Injectable Fillers | Dr. Forley
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Posts Tagged ‘injectable fillers’


Sunday, July 29th, 2018

A common complaint of patients is that they look tired but don’t feel tired. This is often the result of bulging fat pockets in the lower lid combined with a tight attachment of the skin at the junction of the lower lid and the cheek known as the tear trough. It is frequently one of the early signs associated with the aging process. Dr. Forley approaches this concern with both a non-surgical and a surgical option. Camouflage of the bulging fat can be achieved with the use of an injectable hyaluronic filler at the tear trough to aid in blending the transition across the lid-cheek junction. Although this can improve early changes, the fundamental cause of the problem remains unaltered. An advanced surgical technique that Dr. Forley utilizes to treat this issue involves releasing the attachment of the tear trough below the eyelid from the inside so that there is no external scar. At the same time, the fat from the lower lid is repositioned to extend across the lid-cheek junction. This changes the orientation of the fat so that the bulging is reduced in conjunction with filling the depression below the lower lid. This procedure is known as a transconjunctival fat transposition lower blepharoplasty. During your consultation, Dr. Forley will discuss the options that would work best in your individual situation.


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Saturday, December 3rd, 2016

Source: Crisalix

Dr. Forley is pleased to introduce the Crisalix 3D imaging simulator tool to assist you in visualizing the potential outcome of a variety of procedures including breast augmentation, facelift, nose surgery, body contouring, and injectable fillers. The simulation can be done remotely or as part of your in-office consultation with Dr. Forley. This imaging tool is also an excellent way of communicating your desires visually to Dr. Forley.

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Sunday, October 30th, 2016

JUVÉDERM VOLBELLA® XC is the latest U.S. Food and Drug Administration (FDA) approved injectable hyaluronic acid (HA) filler from Allergan that is formulated for subtle enhancement of the lips and to treat the etched wrinkles around the mouth. It was found to be effective for up to 12 months in the clinical trials that were performed and has been widely used in Europe since 2011.




The HA in both JUVÉDERM VOLBELLA® XC and the previously approved filler for cheek enhancement, JUVÉDERM VOLUMA® XC, was developed with advanced Vycross® technology to produce smooth, long lasting results. Vycross® technology enables treatments to be performed with a lower concentration of HA resulting in less swelling. Dr. Forley will evaluate you during your consultation to see if you are a good candidate for JUVÉDERM VOLBELLA® XC.

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Friday, August 14th, 2015

Restylane® Silk is a small particle type of hyaluronic acid filler that provides an additional option to the choices available to patients for lip enhancement. The FDA recently approved Restylane® Silk to define the appearance of the lips as well as to improve fine, etched vertical lines and wrinkles. It is notable for its subtle, natural effect and can be injected progressively until the desired lip volume is achieved. Dr. Forley uses Restylane® Silk not only to enhance the contour of the lips but also for blending of the lid-cheek junction ( the “tear trough”)  to create a more rested, youthful look.

Restylane Silk


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Sunday, April 19th, 2015

The junction between the eyelid and the cheek, also known as the “tear trough”, is an area of the face that makes us appear tired and older when it starts to deepen. It is caused by the anatomic relationship of the eyelid and cheek with bulging eyelid fat and an adherent ligament or fibrous band accentuating the depth and visibility of the tear trough. Frequently, associated shadows that are created will make it appear worse.


A more rested, youthful appearance is achieved when the junction between the eyelid and cheek is blended. The use of injectable fillers is an effective, non-surgical way to improve the area by camouflaging the depth of the tear trough through the placement of Restylane® or BELOTERO BALANCE®. Fat grafts can also be used to effectively conceal the depth of the tear trough. Treating the cause of the baggy appearance, however, requires a surgical approach that handles not only the bulging fat but the tear trough ligament that defines the junction between the eyelid and the cheek. The procedure, known as transconjunctival fat transposition blepharoplasty, involves an incision on the inside of the eyelid through which Dr. Forley releases the tear trough ligament from its bony attachment. The junction between the eyelid and the cheek is then filled with the fat of the lower eyelid to create a youthful, natural, well rested appearance. Any excess fat is removed to enhance the final outcome. A long lasting result is achieved with this technique which can be combined with other procedures to reverse the signs of facial aging.


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Monday, November 17th, 2014

Neck wrinkles or creases that run horizontally across the neck can appear at any age. The onset of these wrinkles is related to a combination of factors: neck anatomy, skin thickness, collagen deficiency, repetitive movement, and sun exposure. They are difficult to treat and persist even after a neck lift or facelift.

A successful method of treatment takes advantage of the unique properties present in the hyaluronic acid (HA) cross-linking technology utilized in the manufacture of BELOTERO BALANCE®. This FDA-approved filler can be safely injected into the superficial dermis of the skin to achieve a smoothing effect that is immediately visible. Since it is a non-particle type of hyaluronic acid, it can be used close to the skin surface yet remain undetectable.






Dr. Forley performs a series of tiny needle punctures for precise BELOTERO BALANCE® injection. Massage of the injection sites is then performed to achieve a blending of the filler with the surrounding skin. Some bruising may be present for a few days after the treatment but this can be reduced by adhering to the recommended protocol of anti-bruising measures. Results will generally last for 6-9 months.

BELOTERO BALANCE® is injected into the superficial layer of the dermis to smooth out neck wrinkles

BELOTERO BALANCE® is injected into the superficial layer of the dermis to smooth out neck wrinkles

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Saturday, August 30th, 2014

As our understanding of the aging changes that occur in the face has expanded, our approach towards treatment has evolved. We now believe a combination of volume loss from atrophy of facial fat and descent of fat in discrete facial fat compartments produces the stigmata of aging such as cheek hollowing, jowls, and deepening of facial folds. Our improved understanding of the anatomical basis for aging has led to treatment strategies that utilize the addition of volume to the face in order to create a more youthful appearance.

A common desire that patients express with regard to cosmetic procedures is to maintain a natural look. A fear that is often voiced regarding the use of injectable fillers to treat volume loss in the cheeks or the folds that extend from the nose to the lip and the lip to the chin is that of looking overdone. Patients will often cite examples of celebrities to emphasize the outcome that they want to avoid. The concern is one that sometimes causes those who would clearly benefit from treatment with an injectable filler to opt out thinking it is the material itself that is flawed.

The use of injectable fillers is very technique dependent in which judgment is of paramount importance to the result. It is not so much the material that is being injected but the amount used and the proper placement that determines the outcome. It is important to seek out an injector with expertise and a good aesthetic sensibility and not succumb to a misdirected “fear of fillers”. When used appropriately, FDA approved injectable fillers offer a safe, effective, and natural result to those who want to reverse the signs of aging.

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Tuesday, November 26th, 2013

Volume loss in the cheek is a common aspect of aging that can be successfully treated with injectable fillers. Improving the projection and contour of the cheek creates a more youthful appearance that  postpones the need for more invasive surgical techniques.


JUVÉDERM VOLUMA XC was FDA-approved in October 2013 for restoring volume to the cheek. It is an injectable gel and is composed of a smooth yet dense hyaluronic acid (HA) that is suitable for deep injection. Similar to its companion product JUVÉDERM® XC, placement of the filler is performed with a series of injections that are targeted towards producing the desired contour.  HA is a natural component of your skin that diminishes with age resulting in decreased skin structure and volume. The flattened or hollow appearance of aging can be converted to a subtle, uplifted look that can be customized with JUVÉDERM VOLUMA XC to balance the aesthetics of your face. It has been proven in clinical studies to last up to 2 years.

Dr. Forley will be one of the first plastic surgeons in New York to offer JUVÉDERM VOLUMA XC when it becomes clinically available in December.

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Wednesday, February 27th, 2013

BELOTERO BALANCE® is an injectable filler composed of hyaluronic acid that was recently FDA-approved for the treatment of moderate-to-severe facial wrinkles and folds. Immediate correction is achieved with BELOTERO BALANCE® due to its elastic and cohesive properties that enables it to integrate into the dermal skin layer in a manner that is undetectable.


The muscle that encircles the lip, known as the orbicularis oris, is responsible for lip animation. Expressions during speaking, eating, and lip puckering contribute to the onset and deepening of the vertical lines produced by this muscle as it contracts. The appearance of these vertical lines as we get older is worsened when combined with a history of sun exposure, smoking, and the thinning of the skin that occurs with aging.

Treatment options using lasers and dermabrasion have met with varying degrees of success. Superficial lines may be improved with minimal risk. Deeper lines, however, require more intensive treatment with increased downtime for healing, possible alteration of the natural skin color, and inconsistent improvement of the lines. In either case, the continued contraction of the muscle will cause a recurrence of the lines over time.

Although Dr. Forley has used hyaluronic acid fillers successfully for many years to treat deepened folds around the mouth and for enhancement of the size of the lips, the vertical lip lines remained a challenge due to the need for a more superficial injection of the filler within the dermis. This could result in visible ridging or swelling of the treatment area due to the type of biphasic chemical cross-linking used in existing hyaluronic acid gel products. A new type of cross-linking technology with unique properties is used in BELOTERO BALANCE® to produce a smoother, thinner type of non-particle hyaluronic acid that can be used to treat even the most superficial etched vertical lip lines with smooth and natural looking results.

BELOTERO BALANCE® is injected into the superficial layer of the dermis to smooth out neck wrinkles

A very fine needle is used for the injections and numbing cream or a nerve block can be used for optimal comfort during the 15-20 minute treatment. Any minor swelling and redness after the procedure will generally subside rapidly. If a bruise occurs, it may be hidden with a concealer until it disappears.

The duration of effect varies but averages between 6-12 months at which time re-treatment is performed. Additional areas that can benefit from BELOTERO BALANCE® are the tear troughs and superficial, etched lines in the skin around the eyes, the cheeks, and the neck.

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Monday, April 30th, 2012

An area of the body that often is overlooked in our anti-aging efforts is the hand. Recent attention has been directed to creating a more youthful appearing hand to match the facial rejuvenation treatments more commonly performed. The aging process in the hand is characterized not only by the changes in the appearance of the skin with wrinkling and brown spots but also by the increased visibility of the tendons and blue colored veins. This is the result of the loss of volume on the back of the hand and thinning of the skin. A key component in restoring a youthful appearing hand is the replacement of the volume that has diminished over the course of time. Here we will discuss a few treatment options that can help your hands to look younger: Radiesse®, Sculptra®Aesthetic, fat grafting, and Fraxel® re:store Dual laser.




After Radiesse®


Radiesse® is an injectable filler used to thicken the tissue on the back of the hand. It is FDA-approved and consists of calcium-based microspheres suspended in a water-based gel that will immediately restore volume to the hand when injected just below the deep layer of the skin. It also has a collagen stimulating effect that may prolong its usual one-year duration.



Sculptra®Aesthetic is an injectable material composed of poly-L-lactic acid that stimulates the production of collagen in the skin. A very natural appearing restoration of hand volume is produced by the gradual thickening of the skin that occurs over a three-month period. Generally, a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The results from the treatment can last up to three years at which time maintenance treatments will be necessary.

Fat Grafting

A simple technique of injecting fat under the skin of an aging hand can achieve long-lasting rejuvenation. Your own fat is obtained using liposuction and then specially prepared prior to injecting it under the skin in fine tunnels. Survival of fat depends on it getting a good blood supply and may require several sessions to achieve the desired result. The physical presence of a thin layer of tissue will not only decrease the blue of the dorsal hand veins and the white of the extensor tendons but will also soften the shape of veins and tendons.

Fraxel® re:store Dual Laser

The new Fraxel® re:store Dual Laser can be used in addition to volume restoration to improve the surface texture of the skin and lighten brown spots. The new, more superficial Thulium fiber laser (1927 nm) wavelength can better address skin discoloration with minimal discomfort. In addition, the deep penetrating Erbium fiber laser (1550 nm) improves skin quality with collagen remodeling.

Microscopic treatment zones delivered by the Fraxel® re:store Dual laser produce “fractional” zones of heating with every zone surrounded by unaffected skin. This technology enables rapid initial healing with redness and swelling lasting for 2-4 days. There is no visible wound healing but some dryness and flaking will occur during the first week. The treatment regimen consists of 3-5 sessions at about 4 week intervals with beneficial changes continuing to occur for 2 to 3 months after each treatment.

During your consultation, Dr. Forley will discuss which treatment options would be best for you.


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