Let me “Fill You In” on Dermal Fillers!

Cosmetic fillers have revolutionized the modern cosmetic surgery practice.  And despite the ever increasing cultural acceptance to cosmetic enhancements and abundance of industry advertising and branding… still, many patients are confused about fillers and what they can and cannot do.  As we age not only does gravity and sun damage affect the quality of our skin, but we lose volume in key areas of the face.  Much like a grape becomes a raisin, volume loss significantly contributes to wrinkle formation.

Facial aging areas

Let me take a moment to clear the air and “fill you in” on the most common fillers used in my practice here at McLain Surgical Arts…

 1. Hyaluronic Acid (HA) Fillers:

The most commonly HA fillers are Belotero, Juvederm, Restylane and Perlane.  These types of fillers have been used in the US since 2004 and have a proven safety and performance record.  Hyaluronic Acid (HA) is a normally occurring substance in the human body, primarily found in skin, joints and neural tissues.  Interestingly, when skin is exposed to excessive UVB rays from the sun over time, the skin loses hyaluronic acid and begins to lose volume and vibrance.  This results in premature aging.  Fortunately, HA can be produced in a laboratory which nearly eliminates the potential for severe allergic reaction that was common to older collagen based fillers.  Although very similar each of the types of HA fillers have specific differences based primarily on molecule size and/or the amount of crosslinking between the molecules.  I personally prefer Restylane in the tear trough areas due to its ease of molding, while I prefer Juvederm in the lips because it seems to last longer.

2. Calcium Hydroxyapatite Fillers:

In 2006, the FDA approved calcium hydroxyapatite for cosmetic injection. This cosmetic filler is made of the minerals that give bone its strength and texture. These minerals are ground into tiny particles and suspended in an aquesous solution, which is injected under the skin. In the trial that led to its approval, calcium hydroxyapatite worked significantly better and lasted longer than collagen injections to reduce severe wrinkles.  This filler is white and is best used at deeper levels of facial atrophy.  Radiesse is my preferred filler for lower facial and cheek large volume replacement.  It has perhaps the most natural result of any of the dermal fillers and has the added benefit of stimulating your skin to form its own collagen.   It is not useful for lips and tear trough areas due to the need to place at very superficial levels in these areas.

Most popular facial dermal filler locations

3. Autologous Fat:

Fat grafting to fill soft tissue deficits has been around since at least the late 19th century and has gained increasing popularity in the past 20 years for facial and body volume restoration.  The primary advantage of fat is that it is autologous and there is zero risk of transmittable disease or allergic reaction.  It is considered semi-permanent because only a portion of the total fat grafted survives permanently, but with improvements in harvesting and application techniques one can expect about 50-60% of the transplanted fat to remain.  In addition to volume restoration of the face, fat is very popular in treating body contour defects;  the buttocks for example, otherwise known as a Brazilian buttock lift.

Hopefully this gives you a bit of information on the most popular fillers used here at McLain Surgical Arts.  There are obviously other options, but these three forms have become the worhorses in reversing age related atrophy and wrinkles in my practice.

For more information on dermal fillers in Huntsville, Al, please visit us online or call 256.429.3411 for a complimentary consultation.

Actual patient: Facelift Plastic Surgery Before

Actual patient: Facelift Plastic Surgery Before


Facelift Plastic Surgery After

…and cosmetic surgery is not plastic surgery!

It can be difficult in this modern day climate of heavy advertising, social media and internet searches for prospective cosmetic surgery patients to learn the truth about cosmetic procedures and the surgeons who perform them. Unfortunately, the online plethora of marketing, advertising and websites has muddied the waters about cosmetic surgery and unscrupulous groups and individuals have taken advantage of the flotsam and jetsam to advance their own agenda. It is disappointing to see, but the “turf battles” in healthcare and among physician specialties are often the nastiest and most intellectually dishonest encounters imaginable. The battles between surgical specialties that encompass esthetic/cosmetic surgery are no exception. This is especially evident in the attempt by some to equate plastic surgery and cosmetic surgery.

Cosmetic surgery

The truth is that no one specialty owns cosmetic surgery. Cosmetic surgery is recognized by the AMA (American Medical Association) as a separate and distinct specialty from plastic surgery. In fact, the nation’s largest cosmetic surgery group, the American Academy of Cosmetic Surgery (AACS) which is comprised of physicians from multiple specialties, including plastic surgery, has voting delegates in the AMA House of Delegates. Cosmetic surgery is the surgery of appearance. It is elective and focuses on the aesthetics of beauty.

Plastic surgery

Plastic surgery is primarily reconstructive in nature and was born out of the need to repair severe head and neck injuries during World War I. As there were no “plastic surgeons” at the time, the U.S. Surgeon General (William C. Gorgas) combined oral surgeons and general surgeons to form the Department of Oral and Plastic Surgery to treat these injured soldiers. Interestingly, Dr.’s Robert Ivy and Varaztad Kazanjian, who are considered the fathers of plastic surgery in the U.S. were originally oral surgeons. The prestigious American Association of Plastic Surgeons (AAPS), which limits its membership to only the most accomplished plastic surgeons in the country, was originally founded by oral surgeons and physicians and was called the American Society of Oral and Plastic Surgeons until 1931.


Actual patient: Buttocks Liposuction Before


Actual patient: Buttocks Liposuction After

Unfortunately, some (not all) organized plastic surgeons attempt to mislead the public about who is competent to perform cosmetic surgery and the most deceptive lies are those that contain some grains of truth. Plastic surgeons (like many other surgical specialists, including but not limited to, Otolaryngologists/ENT, Oral and Maxillofacial Surgeons, Dermatologists and Ophthalmologists) do learn cosmetic procedures during their residency. However, the Accreditation Council for Graduate Medical Education (ACGME) only recommends that residents in plastic surgery perform 55 cosmetic procedures to be considered adequately trained. These include ten breast augmentations, seven face lifts, eight blepharoplasties, six rhinoplasties, five abdominoplasties, ten liposuctions, and nine “other” cosmetic procedures.

I do not believe that number of procedures is enough to become truly efficient in the full scope of cosmetic surgery and in fact, most plastic surgery educators agree with me. This is exemplified in a 2008 article published in the Plastic and Reconstructive Surgery journal, where a survey of cosmetic surgery training in plastic surgery programs in the United States found that the majority of the plastic surgery program directors encouraged their residents to pursue some type of postgraduate cosmetic fellowship. There is no doubt that the residency experience pales in comparison to formal fellowship training in cosmetic/esthetic surgery.


Actual Patient: Tummy Tuck & Breast Augmentation Before


Tummy Tuck & Breast Augmentation After

Fellowship training is widely recognized as the highest level of training available after residency and denotes extraordinary commitment to that field of medicine or surgery. Personally, I was fortunate enough to perform over 1400 cosmetic surgeries during my accredited fellowship.   Also, in contrast to many residency experiences, as the cosmetic surgical fellow, I was responsible for the patients’ from their initial consultation to their surgery and through their postoperative course. Unfortunately, many residents do not gain enough experience in the university setting to meet cosmetic surgery requirements and are sent out to private offices to “scrub in” on cosmetic cases to gain sufficient numbers.  This means that many of the nuances of patient selection, treatment planning, informed consent, and management of postoperative complications are likely missed.  That said, I have many plastic surgery colleagues who are very experienced in esthetic surgery and are excellent at it; but just having the designation “plastic surgeon” does not assure a patient of that surgeon’s proficiency in cosmetic surgery.


Contemporary educators will freely admit that cosmetic surgery is a multi-specialty field that includes leaders and contributions from many surgical specialties. For instance, dermatologists pioneered laser surgery, chemical peels and invented tumescent liposuction.  Oral and maxillofacial surgeons also made significant advances in aesthetic facial skeletal surgery and facial implants.  Ophthalmologists have contributed many techniques for cosmetic eyelid surgery and cosmetic uses of botulinum toxin. Gynecologists have introduced or improved cosmetic vaginal surgery.  ENT physicians have advanced the field of rhinoplasty and facelifting techniques on a continual basis.   Plastic surgeons have made remarkable advancements in breast and body contouring procedures. The list goes on and anyone that disagrees with the fact that contemporary cosmetic surgery is a multi-specialty realm simply has their head in the sand or has intentions of secondary gain.

The real bottom line is that there is no residency for cosmetic surgery and in my opinion, the ideal surgeon is one who has completed a formal fellowship in cosmetic surgery, or has a vast amount of cosmetic surgical experience.  This could be a surgeon or surgeons from a multitiude of specialty backgrounds. Although board certification is an indicator of basic surgical competency, it is only one component that should be considered when choosing a cosmetic surgeon. Depending on the community in which you live, the best person to perform your rhinoplasty may be an oral and maxillofacial surgeon or an ENT/Otolaryngologist and the best person to perform your liposuction procedure may be a board certified cosmetic surgeon or a general plastic surgeon.

Also, any honest and competent surgeon should be willing to discuss their actual training and experience in the procedure(s) considered and not just hide behind some board certification. Lastly, successful and accomplished surgeons seldom disparage their competition because they are: 1) confident in their own abilities, 2) are too busy with surgery to waste time belittling others, and 3) realize that their competition will not last long if they aren’t getting good results, and if they are, they should be respected as colleagues.

If you would like to learn more about cosmetic surgery in Huntsville, AL with Dr. Landon McLain, please visit our website at McLainsurgicalarts.com