Airbrushing: A New Technique for Injectable Fillers


The choice of injectable fillers for the physician or nurse injector is dictated by the patient’s need and is analogous to the choice of brushes for the artist. Filler technology has expanded greatly over the years and the patient can now be offered many new choices depending upon their needs Recently, a new technique has been employed to address previously difficult issues such as the etched lines around the mouth, crow’s foot area or forehead. In the past, injectable fillers – such as the Juvederm family of hyaluronic acids (HA’s) – have been the “go to” choice for correcting the age related volume loss of the face. This is due to the broad safety profile of the material and its biocompatibility. The hyaluronic acid gel is extremely well tolerated and furthermore, it is “erasable” by the injection of an enzyme if any of the very rare complications might occur or even if the patient is not completely satisfied with the outcome.

Traditionally, hyaluronic acids have been injected in various levels below the skin. Juvederm Ultra XC is used superficially because it is smoother and thinner, Juvederm Ultra Plus XC is a bit thicker and is used deeper below the skin and Juvederm Voluma XC, the thickest and most elastic hyaluronic acid gel is used in the deepest planes below the skin and serves to achieve the most “lift” and shaping of all of the HA’s. Now with “airbrushing” we have the ability to inject very superficially in the skin itself to achieve smoothing we were heretofore unable to provide without more invasive procedures such as laser resurfacing or dermabrasion.

“Airbrushing” involves reconstitution of Juvederm Ultra XC to provide a thinner, more fluid gel that we can inject using extremely fine needles. Instead of injecting below the skin and essentially stretching the skin to pull out the wrinkles, the superficial injection allows us to make the etched wrinkles more shallow without the typical volume distortion or “pillow-face” or “fish lips” we’ve all come to recognize. By injecting very close to the surface of the skin we achieve a smoothing of the wrinkles akin to adding water to a dry sponge. Smoothing without distortion. This technique is performed using magnification and sometimes additional local anesthesia, especially around the lips that are one of the most sensitive areas of the body. The “airbrushing” technique does take a bit longer than the usual HA injections so expect a little more time for treatment.

This technique has been extensively researched by Dr. Steven Fagien of Florida, Dr. Val Lambros of California, and others and they have shown that this technique appears to be biostimulatory. That is, it stimulates the skin to generate collagen in the injected areas. In short, though we know that the HA product will be absorbed by one year, there remains compelling improvement over time. The wrinkles do not seem to ever be quite as deep as before the injection. Used in conjunction with Botox that lessens the muscular cause of many of our wrinkles and a good corrective skin care program, the skin can appear much more youthful and vibrant. Since the Juvederm family of HA’s is mixed with a local anesthetic, injectable treatment is easy and there is often little or no downtime. Occasionally, bruising can occur so it is important to plan accordingly before that special event when you want to look your best.

Author: Kevin L. Smith, MD

Here are a couple of BEFORE & AFTER pictures.