Various filler materials exist, and are catered to cosmetic outcome, as well as patient goals for longevity. Filler material can broadly be separated into permanent and temporary, however most various types exist on a spectrum from months to years. Juvaderm is temporary filler with multiple formulations that vary in thickness, best suited for certain locations on the face respectively. Other more long lasting filler materials include fat from our own bodies, poly-L-lactic acid (also known as Sculptra), and Calcium hydroxyapatite (also known as Radiesse).
Noninvasive Orthognathic Surgery/Genioplasty
Orthognathic surgery has traditionally been performed via invasive procedures, to include using a bone saw to alter the mandible and advance the jaw forward. This can be done cosmetically, or for medical conditions such as dental misalignment and airway collapse causing apnea and other medical conditions. Noninvasive jaw and chin surgery typically does not address such medical issues, but can improve cosmesis in patients who are not happy with the appearance of their lower face. This is commonly performed through the use of chin implants as well as both temporary and permanent filler materials, sometimes referred to as “liquid genioplasty”
In facial cosmesis, the chin and jawline are some of the most pronounced and noticeable subunits of the face. Accordingly, small changes in angulation and subcutaneous fat lead to drastic changes in facial structure and appearance. Retrognathia, otherwise known as a recessed jaw, is a common issue addressed with Orthognathic or “jaw surgery”. A small jaw can give the appearance of an overlying projected or large nose. Microgenia, known as a small or under projected chin, is a common issue addressed in Genioplasty or “chin surgery”. A small chin can also give the appearance of an over projected nose, and can enhance the appearance of facial fat below the jawline.
Juvederm is made of Hyaluronic acid, which is a compound naturally produced by human skin. A main benefit of Juvederm is that misplaced filler or migrated filler can be broken down with the use of hyaluronidase, which is injected into areas where breakdown is preferred. There are many formulations of Juvederm, such as Voluma XC (popular in cheekbone injections), Volbella (popular as a lip filler), Ultra XC (lips and perioral area), Juvederm XC and Vollure XC (Facial wrinkles and nasolabial folds). These formulations vary in thickness and viscosity.
Depending on the patients skin thickness and nasal deformity, many of these may be used to address the nose. Popular techniques include injecting material along the dorsum of the nose in order to achieve a smoother contour, along the sidewalls to increase nasal width, and along the anterior most dorsum in order to create the perception of a narrower nose. Injecting near the tip of the nose is described, however it may place patients at risk of injection into an artery that supplies the nose, which can cause serious complications such as blindness and skin death. Juvederm lasts for between ½ to 1 year.