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VG rx:

the art of
FIllers

Dr. Paul Jarrod Frank explains the best solutions for facial sagging and volume loss.

Written By JESSICA PRINCE ERLICH

Q: IS THERE A WAY TO REVERSE FACIAL SAGGING WITHOUT HAVING SURGERY?

A: “There are two reasons why our faces fall over time,” says Dr. Paul Jarrod Frank, a New York City dermatologist. “One is loss of elasticity and the other one is redistribution and change of volume.” When injected precisely and conservatively, fillers can fight the inevitable gravitational pull to lift up everything from sunken cheekbones to droopy jawlines. To help his patients understand how the process works, Frank uses an example of a deflated balloon: “as it loses air over time, the plastic sags, but if you put a little air back into it, you’ll see the plastic tighten and lift up again.”

The key to achieving the best outcome is to see a doctor with an experienced eye and an arsenal of varied injectables. “To get a lift, you need a combination of the right products and that’s where artistry comes to into play,” says Frank. “You’re not just filling up a balloon with air—you’re putting the right product, with the right viscosity, in the right area of the face, and often times it involves layering a few different fillers.” With that philosophy in mind, Frank’s medical tray is always well-stocked with hyaluronic acid options (brand names include Voluma, Restylane, Restylane Lyft, and Restylane Silk)—popular amongst dermatologists for their predictability, adjustability, and even reversibility. He also counts the dermal filler Radiesse as his non-reversible filler of choice. To lift the cheek area, he favors Restylane Lift or Voluma injected above the bone and in the soft tissue of the fat with a fine needle. To treat the forehead, he opts for Restylane Silk inserted above the bone in the area of indentation. Around the jawline, he places Radiesse right over the bone (it helps yield more natural symmetry) with the assistance of a thin, blunt cannula for long-lasting definition. “When I do volume restoration, some patients have naturally bigger cheeks, some have more naturally defined jawlines, some have more hollowness in the temple, and what I do is I restore only where it’s needed.”

Regardless of which part of the face he’s reflating, Frank works from the outside in—a technique that allows him to add volume back into the lateral portions of the face (the cheekbones, the jawline and the temples) first and finish by filling fine lines around the eyes and mouth (for that he likes Restylane). “It’s about putting a little bit [of filler] in a lot of spots and that ultimately leads to the most natural results.” And naturally, a lifelong fresh-face requires a maintenance plan. While results show up fast—in about one to two weeks with no downtime or pain (injections are administered under topical anesthesia and patients usually return to work the following day)—Frank advises touch-up appointments no less than two to four times a year. For first-time injectees he recommends returning one to two weeks later for any necessary adjustments. “I think the most artistic thing to do with volume restoration is not just to fill tank up and wait for it to go back to empty; people don’t want that—once they look great they always want to look great.”