Fillers Specialist


Dermatologists located in Arlington, VA

Juvéderm® injectable hyaluronic acid gels offer a long-lasting and natural-looking treatment for a variety of cosmetic facial concerns to correct volume loss, skin folds and wrinkles, and sagging skin. Dr. Lina Naga and Dr. Terrence Keaney of SkinDC use Juvéderm fillers, as well as other dermal fillers, as an important part of their cosmetic dermatology armamentarium.

Fillers Q & A

What are dermal fillers?

Under the outer layer of the skin is the dermis, a layer composed of specialized cells called fibroblasts and the products that they create, including collagen, elastin and hyaluronic acid. Beneath the dermis are the deeper facial fat pads which provide support to the skin and provide facial shape. When patients are young and these tissues are healthy and full, collagen and elastin support the skin, while facial fat pads create the smooth, curved and defined facial features. Over time, as the skin loses its elasticity and fat pads are reabsorbed and shift, there is a change in facial volume and shape leading to the classic signs of aging — lines, folds, wrinkles, bags under the eyes and hollowed cheeks and temples. Dermal fillers make up for lost volume by  supporting overlying skin, resulting in a restoration of lost volume, eradication of folds and wrinkles, and recreation of a youthful facial shape.

What are Juvéderm fillers made of? Are they safe?

Juvéderm is a filler composed of hyaluronic acid. Hyaluronic acid is a substance that is produced by skin cells naturally in the body and plays a critical role in supporting youthful-looking skin. It exists primarily between cells in the skin and forms what is called the extracellular matrix. Since it is a naturally occurring material in the body, it has a very low allergenic potential and the body is equipped with enzymes that slowly degrade it. For these reasons, and because it inherently attracts water and provides plumpness, it is an ideal filler material, and numerous hyaluronic acid fillers are now available. Different hyaluronic acid fillers have different concentrations, qualities and thicknesses and are designed for specific uses and facial areas. Dr. Naga and Dr. Keaney have extensive experience with and a thorough understanding of the different fillers and will recommend the appropriate filler depending on the location of the problem area, patient anatomy and desired result. Each Juvéederm syringe includes lidocaine, a widely used and safe local anesthetic, to ease any discomfort in the injection process. With hyaluronic acid fillers, patients experience effects lasting 6 months to 2 years, depending on the product used and the location it is placed in. The filler is naturally absorbed and degraded by the body over time.

What areas can Juvéderm fillers treat?

Juvéderm currently has 5 formulations, each with its own characteristics and an optimal use, that are often used in tandem to provide a personalized treatment. These products are:

Vycross Technology

    • Juvéderm Voluma® XC: a smooth, strong filler that is great for volume or structural support in the cheeks, chin, and jawline.
    • Juvéderm Vollure™ XC: is a versatile product that can be used in a variety of areas including lines around the mouth and nose, or in the lips, temples, nose, and cheeks.
    • Juvéderm Volbella® XC: a light hydrating filler for subtle lip plumping, tear trough or ‘eye bags’ improvement, and treatment of fine lines including vertical lip lines.

Hylacross Technology

    • Juvéderm Ultra XC: a robust filler that is great for lip augmentation and mid face folds.
    • Juvéderm XC: original product that smoothes wrinkles and lines around the mouth and nose.

What is Restylane?

Restylane® is a dermal filler product with 5 formulations used for smoothing, plumping, and wrinkle reduction. Dr. Lina Naga and Dr. Terrence Keaney of SkinDC in Washington DC, use Restylane fillers when the particular properties of the fillers suit an individual’s treatment plan. Call SkinDC today for your personal consultation.

Restylane formulations also are composed of hyaluronic acid. Though hyaluronic acid serves as the basis for many dermal filler brands, Restylane hyaluronic acid is in gel form, with gel particles of varying sizes, giving each formula its own properties. Dr. Naga and Dr. Keaney choose the Restylane product that best suits the patient’s treatment goals. For example, a person with moderate lines may be ideal for Restylane Refyne™, while another patient with deeper wrinkles could be a candidate for Restylane Defyne™. Each patient has unique treatment needs, so a single product, or even a single brand, used alone may not be versatile enough to treat all of a patient’s concerns alone.

Which areas do Restylane fillers treat?

Restylane Defyne is ideal for deep nasolabial folds and marionette lines. These are more commonly known as laugh lines and appear on each side of the nose and below the corners of the mouth. The gels added to hyaluronic acid cross- link to provide a natural result that stays flexible and moves naturally with the expression movements of the face.

Restylane Refyne is a very similar formulation treating the same areas, but works better on more moderate lines and folds. Like Defyne, Refyne uses the cross-linking gels that keeps a natural and flexible shape after injection to both fill out facial volume and move with the natural range of expressions.

For moderate and severe facial wrinkles, folds, and for lost volume in the cheeks, Restylane Lyft may be the product of choice. A mid-face product, the properties of Lyft suit it for building cheek plumpness in a natural and lifting pleasing way. Optimal results typically appear after a few weeks, and nearly 75% of people in a clinical trial saw results a year after treatment.

Restylane Silk was the first FDA-approved lip augmentation filler. It not only plumps up lips to restore lost fullness, but also smoothes lines around the mouth, as well as restores the natural lip shape that is often lost with age.

Restylane’s formulation treats mid-face areas, such as the like nasolabial folds, as well as and chin and mouth marionette lines. It is also suitable for lip enhancement and augmentation.

Are Restylane products safe?

Hyaluronic acid products generally have few side effects, and serious adverse effects are rare.   There may be swelling around the treatment areas, but this subsides within a day or 2 for most treatments. Bruising may occur with any injection, including dermal fillers like Restylane.

What is Radiesse?


Radiesse targets the face and hands. In fact, it is the first dermal filler approved by the FDA for use as a volume filler for the hands. The backs of the hands are an area that often displays the signs of aging, countering a person’s best efforts at maintaining a youthful appearance. Radiesse replaces lost volume and minimizes the appearance of raised tendons and veins revealed by loss of skin elasticity, while preserving creating a smooth and natural appearance.

Radiesse is also excellent at smoothing the effects of moderate-to-severe lines and wrinkles. In particular, it works well at improving wrinkles in the chin, smile lines at the side of the mouth, the folds that come before jowl formation, and the folds that make it seem a person is frowning. It is also an excellent product at defining the jawline, providing structure to this important facial feature.

What can I expect from a Radiesse treatment?

As with other dermal fillers, Radiesse is injected with a fine needle or microcannula into the treatment area. The newer formulation of Radiesse includes lidocaine — a common and safe local anesthetic — which minimizes any discomfort from the injections themselves. There are few chances for side effects. The treatment area may be sore for a few hours after treatment, but there is generally very little down time from a Radiesse treatment. Radiesse may be recommended with other products or treatments as part of your personal care plan from your SkinDC care provider.

What is Sculptra?


Sculptra® Aesthetic collagen stimulator is a bio-compatible substance that is also used to form the dissolving stitches used during surgery. It creates natural and long-lasting skin smoothing results. Dr. Lina Naga and Dr. Terrence Keaney of SkinDC in Washington DC, use Sculptra to fill facial folds, improve aging changes in the chest and body, and provide full face revoluminization. Call the office today to set up an appointment for a Sculptra consultation.

Why is collagen stimulation needed?

Collagen is a fibrous substance in the deeper layers of the skin that supports the outer skin and aids elastin and hyaluronic acid. Elastin helps maintain skin shape, while hyaluronic acid is key to skin hydration. More collagen permits the presence of more elastin and hyaluronic acid. Collagen production starts to slow when a person is in their 20s. In fact, about 1% of the body’s collagen is lost each year after that. Stimulating the production of new collagen helps to slow that process. When the growth of new collagen combines with the benefits of other cosmetic treatments, results can be astonishing. Wrinkles and lines fill in, and the skin naturally holds more moisture and nutrients.

How does Sculptra Aesthetic work?

While Sculptra provides some immediate results, like other dermal fillers, Sculptra is known for slowly providing volume and new collagen with very long-lasting results. Upon initial treatment, Sculptra adds support in the dermalis layer, propping up skin folds beneath the surface. That fades somewhat, but over time, the particles of poly-L-lactic acid, or PLLA, are absorbed by the body which stimulates new collagen near the locations of the injections. Collagen does not typically renew unless faced with injury or damage, such as cuts or burns. PLLA stimulates growth of collagen without tissue damage. Often injected using a cross-hatch pattern, Sculptra’s effects last longer than 2 years, though individual results may vary.

Where is Sculptra Aesthetic used?

Sculptra is an excellent product at filling in temporal hollowing (sunken in temples) and providing full face volume. It is an excellent option for skinny patients who may appear some what ‘skeletalized’ with the loss of facial fat with time and exercise. It is also an option for the lower face to define the jawline and cheeks. Sculptra can also be used to improve the age related changes on the chest and dimpling seen with cellulite in various areas of the body. A typical course of Sculptra treatments consists of 3 injection sessions over 3-4 months to achieve the longest-lasting effects.


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