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Dermal Fillers

Did you know that we start breaking down our support structures in our skin at about age 20?  


That means that we start to lose volume before we are even legal to drink alcohol.  And that is just due to our genetics and chronological aging.  If we add in environmental toxins such as UV light, blue light, pollutants, tobacco, stress, etc then we really start breaking down collagen must faster than the normal aging that happens from adding candles to our cake every year. 


You can help maintain the collagen and firmness and volume you have by making smart choices.


Limit stress, sleep 7+ hours per night, drink water, eat well, exercise, limit environmental toxins, etc.  You can also choose to use skin care products daily that contain retinol, peptides and growth factors. You can stimulate collagen production with regular energy kisses with microneedling, radio frequency and lasers. You can replace lost volume with “fillers”.  There are so many filler options on the market since Dr. Sandy started injecting fillers in the 1990s with collagen.  


At Johnson Dermatology, as of 2021, we offer PLLA (Sculptra) which is a biostimulator that stimulates your own collagen so we use it much like we do fillers, calcium hydroxylapatite (Radiesse) and our favorite filler hyaluronic acid. Hyaluronic acid is our favorite filler because it is the safest in our opinion since you can dissolve it immediately with a medicine called hylenex.


Never get injected with HA filler if the injector does not have hylenex ready in the rare instance of a complication.  We are aware of 17 different FDA approved options for hyaluronic acid (HA)  fillers currently available on the market that last 6-24 months on average.  


At Johnson Dermatology, we are pleased to offer our favorite 5 versions of juvederm, 3 versions of the dynamic teoxane/RHA and 6 versions of restylane.  


These different versions of HA have different properties and functions and so need to be injected into the proper area of the skin to get the best and most long lasting skintastic results.  A person can inject a thick filler into the superficial skin and that person may develop knots or bumps.  A person can inject a thin filler into the deep skin and get absolutely no change to their skin. The same is true for real estate as it is for fillers—location matters. 


Some of the most common reasons to have fillers injected are:


To replace lost volume, tack skin back into place after it has sagged, enhance small areas that should be larger, enhance lips, redefine lips, lift eyebrows, reshape nose, reshape chin, fill in lines, soften the chest surface, remodel ear lobes, lift the buttocks, and fill in dimples. At Johnson Dermatology we believe fillers are for enhancing your natural beauty and one of our priorities is a natural looking aesthetic.


Because these products are often considered dermal implants, there is a risk of infection and complications.  It is advised to get your fillers by a well trained filler injector in a medical facility as it is a medical procedure.  This can be difficult to navigate because there is no such thing as “filler certification”. A one week class can give one a certificate but only a doctor or dentist can purchase filler and they are responsible for making sure the injector they give it to is fully trained.


At Johnson Dermatology, none of our injectors have had less than 6 months training and have continued injection education at least 6 times per year.


As Malcolm Gladewell and others have taught us, it takes at least 10,000 to become proficient at something.  At Johnson Dermatology, we are honored to inject people with fillers every day of clinic for the past 15+ years. On average, we inject 40 patients per day. An experienced injector will not be able to guarantee best results with no problems but will have the knowledge to minimize risks as well as have the knowledge to manage any complications.  


We discuss post-operative/treatment skin care with people who have injections to try to maximize benefits and minimize complications. Unfortunately complications can happen.  We also have the experience to select the right filler to give the best results—similar to choosing the right tool.  An experienced injector may get better results with 1-2 syringes as opposed to an inexperienced injector with 5-6 syringes of filler.


The average person needs one syringe of filler per decade of life for full face rejuvenation.


However, we recommend a personalized consult for best estimations of how much you need. Most HA fillers come in a one cc syringe which is 1/5 of a teaspoon. We do not open syringes and leave half for later as that is only 1/10 of a teaspoon and highly discouraged from the companies that make fillers. Once open and sitting there is increased risk of contamination and there is no way to know if the integrity of the product is maintained. This is for your safety. 


The most common adverse event with injections is bruising.  


Again, an experienced injector should cause less bruising for people than a novice injector.  Bruising and complications do happen with any injector.  That is why we love offering laser treatments and a bruise minimizing protocol.  When bruising does occur, we can minimize the bruise, help it resolve faster and cover it. 


To minimize infections, it is important to thoroughly clean the skin (and mouth if injecting near the mouth) before injection as well as not to inject a person who has an active or recent infection or has had recent dental treatments.  With that being said, sometimes injection of filler into the lips can trigger a reactivation of an infection such as a herpes cold sore.  This happened in 2021 to Dr. Sandy after being injected.  Fortunately, Nina was able to prescribe prescription treatment to minimize the severity of the infection.  The filler doesn’t cause the infection but just like the trauma of a sunburn can reactivate a cold sore so can the trauma of filler injections. If you get cold sores it is important to notify your injector so they can discuss premedication options to prevent this flare of cold sore.


Johnson Dermatology is honored to be a top injector for Allergan, Revance, and Evolus.


We are honored that so many people trust us for their fillers/injections initially and are thrilled with their results.  For great results—remember the filler (injector) is often as important or more important than the filler (product).  To learn more which fillers are best for you to keep you most skintastic, please contact us through the portal, on our contact us page of our website, or by telephone.  

Juvéderm® XC Treatment


(Click & drag your cursor to the left & right to see before & after images)


Treatment for Parentheses Lines, Marionette Lines, Corner Lines & Vertical Lip Lines (2 Weeks)
Treatment for Parentheses Lines, Marionette Lines & Corner Lines (2 Weeks)


See Real Patient Results >


For more information, visit the Juvéderm® website.

Juvéderm Voluma® XC Treatment


(Click & drag your cursor to the left & right to see before & after images)


Treatment for Zygomatic Arch, Anteromedial Check & Submalar Region (1 Month)
Treatment for Zygomatic Arch, Anteromedial Check & Submalar Region (1 Month)


See Real Patient Results >


For more information, visit the Juvéderm Voluma® website.


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