Deciphering Dermal Fillers: An In-Depth Exploration

Aging gives us a mixed basket. It gives us more experience, wisdom, knowledge, and character, but it also gives us more wrinkles, hollows, and droops that we’d rather not accumulate. That’s because our bodies slow down their natural collagen production processes as we exit our roaring 20s. Collagen makes up about a third of our body’s protein content! It’s largely responsible for regenerating middle-layer skin cells that give elasticity, strength, and structure to the skin. It also strengthens and conditions our bones, ligaments, tendons and cartilage. So when age starts turning down the collagen tap, what’s a person to do? Today, we will do a deep dive into one potential solution—dermal fillers—with Nicholas Pannitto, one of our expert Board-Certified Aesthetic Nurse Practitioners here at Apex Dermatology. He specializes in providing our patients with anti-aging solutions across Northeast Ohio.

“Collagen is responsible for maintaining facial volume and elasticity along with providing structure and support for our face,” explains Pannitto. “Along with collagen, we see a gradual decrease in facial bone density, fat tissue, and skin elasticity, which also contribute to common signs of aging.”

Pannitto explains that many patients come to him when their dwindling collagen production manifests itself in symptoms such as:

• Wrinkling skin
• Facial hallowing
• Deeper folds
• Sagging tissue

“Facial volume loss is something every person will inevitably experience as we age, and hey, it’s better than the alternative, right?” points out Pannitto. “So, what does this mean, and most importantly, how can we prevent it?”

“Over the last 40 years, aesthetic providers in the fields of Cosmetic Dermatology and Plastic Surgery have been using dermal fillers to address facial volume loss in patients,” explains Pannitto. “While many people may associate dermal fillers with the Kardashians and a so-called “Botox lips” look, they are actually much more natural than you may think.”

Dermal fillers are FDA-approved soft-tissue fillers, usually with a gel-like texture, that we can inject into areas on the face to smooth out wrinkles and re-establish volume in the face and lips for great anti-aging impact. During a dermal filler procedure, we use local numbing medication to make the process more comfortable. It’s an outpatient procedure that usually takes from 45 minutes to an hour. The result, after a few days of healing, is a smoother, more structured, plumper visage that can erase the evidence of aging.

To get the optimum plumping and wrinkle-smoothing results, we may recommend more than one injection session, depending on your individual goals and needs. It also depends on which dermal fillers we use, which can also impact how long the results last or need to be refreshed. Whether you want a lip injection to get luscious, yet natural-looking lips, or cheek filler to restore younger facial structure, we can discuss your needs specifically.

Typically, side effects are minimal: a little bruising or swelling for a few days that passes quickly by following our recommended aftercare procedures at home.

Pannitto stresses how important it is if you are considering going in for dermal fillers, to choose a board-certified nurse practitioner or physician’s assistant with experience getting fresh, smooth, realistic results.

“Our society overuses dermal filler to drastically augment the face,” says Pannitto. “But one of the most important things I’ve learned in my years as a cosmetic injector is that a little goes a long way, and you can reduce the signs of aging without anyone even realizing you’ve had work done. The key is to replenish facial volume loss and enhance your natural beauty.”

We get a lot of questions about the difference between Botox vs. fillers. And everybody wants to know how long do lip fillers last! There are two broad categories of dermal fillers that we use at Apex Dermatology with a range of different properties and products that we can tailor to the patient’s individual needs: hyaluronic acid-based fillers (HA) and biostimulators. Here at Apex Dermatology, we only offer the best FDA-approved dermal fillers that have been extensively tested for safety and great results.

“Hyaluronic acid is a naturally occurring substance found throughout our body’s connective tissue, eyes, and joints,” explains Pannitto. Hyaluronic acid is actually a type of sugar. HA dermal fillers come in gel form and are injected to plump and hydrate skin tissues, smoothing out wrinkles.

“HA filler is injected into different areas of the face to help replace lost facial volume and give structure back to the face. Results can last anywhere between 6-15 months depending on the type of filler and injection area.”

After that time, the body will slowly and naturally absorb the filler particles, and you may decide to repeat the procedure to maintain the results you had initially. Most of the HA fillers we used also have lidocaine infused to help numb pain and minimize discomfort after the injection.

Biolstimulator dermal fillers also restore lost facial volume and smooth wrinkles, but they do it by way of different mechanisms. In addition to the short-term volumizing impacts just from the injection, these dermal fillers stimulate localized collagen and elastin production in the face. This can lengthen the smoothing impact of the injection to some extent by spurring fibroblast cells.

“Results typically last longer than HA fillers but don’t mimic the same instant gratification that HA fillers can achieve,” says Pannitto. “Personally, I like to use a combination of both HA and biostimulating fillers to help patients achieve optimal results.”

Botox is also a type of anti-aging treatment, but it’s not actually a filler. It is a neurotoxin that temporarily “paralyzes” the underlying muscles in those lines to temporarily smooth moderate crow’s feet, frown lines, and forehead lines.

You probably know more than anybody what areas of your face you want to smooth and fill, so it’s important to discuss this with your board-certified dermatology provider. Pannitto says that a consultation is the first step.

“Everybody’s aging process and facial anatomy are different,” he explains. “I customize each patient’s treatment plan by conducting an in-depth facial analysis tailoring it specifically to the individual.”

Some dermal fillers work better than others in certain areas and on certain people. This is why a totally personalized approach is the one that will work best.

During each personalized consultation, we will discuss all aspects of your goals and medical history so that together we can make an informed decision about your anti-aging journey and which dermal fillers or other treatments will work best for you. For instance, we will need to know about any medications you are taking because some of them can increase the risk of potential complications with dermal fillers.

We will also discuss any allergies you have, neurological conditions, and any bruising or bleeding conditions you’ve experienced in the past. Some common medications that can complicate dermal fillers include NSAIDs such as ibuprofen, aspirin, and naproxen. If you are on any blood thinners, these can also increase post-injection bruising side effects. Also, people with suppressed immune systems may experience more complications from dermal fillers, so becoming educated about these risks is important. Just like any medical procedure, there are potential side effects and risks to injecting dermal fillers, so we will thoroughly discuss these with you beforehand so that you can make a fully informed decision.

Typical dermal filler injection side effects usually only last for a few days and include swelling, bruising, and some pain at the injection site. Following our aftercare procedures at home after dermal filler injections can improve recovery times and diminish side effects while leading to the best anti-aging outcomes.

Here at Apex Dermatology, we are happy to work with the top-notch, board-certified anti-aging practitioners in all of Northeasat Ohio, including Nicholas Pannitto, who has a long fascination with anti-aging and aesthetic medicine.

I began my journey working in plastic surgery and that opened the door to me discovering my true passion, cosmetic dermatology,” recalls Pannitto. “Non-surgical plastic surgery and cosmetic dermatology have a lot in common, but I fell in love with cosmetic dermatology because of its emphasis on prevention.”

Our patients who have worked with Pannitto have often called him an artist for the fantastic results he’s been able to achieve, and that’s no coincidence.

“I’ve always been creative. I’m even considered the artist in my family and dermal filler has given me a way to hone my art skills and combine it with my love of science,” says Pannitto. “It takes a lot more than just simply pushing on the end of a syringe to be a talented injector. You need to be an expert in facial anatomy and at the same time, have an artistic eye, that’s the key to achieving facial balance and coming out with beautiful and natural-looking results every time.”

Pannitto also says that there is still a lot of misinformation out there about dermal fillers that he and the team at Apex Dermatology are eager to clear up for patients:

• For example, at the beginning of their journey, many people think that all dermal fillers are created equal. Many, many different types of dermal fillers exist and fall into different categories that work best for different areas of the face, and for different people.
• Another myth is that dermal fillers will make you look like a totally different person. While that may have been what you see on social media when it’s done poorly, an expert board-certified aesthetic nurse practitioner will be able to bring out the natural beauty that only you have.
• Dermal fillers are also not a surgical procedure. They are minimally invasive injections and generally, with the correct preparation and aftercare, do not require any downtime. Typically, you can get right back to your daily activities after a little bit of rest, as long as you avoid alcohol, hot sunlight, and working out for a couple of days. That said, the swelling and bruising may take a few days to resolve, so it’s not something you’ll want to do the day before a major life event, so schedule accordingly.
• When administered correctly, dermal fillers also will not stretch out the skin permanently either.

The most important thing about contemplating dermal fillers is that you get solid information about your options and that you seek advice and treatment with a board-certified aesthetic nurse or P.A. who has experience getting fantastic results. Educate yourself and get a thorough consultation about your goals, including all of the things that could impact the results, including medical conditions and medications you may be taking that could impact decisions about which dermal fillers to use and when to schedule treatment.

Once you’ve decided on getting dermal fillers, Pannitto outlines the process of getting started, from consultation to a smoother, younger-looking you.

“A proper consultation is a key part of the process,” says Pannitto. “It helps each patient decide which areas should be treated and what product is best. There is no one-size-fits-all approach when it comes to filler injections. The overall goal is to replenish lost volume, correct asymmetry, highlight natural beauty, and regain patient self-confidence!

When preparing for the big day, there are a few things patients need to keep in mind,” says Pannitto. “The night and day of the procedure avoid alcohol and over-the-counter medications. Also, make sure you’re well rested, well nourished, and hydrated. Don’t be nervous! The pain is minimal, and your provider can talk with you about different comfort measures, from topical anesthetics to ice packs.”

“You made it to the Apex waiting room and you’re just minutes away from a younger, fresher you,” explains Pannitto. “You will begin your procedure by signing consent forms. Your provider will take a few before photos of you and will then apply your topical anesthetic to make sure you are comfortable during the procedure. 15 minutes later, you’re ready to go. Appointment times can vary, but on average expect to spend about 45 minutes to an hour with your provider. Your provider will send you home with detailed post-procedure care instructions to ensure optimal results and healing.”

“While risks associated with dermal fillers are minimal, just like with any medical procedure they do exist,” says Pannitto. “Some of the most common side effects are swelling, bruising, redness, and tenderness. These side effects won’t last long, but if you notice any of these lingering longer than 14 days, contact your medical provider. Risks and side effects are one of the most important reasons why patients need to make sure they’re seeing a qualified, experienced, and credentialed medical practitioner for injections. An experienced injector knows how to minimize the common side effects and prevent any more serious problems from occurring.”

“The field of aesthetic medicine is rapidly changing and evolving, especially when it comes to injectables,” explains Pannitto. “Regenerative medicine is one of the newest trends emerging in the cosmetic space today. Regenerative medicine involves using products such as biostimulators. The results I’ve seen from performing this treatment are astonishing and it’s an easy and incredibly safe procedure with little downtime.”

Pannitto also stresses that the Apex Dermatology team, while keeping a close eye on new techniques, technology, and procedures, safety and optimal outcomes are the most important things we focus on.

Our aesthetic team is constantly furthering our education through training and conferences to ensure we are using the most up-to-date filler techniques that produce minimal to no bruising and drastically reduce adverse reactions,” says Pannitto “Safety will always be the most important part of our practice and staying up to date on a forever changing field proves how dedicated our team is to safe injections.”

While we’ve covered many of the risks and side effects of dermal fillers already, it’s important to be aware of some of the rarer risks that have been associated with dermal fillers in the past. We want our patients to be fully educated but also assured that the safety of our patients and beautiful results are our top priorities. Some of the very rare risks of dermal fillers include side effects that do not go away naturally or unintended injections into blood vessels. Some patients may also experience unforeseen allergic reactions, rashes, oozing, or infections to some dermal filler applications. This is why we only use FDA-approved, well-tested dermal fillers and work to understand our patients’ medical histories before we agree to any course of treatment.

We so appreciate Nicholas Pannitto for sharing his expertise in dermal fillers and anti-aging treatments today!

“If you’re on the fence about beginning your aesthetic journey, feel free to book a consultation so we can sit down and discuss your goals together,” advises Pannitto. “One of my favorite parts of my job is helping patients feel comfortable in their own skin. I’ve had patients cry tears of gratitude minutes after I finished a procedure. Nothing makes me happier than knowing I was able to help one of my patients boost their self-confidence and bring out the beauty that was always there, to begin with!”

Nicholas Pannitto is a Board-Certified Aesthetic Nurse Practitioner with a passion for aesthetic medicine and the science of antiaging. Since the Cleveland native’s 2019 graduation, he has worked in plastic surgery and in a medical spa setting.
He graduated from Chamberlain University Nursing school in 2019 and Nurse Practitioner school in 2022. He regularly works on continuing his education by attaining aesthetic and cosmetic certifications to ensure he is up-to-date with the best practices and standards of care. He strives to continuously provide his patients with outstanding care and optimal results. He takes a holistic approach to aesthetic medicine to help patients achieve their desired result.
During his free time, he enjoys supporting all the Cleveland sports teams (especially the Browns). He is an avid health enthusiast and enjoys spending time with his wife and family. You can schedule an appointment with Nicholas at the Concord location.