Hyaluronic acid fillers, a popular type of dermal filler, can help restore age-related volume loss, improve facial contour, or fill unwanted lines. Hyaluronic acid (HA) is a naturally occurring substance found throughout our bodies and does not require skin testing prior to HA injection.

Each of the many HA fillers differs from the others with regard to a number of factors including: relative firmness, ability to lift versus fill, and how much water they attract after injection.  As HA products are all unique, it is common for us to recommend a variety of HA fillers during a treatment session to achieve best outcomes.

Where are HA fillers injected?

HA fillers are used for a wide variety of applications throughout the entire face to restore a more youthful contour. An example of applications in the upper face include the temples, mid-face, cheeks, and under and around the eyes and eyebrows. In the lower face, applications can include the area around the mouth, lips, chin, jaw line, and the nasolabial folds. These products can also be used for non-surgical contouring of the nose and re-establishing volume in the earlobes. When injected properly, HA fillers produce a smooth, natural look that is not noticeable to others.

Can HA fillers be removed?

All HA fillers may be dissolved or “removed” by injection of hyaluronidase, a naturally occurring enzyme that quickly and effectively breaks down hyaluronic acid fillers. It is comforting for some first-time users to know that if they have concerns about their appearance after HA filler injection, the effects can be reversed.

How long will HA fillers last?

The duration of effect of HA products is typically measured in months to years.  There is significant variability depending on the product used, where it is placed, and the individual’s body chemistry.  Our goal is to achieve optimum volume correction and maintain those results. Dr. Biesman and his team will advise you on how often your filler may need to be “touched up.”

What can I expect before getting HA fillers?

There are no special preparations required prior to HA filler injection.  Discontinuing the use of aspirin or blood thinners 10-14 days prior to treatment will reduce the likelihood of bruising; however, if the use of blood thinners (even baby aspirin) has been recommended by a doctor, you must obtain permission from the prescribing physician before discontinuing these products.  HA filler injections are given in the office.  Most patients choose to use topical anesthetic cream prior to injection.  We typically allow 15-30 minutes for topical anesthetic preparations to exert their full effect. Your skin will be cleansed before injections begin.

What Can I Expect After Treatment?

Some degree of bruising and swelling can occur after HA filler injections.  While this is not always the case, it is best to avoid undergoing HA injection if you have an important business or social events with in the following 24-48 hours. Our practice offers a unique treatment developed by Dr. Biesman and his team using a special light which can decrease the likelihood of bruising after injections and is only available at our office. If bruising does occur after your treatment, we offer complimentary treatment with a laser that will help the bruising clear more quickly.  Simply notify our office that you have a bruise and we will work you into the schedule at a mutually convenient time. Some patients also like to use homeopathic preparations such as Arnica Montana in advance of their treatment to help reduce the amount of bruising. We are happy to make this product available to our patients upon request.

While it is common to experience mild “soreness” or awareness of fillers after injection, true pain is extremely rare.  Please contact our office immediately if you develop significant bruising, redness of the treatment area, pain, or other concerns after HA filler injection.

As described in the overview of hyaluronic acid (HA) fillers, numerous HA products are available in the United States.  The information to follow will provide an overview each of the FDA approved HA fillers and some of their common uses.


Juvederm is the brand name of a family of FDA-approved injectable fillers.  Included under this brand are Juvederm Ultra, Juvederm UltraPlus, and Juvederm Voluma.  Juvederm Ultra is the softest of these products and is generally used to provide gentle, soft volume correction or treatment of superficial lines.  In late 2015, Juvederm Ultra received FDA approval for enhancement of lips.  In this capacity, it provides a soft, gentle restoration of volume that can help youthful lips appear even more lush and full, or can restore a more youthful appearance to lips that have lost volume due to the aging process. Juvederm products do attract water after injection.  When placed under the eyes they can lead to an undesirable “puffy” effect so Juvederm should NOT be used in the “tear trough” region.

Juvederm UltraPlus is a more robust filler than Juvederm Ultra, and is used when a greater degree of volume correction is desired, especially around the mouth.

Juvederm Voluma is formulated differently from the other Juvederm products currently available in the United States.  Voluma is a “stiffer” product, which makes it ideal for lifting and providing contour. Juvederm Voluma is designed for use in the mid-face, but can also be used in the temples, chin, cheekbones, midface, along the jaw line, and in other areas.  The Juvederm family of products may be used in combination with each other or in conjunction with other soft tissue fillers to achieve best outcomes.


Restylane is the brand name for a family of HA products including Restylane, Restylane Silk, and Restylane Lyft.  The easiest way to understand the differences between the Restylane products is to envision Styrofoam balls (representing HA molecules) of different sizes.  Each of the Restylane products are made of the same HA material but are comprised of different sized “molecules” with Restylane Lyft composed of the largest size, Restylane Silk the smallest size, and Restylane the intermediate size.  The larger the particle size, the greater the amount of lift the product provides.  The Restylane products are a bit firmer than the softer Juvederm products.  They also tend to attract less water after injection, making Restylane products a better choice for use in the delicate area under the eyes.

Restylane is a versatile filler that is typically used around the mouth, under the eyes, in the nasolabial folds and for the treatment of other facial lines and wrinkles. Along with Restylane Silk, in addition to other indications, Restylane is FDA approved for use in the lips.  Restylane can also be used under some acne scars, in the nose, and earlobes, among other areas.  Restylane was also the first HA filler to receive an FDA indication for use in the lips.

Restylane Silk®, made of the smallest HA particle size, is specifically designed for enhancement of lip volume and treatment of fine, etched lines around the mouth.  It can also be used very effectively under the eyes and in the unwanted lines that sometimes occur on our cheeks when we smile.

Restylane Lyft® is made of the largest sized HA particles and is FDA approved for both treating facial wrinkles and folds as well as for correction of age-related volume loss in the midface.  It may be used for correction of sagging cheeks, treatment of heavy lines and folds, in the chin, along the jaw line, among other areas.  As is true of the Juvederm family, Restylane products may be used in conjunction with one another or with other fillers to produce best outcomes.

Belotero Balance

Belotero Balance is a soft filler recently FDA approved for the correction of superficial lines such as those occurring around the mouth.  Belotero may be used in the tear trough region under our eyes, and is also highly effective at treating the fine, curved lines that often appear in our cheeks when we smile. In select cases, Belotero can improve the appearance of the fine, superficial lines in our lower eyelids that are exacerbated with smiling, a condition which is otherwise challenging to treat.  Like other HA fillers, Belotero Balance can be dissolved by injection of hyaluronidase.

Dr. Biesman and Molly Katz, RN are highly skilled injectors who select the appropriate products and injection placement to help you achieve your best look.  Please contact our office if you would like more information about hyaluronic acid fillers to enhance your natural beauty and help you look as young as you feel.

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