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Dr. Romano’s “Exquisite Care”
Medical Spa

Injectables and Fillers
Botox
Artefill

Thermage -
Radiofrequency energy
non-invasive skin tightening.

Medical Grade Skin Care
Prescription Strength Skincare Products
Acne
Pigmentation
Wrinkles & Loose Skin
Skin Textural Irregularities
Scars
Stretch Marks
Sensitive Skin
Ultrasound

Anti - Aging-
Reversing  external and internal
consequences of age.

Diet
Supplements
Skin Maintenance
Postoperative Skin Care

Artefill and Hyaluronics

Proper selection of the patient, the anatomic area, and technique are extremely important in the use of Artefill. I prefer Artefill for patients that desire a potentially permanent result in areas of fine etched-in wrinkle lines or areas that need a firm, non-compressible product, such as in raising the mouth corners or acne scars or other scars.

Artefill is a suspension of chemically inert, biocompatible, extremely small synthetic particles or microscopic spheres mixed with collagen. The microsphere particles are composed of polymethylmethacrylate (PMMA). The process to produce these microspheres is unique and produces extremely small purified particles that allows for excellent filling, and minimizes reaction or infection. The microspheres are small enough to pass through the eye of a tiny (27 gauge) needle. The microspheres themselves and in combination with our own body collagen, is what serves as the structure for filling the defect. This occurs immediately but gets better over time. It is designed to be permanent.

Skin allergy testing is required one month prior to treatment. The treatment is preceded by a local anesthetic so you have no pain. Camouflage makeup is applied before you leave. You can return to work immediately. There should be no bruising and you will see a natural and beautiful result right away. This result fades slightly then returns in 2-3 months to give you the permanent look you want.

Artefill is Best for:

  • Where a potentially permanent result is desired.
  • Fine etched in wrinkle lines.
  • Some furrows and crease lines.
  • Laugh lines (nasolabial furrows)
  • Lip border enhancement
  • Smoker’s lines of the lips
  • Frown lines
  • Transverse forehead lines
  • Use with Botox in certain areas (combination therapy)
  • Raising mouth corners
  • Depressed acne or other scars
  • Irregularities in the nose after rhinoplasty
  • Nipple enlargement

Hyaluronics

There is an ever greatly expanding population of men and women that are excellent candidates for minimally invasive facial rejuvenation through the precise selection and application of the appropriate facial filler or injectable. Patients with even the smallest area of concern can now often get this treated and cured, so that really, no complaint or concern is too minor. I understand how these features can at times so profoundly offend patients, and I will help you with this.

Patients have a variety of issues and a variety of different anatomic features that bring you to consultation. These include wrinkle lines, deep laugh lines, furrows and creases, angry look, and lack of definition. The cheeks may droop and the corners of the mouth droop and look sad. Rejuvenation occurs at the level of the skin or just below where the appropriate product is applied. There is no one product that should be promoted to “fit all”. It may be two or more different products in the same or different sessions or locations. This is known as combination therapy.

The treatment areas intimately overlap with your many different anatomic facial features here that must be analyzed and addressed prior to your injection. I will coordinate the features of your anatomy with your expectations, formulate a plan with you, and guide you through this.

There is a well defined spectrum of specific techniques and products for facial rejuvenation. I prefer the hyaluronic products for areas such as the lips where a very soft gel product is best. It is also best in areas of furrows and depressions and NOT fine etched-in wrinkle lines or areas that need a firm, non-compressible product, such as in raising the mouth corners.

The hyaluronics like Perlane, Restylane, Juvaderm and others are basically a very pure and stabilized form of hyaluronic acid. It is a clear, transparent, viscous gel like material that has been used as an implant for over 20 years. It is completely organic and not made from any animal products. Hyaluronic acid is a constituent of all connective tissues in humans and most vertebrates. It is a naturally occurring polysaccharide which is an important structural element of all connective tissues in the body, which includes the skin, connective, joint fluid, and subcutaneous tissues. Hyaluronic acid belongs to a group of substances that are similar in all living organisms. It is a relative of GAG (glucose amino glycan). Therefore, in its pure form, it is extremely biocompatible and safe. The stabilized form of hyaluronic acid is designed to last a very long time and undergoes degradation only very slowly over the course of about a year.

The treatment is preceded by a local anesthetic so you have no pain. Camouflage makeup is applied before you leave. You can return to work immediately. There should be no bruising and you will see a natural and beautiful result right away.

Hyaluronic Products are Best for:

  • Furrow and crease lines and NOT for fine or etched-in wrinkle lines
  • Laugh lines (nasolabial furrows)
  • Tear trough lines (under eye furrows)
  • Lip or lip border enhancement
  • Cheek enhancement
  • Chin or jawline enhancement
  • Use with Botox in certain areas (combination therapy)
  • Raising mouth corners
  • Use when you WANT something that is temporary (“trying out the look”)


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Botox , Cellulite / Fat Reduction, Injectable Fillers,
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Dr. James Romano, M.D.
San Francisco Plastic & Reconstructive Surgery
1650 Jackson St., Suite 101, San Francisco CA 94109

415.981.3911