Your Skin, Your Image #4 – Cosmetic Facial Fillers: What are my Options? What’s a Vampire Lift Anyway??

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

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The past decade saw with it an enormous growth in cosmetic surgery.  The bulk of this growth was carried by non-surgical and no down time cosmetic procedures.  These included, BOTOX® and cosmetic fillers (such as Juvéderm®, Restylane®, Radiesse® and Sculptra®) as well as laser procedures.  Amongst these procedures none have seen such an explosion of the market share and competition as have the cosmetic fillers market.  Although the number of fillers has increased significantly they can still be divided to several categories: temporary, semi-permanent and permanent.

Los Angeles Facial Plastic & Cosmetic Surgeon
Los Angeles Facial Plastic & Cosmetic Surgeon, Dr. Hootan Zandifar

Temporary Fillers:

This category has seen the most number of new products.  Typically these fillers are derived from materials that naturally exist within the body such as hylauronic acid (Juvéderm®, Perlane®, Restylane®…) or collagen (Artefill®, CosmoDerm®, CosmoPlast®…).  The hylauronic acids have increased in popularity in this category primarily because of their ease of use, low risk of complications and the ability to undo the effects with injection of another substance (hylauronidase).

Collagen fillers on the other hand have either decreased or stagnated in their use mainly because of the increase side-effect profile associated with them.  In either case the injection are relatively affordable, they take place in the physician’s office with or without any numbing and the results are seen immediately.  These fillers can be used to enhance lip appearance, remove wrinkles around the lip and fill in the nasolabial and marionette lines.  The results can be expected to last anywhere from 2-6 months and re-injection is needed to maintain the effect.

Semi-Permanent Fillers:

This category is mainly dominated with two filler products (Radiesse® and Sculptra®).  Your body absorbs both of these products over a longer period of time and with the process of absorption, the body replaces the product with its own collagen.  This results in an effect that can last anywhere from 1-3 years.  Although these products are usually injected in the office, numbing is always needed because these products are injected in deeper tissues.  They can be used to  fill in the cheek and temple region, improve the appearance of deep nasolabial folds and assist in improving the appearance of hollow eyes.

Permanent Fillers:

For years the main product in this category was liquid Silicone.  However, due to the high degree of complication this product is no longer used as permanent filler.  Some of the other permanent fillers that have since been introduced to the market are gortex or silicone implants that require a surgical procedure to place them.  They can be used to enhance almost any facial feature from cheeks to lips to the chin.  The results are permanent and in order to reverse it another surgery is needed to remove the implants.  For this reasons few choose to have these procedures.  Recently, this category of fillers has seen a few innovative options that promise to revolutionize the cosmetic market.  They include fat injection, serum injection and stem cell injection.

Fat injection:

This procedure is performed by removing fat from the abdomen or the inner thigh using a liposuction method.  The fat cells are then re-injected in the face to enhance facial appearance.  The fat cells will then remain in the injected tissue and continue to function normally.  Fat injection can be used to enhance any feature of the face and is very versatile in use.  The results are natural appearing and permanent.  However, because of the need for a liposuction anesthesia is needed for this procedure.

Stem Cell injection:

This procedure is very similar to fat injection in that fat from the abdomen or inner thigh is removed for injection.  Then the stem cells from the fat cells are isolated and injected into the face.  These stem cells will then stimulate growth of collagen in the areas injected.  The results are natural and permanent.  Again all facial features can be enhanced with this procedure.  It does, however, have the same limitations as fat injection.

Serum injection:

As featured in an earlier blog by Dr. Raphael Nach, serum injection has become increasingly popular in recent years.  This has been popularized via the Selphyl® system and has recently been dubbed as a “blood filler” or a “Vampire facelift”.  This process requires the removal of a small amount of blood and harvesting of the serum portion of it.  The serum is then injected in to the desired area.  It stimulates collagen and tissue growth in the injected location and the results are natural and permanent.  This can be done in the office with no down time.

As you can see the category of fillers is vast, diverse and confusing.  To better understand your options you can schedule your consultation or visit our website at

A message from Dr. Hootan Zandifar director of Skin Center of the Division of Facial Plastic and Reconstructive Surgery at the Osborne Head and Neck Institute.

“I have seen both great and not so great results from cosmetic filler injections. The main factors that yield great outcome seem to be the appropriate selection of the material for the patient.  Injections need not be overdone or drastic.  The results should be subtle, natural and beautiful.  It is important that you know and understand your options of fillers before embarking on this procedure; I know when done correctly you will be very happy with the results.”

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