radiesse® is ideal for correcting boney structures such as a uneven nasal bones, or an under-projecting chin. Another unique use for Radiesse® is injection into the aging hands to blend in prominent tendons, bones and veins. The advantage to Radiesse® is its relatively predictable results. Disadvantages to Radiesse® include its white grainy consistency which precludes its use in fine lines or superficial areas such as under the eyes. Radiesse® is approved by the FDA for use in deep lines as well as facial boney augmentations.


Sculptra® is made of an absorbable compound called poly-L-lactic acid. It is the only filler material which provides gradual results over time. After every Sculptra® injection, your body gradually synthesizes new collagen over time leading to a natural appearing result. Three Sculptra® treatments are typically necessary over a few months for ideal results lasting up to 2 years. The advantage of Sculptra® is its ability to provide dramatic results which develop gradually over a period of months. The down side is the inability to predict the final result as it varies from individual to individual. While ideal in patients requiring large volume correction such as sunken cheeks with aging or weight loss, Scupltra® is not recommended in correction of fine lines or small details such as in lips. Sculptra® is only approved for injection into the cheeks and nasolabial folds by the FDA.


Artefill® is the only approved permanent filler material. It is composed of collagen and a synthetic Polymethylmethacrylate. While your body absorbs all other filler material, the Polymethylmethacrylate in Artefill® stays around forever, providing a structural framework for your body to deposit new collagen. Unlike other fillers, a skin test is necessary prior to treatment with Artefill® to assure you are not allergic to the collagen in Artefill®. The injection site approved by the FDA for Artefill® is the nasolabial folds or laugh lines. For those who only want a permanent improvement, Artefill® is ideal. The disadvantage to Artefill® though is its permanence. Should there be any form of lumpiness, unevenness, or other problem with Artefill®, correction is extremely challenging at best particularly if the Artefill® is injected superficially. It is also conceivable that the areas injected with Artefill® will not age or droop as other areas on the face, leading to a mismatch which again is extremely difficult to correct if performed by inexperienced hands, Artefill® is only approved by the FDA for injection into the nasolabial folds or laugh lines around the mouth. Use of Artefill® in other areas is therefore considered "off label."

After the Procedure

Immediately following the procedure, you may notice some minor discomfort, stinging or throbbing at the injection site. Occasionally, some bruising or swelling will occur, but it is usually minor. Any redness at the injection sites usually disappears within 1 to 2 days. However, in some individuals, particularly fair-skinned patients, this redness may persist for up to a week.

No bandaging is needed and you are free to eat, drink and wear makeup with sun-block protection. Our office will contact you during the following week on a daily basis to be certain you are progressing well.

People absorb injectable fillers at varying rates, but treatments generally last about 6 to 8 months before re-treatment is necessary.