Cosmetic Q&A: Mixing Fillers?

smileQuestion: Is it ok to mix the different dermal fillers?

Dr. Rohrich: Yes it is ok, in general.

Fillers should only be injected by people that are superbly trained, competent, and have the experience to do so. Having trained thousands of plastic surgeons to use both Botox and fillers, I always stress how vital it is to understand the anatomy, the mode of action, and the duration of each filler.

In general, the longer lasting fillers are placed in a deeper fashion and the hyaluronic fillers should have a more superficial range.  You can add both of these which are done commonly in the nasolabial fold areas and the commissures where stacking is performed for increased longevity – such as the use of Radiesse in the deep nasolabial fold followed by an application of hyaluronic acid superficially in the commissures.

Question: Is it ok to mix hyaluronic fillers and local anesthesia?

Dr. Rohrich: It is very important and essential.

I have been using fillers with local anesthesia and epinephrine for over two years now to decrease patient discomfort, as well as post operative bruising and swelling significantly.  It is a very useful technique and many of the fillers are incorporating this locally into their fillers.

The key is including epinephrine as it decreases the sensation of the bruising and swelling.  Another way to diminish bruising and swelling is the use of cold application massage therapy and the application of ice pre and post operatively as well as topical agents 20 minutes beforehand.