Dr. Shervin Naderi refills cheek filler using Juvederm Voluma, placing it directly on bone to lift and mask under-eye fat. He explains why needle angle matters to avoid blood vessels, how pressure prevents bruising, and why maintenance touch-ups work better than waiting for the filler to fully dissolve.
Questions this video answers
June 27, 2019.
Juvederm Voluma.
Chapters
Hi. So we're doing a little refill here. This is not primary augmentation with Trillers. This is a touch up just to maintain. We have videos before showing how we started with Juvederm Voluma. This is to maintain, but I want to show you exactly the technique again. We're basically building up the upper cheekbone area, the orbital rim to support it, to basically cover up some of the lower lip fat pads and make her look more rested. So here we go. Always tilt the head down. If you tilt the head back, you basically cover up that area. We're gonna go, these are right down to the bone. They're basically right on top of the bone. And I make a tunnel up right on top of the bone. Make a tunnel up. Right on top of the bone. Make a tunnel up. Same thing here. I'm not injecting in the subcutaneous area to start. It's basically starting off on top of the supra periosteal. There's really in that plane when you're not going horizontally or not skiving. There is really almost no chance of intravascular injection because your needle tip is right on top of the bone, straight up. And there's really no blood vessels right on top of the bone itself in that area. If you go in this direction, if you go in this direction, there's much more likely that you're going to cannulize a blood vessel. The injection creates a tunnel outwards, not tunnel inwards. So here we're in the starting point and you can see it's already lifted up a little bit. Hold pressure on bleeders to make sure that you don't get a bruise. Continue our manicus arch area. Continue the mid face injection to get them right on top of the bone and then building it out. Right on top of bone, building it out. Let's take a look. Cool. You can see that she does have bleeding, but she's not really bruising because the blood is coming straight up. If you get a blood vessel in the way, then you get the bruising right immediately and you notice it. There's zero bruising right now. A little bit of pressure prevents that from happening. Pineapples are great for post procedure swelling. Avoiding nuts and seeds and fish and fish oil and omega 3s and all that stuff is more important for avoiding any type of bruising. We always tell patients, avoid anything with omega 3s, nuts, seeds, fish, fish oil, omega 3 containing products that you don't really think about. There's muffins and omega 3s eggs are omega 3s. Avocados and olive oil. All that has omega 3s mega sixes. And that can definitely make you. And you can see the two sides of the face right now. If you compare the two sides, this side looks more rested. The eye bag is covered. Looks smoother. This side. You can see the discoloration is kind of sucking in a little bit more. Continue a little bit more. Build up nice high, sexy cheekbones for her to create a nice triangle look on the face. You can actually totally see the contour. How nice and youthful this side is. We're going to match it on this side. Ready? It's not the most comfortable thing in the world, but it's not the worst either. It's fast. There's a little crunching sound that tends to alarm patients more than even the pain or discomfort. We usually have music blasting for them, but for the video we shut that off. So she's just listening to my talking right now. Let me see the two sides. Children's. There's no lumps or bumps. You feel it out. Just to make sure there's nothing there. A little bit. This is going right into basically the area of the tear trough. Volume. It can be injected into the tear trough. It's not a very hydrophilic material, so it is useful in that area. Again, injections right out of the bone. I'm hugging the bone surface. I like the cheeks. Both look really good. Drop here at winter time. Cool. Really nice cheekbones. I think actually we're going to stop with one. I was thinking we need more, but the one here, really nice and smooth. There's no bag showing anymore. Really nice results. And you kind of see that with just once. You see when it's placed in the right place to upkeep again. We don't want people always ask, how long do these injections last? I don't like that question because I say it's like asking how long does a hair haircut last? You don't want to wait till the hair is down to your knees. You certainly don't want to wait for all the filler to go away. So we do these periodic injections to refill and revolumize and make sure we don't go back to the starting point. So this was it. We are done. Till next time. Bye.
