Facial contours, skin wrinkles, and skin folds caused by the descent of underlying facial fat can be effectively treated using injectable fillers. They have a high safety profile, minimal downtime, and are a more affordable option than surgery in most cases. Many facial features appear hollow over time and can be restored to a more youthful appearance by adding volume. This includes areas such as sunken cheeks, the lid cheek junction with the presence of undereye circles, a concave appearing temporal region lateral to the forehead, or thinning of the lips. Blending of the nasolabial folds, hiding the appearance of the jowls, and defining the jawline can also be achieved with fillers. Horizontal creases that develop from repetitive neck flexion can be smoothed out successfully when fillers are placed superficially within the dermis of the skin.
Hyaluronic acid is a compound naturally present throughout the skin. In addition to collagen and elastin fibers, it is a major component of the deeper skin layer known as the dermis. A portfolio of Juvederm™️️, Restylane®, and RHA® hyaluronic acid injectable fillers are used by Dr. Forley to create a customized treatment approach to achieve the best results for his patients. Depending on the area that needs to be treated, Dr. Forley will select the appropriate filler and layer it carefully beneath the skin surface using a fine tipped needle. His goal is to achieve a natural appearance without any telltale signs of having been treated. Minor short-term bruising and swelling may occur but most activities may be resumed almost immediately. Results following treatment can last between 1-2 years depending on the filler that is used.
Radiesse is a compound that consists of calcium-based microspheres. In addition to restoring volume, it has been shown to stimulate the surrounding tissues of the body to generate added collagen deposition. Applied in much the same way as the traditional filler, there is minimal risk to Radiesse injections with little to no side effects. Radiesse will naturally degrade into harmless compounds over 12-18 months and be absorbed by the body.
Sculptra Aesthetic is composed of an injectable biocompatible material, poly-L-lactic acid (PLLA), that stimulates the production of the skin’s own collagen resulting in a gradual and very natural appearing restoration of facial volume and contour. A dramatic lifting effect of the sagging tissues of the face can be achieved. Generally, a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The youthful appearance that results from the treatment can last up to 3 years at which time maintenance treatments will be necessary.
The long-term success that has been achieved in recent years with fine tunneling methods of introducing fat grafts has enabled the successful use of the body’s own tissue to recontour the face, enhance the cheek and chin, and soften folds and wrinkles. It can also be used for enhancement of areas of the body, such as the breast and buttocks, or to treat contour depressions resulting from previous surgery or trauma. Dr. Forley’s safe and effective fat grafting technique, using local anesthesia, allows for great flexibility in its application, and provides a soft, natural feel. The fat is obtained from an area such as the abdomen or hip with liposuction techniques and then processed to concentrate the fat cells. A special needle is then used for injection of small amounts of fat in multiple fine tunnels. Achieving the desired contour with a layering technique maximizes its longevity by enabling the growth of new blood vessels to nourish the grafted fat cells. The injected fat is living tissue and the blood supply it develops in its new location enables the achievement of long-term results. If some absorption does occur, additional treatments may be necessary, but the final result of fat grafting can last for several years. There is minimal pain connected with the procedure and any discomfort is controlled with oral medication. Patients are up and around the day of the procedure with gradual resolution of any swelling or bruising.
Meet Dr. Forley’s patients and hear about their experiences.
Injectable fillers are used to replace volume in the face that has shifted downward or diminished with the aging process. Unnatural outcomes from fillers are often the result of not adhering to the concept that “less can be more”. Problems arise when excessive amounts of fillers are injected in an effort to lift the face non-surgically. Facial balance is altered and an unnatural, over-inflated look may be the result. Dr. Forley’s goal is to restore your appearance and not alter the underlying characteristics that are unique to your face. His understanding of facial anatomy and aesthetics, enhanced by his plastic surgery background and attention to detail, enables him to produce natural results with this minimal downtime procedure. Dr. Forley will provide you with realistic expectations and inform you when alternative procedures would better meet your needs for a more youthful look.
The use of injectable fillers has revolutionized our approach to reversing many of the unwanted signs of aging with a minimally invasive, safe, and effective procedure to replace and restore facial volume. The concept of using a permanent filler may be appealing due to the thought that follow-up maintenance treatments won’t be necessary. However, the aging process is one of continual, fluid evolution and is not a static, fixed event. A permanent filler produces permanent results that will not adapt to the aging changes that continue to occur over time. What may look good now with a permanent filler will not necessarily appear beneficial in the future as aging progresses and can be difficult to correct. Long term results of 12-24 months are now possible with the current generation of hyaluronic acid fillers, such as Juvederm and Restylane. This time frame enables Dr. Forley to match your treatment needs to the inevitable changes that occur in your face with the passage of time.
Surgery is effective at lifting sagging skin and deeper layers of the face, reducing excessive amounts of skin, tightening muscles, and improving contours and dimensions of the face and neck. However, as we get older there is an atrophy or decline in the amount of facial fat that contributes to soft, youthful contours. This decrease in fat volume has been recognized as a major contributor to the aging face. Volume replacement, usually with your own fat, has now become a routine adjunct to surgical procedures of the face.
The use of injectable fillers for improving the appearance of the nose has been popularized but also misunderstood in recent years. Fillers can be used to camouflage minor irregularities, soften post-operative depressions of the bone or cartilage, or correct minor asymmetries. However, when the aggregate concerns regarding the appearance of the nose are considered, the best long term option remains surgery for most patients.
There can be several reasons why a patient may be dissatisfied or disappointed with the results of an injectable filler. Perhaps too much change has occurred, filler was placed too superficially and is visible, or the patient had unrealistic expectations as to the result. Fortunately, a solution exists for the commonly used hyaluronic acid (HA) fillers such as Juvederm, Restylane, and RHA other than waiting for them to dissolve over time. Hyaluronidase is an enzyme that will safely dissolve the HA fillers following its injection into the problematic area. Reduction of the filler will start to occur almost instantly and then progress over the next day. The enzyme has no effect on the skin or tissues of the face. Hyaluronidase is not effective for non-HA fillers like Radiesse or for Sculptra.
Bryan G. Forley, M.D., F.A.C.S. is a board certified plastic surgeon who specializes in aesthetic facial, breast and body contouring surgery. He has been in private practice in Manhattan since 1994. Dr. Forley is affiliated with the Mount Sinai Beth Israel Medical Center, New York Eye & Ear Infirmary, and Mount Sinai West.
Annual guide to the top 5% of New York City Physicians.
Doctors are selected from ballots sent to over 18,000 New York City physicians. Identifies those doctors held in highest regard by their peers. Dr. Forley has been listed annually since 2008.
The authoritative guide to finding highly qualified physicians throughout the New York region. Doctors are selected based on nominations by their peers and reviewed by Castle Connolly’s physician-directed research team.
UK-based Tatler discussed Dr. Forley in its 2008 Beauty and Cosmetic Surgery Guide as one of the "A-list of cosmetic surgeons"..."who are at the top of their game"...and whose "innovations are shaping the art of cosmetic surgery around the world." It was noted that Dr. Forley’s "discreet Upper East Side clinic is perfect for women and men in search of minimally invasive natural-looking surgery.
Julia Reed writes that Dr. Forley, "disarms me by asking what I might like to have done. Nothing, I say, sure that I mean it. And then he shows me before and after books of tiny little neck lifts, subtle browlifts involving tiny little incisions well hidden within the hairline. In ten years, he assures me, I’ll be thinking about it. I actually like him. And I fear he may be right."
As our understanding of the aging changes that occur in the face has expanded, our approach towards treatment has evolved. We now be...
August 30th, 2014
Read More
The first signs of aging in the face often occur around the eyes and are typically described as baggy lower eyelids. Multiple fact...
April 17th, 2011
Read More
We often see patients who complain that they suddenly look older - occasionally they will pinpoint a specific ti...
January 26th, 2011
Read More
