As the face ages, facial fat repositions and decreases, bone changes, and skin loses support. The result is often not a single wrinkle but a broader loss of the volume and contour that gave the face its shape.
Patients may notice
Filler may be considered when the concern is volume loss, contour, or definition, rather than skin surface changes or lines driven by muscle movement.
Most modern fillers are made from hyaluronic acid, a substance naturally found in the skin that attracts water and helps maintain hydration and volume.
Individual fillers differ in their rheology, the way a gel behaves once placed in tissue. Firmness, flexibility, lifting capacity, spread, longevity, and tissue integration all vary. Each part of the face also moves and supports weight differently, so a product that behaves well in the cheek may be wrong for the lip.
The right filler is not chosen by brand. It is chosen by how the product must behave in a specific part of the face.
Explore representative outcomes from patients treated by Dr. Gerrish and his clinical team.
Combination Injectables
A combination injectable approach using neurotoxin to address fine lines and wrinkles and hyaluronic acid dermal filler for facial balancing.
Individual results vary.
Facial Balancing with Dermal Filler + Botox
Facial balancing using dermal filler and Botox to refine facial proportions and overall balance. Treatment performed by Jocelyn Brackett, NP, at our Virginia practice.
Treated by Jocelyn Brackett, NP
Individual results vary.
Dermal Fillers
Dermal filler was used to enhance upper and lower lip volume and contour while maintaining natural proportions.
Performed by Jocelyn Brackett, NP
Individual results vary.
Individual results vary. Outcomes depend on anatomy, treatment selection, treatment plan, and individual healing response.
Both are injectables, but they work differently and are chosen for different goals.
Hyaluronic-acid filler
Places a gel that creates volume, contour, or definition you can generally see soon after treatment. Most hyaluronic-acid fillers can be dissolved with hyaluronidase if adjustment is needed.
Biostimulator (for example, Sculptra)
Prompts gradual collagen formation over weeks to months rather than adding immediate gel volume. It cannot be dissolved the way a hyaluronic-acid filler can. Learn more on the Sculptra page.
We work with the Juvederm, Restylane, and RHA collections so the right gel can be matched to your anatomy, tissue, and goals. The specific product is chosen during your assessment rather than from a menu. Each family is provided below for reference.
Filler is considered when the concern is volume, contour, or definition. Which areas are treated depends on your anatomy, product labeling, injector training, and your goals.
Filler best addresses volume, support, or contour. Movement lines, skin-quality concerns, and deeper structural change may call for another modality.
Active infection or inflammation near the treatment area makes filler inappropriate; certain autoimmune or inflammatory conditions warrant caution.
“The most natural-looking filler result is often defined by restraint. The product matters, but knowing where not to inject matters just as much.”Dr. Scott Gerrish
Filler generally creates a visible change at the time of treatment. The immediate appearance, however, often includes swelling, and it is not the final result.
Swelling, tenderness, and bruising are common in the first days after treatment, particularly in the lips. Most swelling resolves over one to two weeks, and the settled result becomes clearer during that time. This is why refinement, if needed, is usually assessed after the area has settled rather than on the day of treatment.
You may be given aftercare guidance on activity, ice, and what to avoid. Bruising can be more noticeable in patients who take blood thinners or certain supplements, which is worth discussing beforehand.
Two people can receive the same product with very different results. Product choice matters because each filler behaves differently once placed, but the decisions an experienced injector makes shape the outcome even more.
Many patients ultimately receive a different filler than the one they initially requested, because another product may create a more natural-looking or longer-lasting result for their anatomy.
The treating clinician determines
Previously placed filler can persist longer than many patients expect. When clinically appropriate, the Gerrish MedEsthetics Clinical Team may use diagnostic ultrasound to identify existing filler, assess vessels, and understand tissue depth before planning treatment.
In selected cases, ultrasound can guide injections by clarifying the needle or cannula's relationship to tissue planes, vessels, existing filler, and the intended placement depth. Not all injections use real-time guidance.
Ultrasound adds information to support clinical decisions. It does not replace anatomical expertise, injector judgment, or careful technique, and it does not eliminate risk.
This information can help determine whether to add, adjust, dissolve, or avoid additional filler.
Longevity varies. Many fillers last from several months to approximately two years depending on the product and the area. Results vary from person to person, and maintenance treatments are individualized.
Longevity depends on factors such as
First determine whether the concern is truly volume-related, then select the filler and tissue plane suited to the area.
In Vienna, neurotoxin and dermal filler treatments are performed by experienced nurse practitioners working within Dr. Gerrish's clinical protocols.
Learn why relaxing muscle movement and restoring volume often solve different problems.
Learn MoreDiscover how collagen stimulation differs from traditional hyaluronic-acid fillers.
Learn MoreExplore how volume, skin quality, and facial movement work together to influence aging.
Learn More
