Posted on January - 01 - 2014

Juvederm Voluma, our newest “filler”

Juvederm Voluma, the new filler


As I have mentioned in many blogs and articles, the appearance of the aging face is mainly from:

  • Loss of Volume
  • Damaged skin
  • Loss of elasticity
  • Loss of hair
  • Bad teeth

This article concerns Volume loss, but all in the above list can make significance in creating a younger looking you..

For loss of volume, the treatment is injection of “fillers” or fat grafts. The most common fillers are Juvederm, Restylane, Perlane, Sculptra, and Radiesse. All have their individual best specific uses, e.g., for the hollows under the eyes I have found in my hands the best fillers are either Restylane or Sculptra (most doctors will not use Sculptra in this area, and it must be injected very carefully or nodules may result).

Juvederm Voluma, which will probably be called simply “Voluma,” is the new kid on the block for fillers. Its attributes are over 60% will still be in place at the 2-year mark. This is pretty special as most other products last from 6 to 12 months, with the exception of Sculptra, which also last about 2 years.

VOLUMA, however, is FDA approved for only re-volumizing the cheeks and midface. I have used it on several patients and have been very satisfied with it, as have my patients.  Re-volumizing that area can turn back the clock several years—more than you would think.

Conservative injections are the order of the day as far as I am concerned. It’s much better to have another injection session at a later date rather than over-inject any product.  Also it takes a few weeks for some patients to get used to looking like they did 5-10 years ago.

Fortunately, hyaluronic acid products such as Juvederm, Restylane, Perlane and even Voluma are reversible with injections of the enzyme hyaluronidase.

So which fillers do I use? All of them, according to the patient’s volume loss and goals.  A careful examination of the patient is necessary and a discussion of the goals and the pros and cons of each product. None of the products are perfect for all areas. Sometimes I use a couple of products in one session, such as Voluma for volumizing the cheeks and Restylane for under the eyes.  All injectbles take about 30 minute to perform.

Hope this has shed some light on our newest “filler”, Juvederm Voluma, along with the others that are available.

E. Ronald Finger, MD      Savannah Plastic Surgery


Website: Finger & Associates
Phone: 912-354-4411

Posted on December - 25 - 2012

What is the difference in injecting fillers (Restylane, Juvederm, Sculptra, Fat transfer) in men and women?

 The first thing to consider when injecting fillers is that most men don’t want to look feminine and women would not appreciate appearing masculine, but there are some similarities. A prime example is that no one likes big depressions or circles under their eyes. They make one look tired and aged.


Another area is the chin and jaw line, but there is a difference as well as a similarity here as well. The deficiency and loss of fat, skin thickness, and some bone causes the dreaded jowl. The non-surgical treatment is to inject fillers or fat onto the pre-jowl sulcus (the depression between the jowl and the chin) and also behind the jowl toward the ear along and below the jaw. To reduce the appearance of the jowl is the similarity.


The difference is the amount of filler injected. Men want a heavier, masculine jaw and chin and this requires more attention and volume to the lower face. A strong jaw and chin is masculine. Still women need injecting in that area as well, but just not as much volume.


While both males and females will need volumizing of the upper face, the male does not usually want the high, full cheekbones that females prefer. Again, it’s matter of the volume difference, and this is in the artistry of the injector.


Another contrast is the upper lip. Volumizing the upper lip for a male is usually avoided unless specifically requested. However, it is one of the most common areas for injecting females.


Neurotoxins such as Botox or Dysport require a larger dose for the male patient, as their face is larger as are the muscles you are trying to affect


Finally, the doctor should have a “less is more” mentality when injecting fillers in the male patient, as over-correction is usually not appreciated. Men do not do their homework regarding their goals like females or relate their perceptions to their doctor, so, men, be quite clear as to the expected result. Communicate with your doctor accurately as to your expectations.

Website: Finger & Associates
Phone: 912-354-4411

Posted on June - 19 - 2012

13 Signs of Aging with Treatment Options

13 Signs of Aging

  1. Skin – age spots, wrinkles, large pores, loss of elasticity and clarity.
  2. Hair – loss or thinning hair. Lush, thick hair makes everyone look better.
  3. Teeth – yellowing of teeth, crooked teeth, missing teeth-all easily treatable
  4. Loss of facial volume – Youthful faces are full and convex. Aging causes loss of volume in skin, subcutaneous tissue, and even bone. These losses cause shadows, hollows, which contributes to sagging.
  5. Sagging brow – brows sag with age, particularly the outer brow. There should be an arch with the highest point between the middle and outer 1/3 of the brow. This contributes to excess skin in the upper eyelid.
  6. Upper eyelids – excess skin and even some fat occurs with age. Some have this genetically. Either way it is treatable with minor surgery.
  7. Lower eyelids – bags and/or excess skin may develop. Hollows along the bony rim beneath the lid occur from loss of volume and/or bags. The circles are usually shadows from the volume loss.
  8. Crow’s feet – wrinkles lateral to the eyelids usually from lots of sun damage and animation
  9. Lips – aging thins the lips, and the distance between the nose and upper lip elongates. The corners of the mouth may turn down.
  10. Jowls – these develop from loss of volume and elasticity
  11. Neck – excess skin and/or fat develops. Platysma muscle bands may occur
  12. Ears – enlarge because cartilage continues to grow.
  13. Nose – continues to grow because of the cartilage growth. Drooping occurs from this and from loss of volume at the base of the nose.

Treatment of the above aging features

  1. Good skin care. We prefer New Youth Cosmeceuticals. Resurfacing with lasers, such as the Fraxel’s or less invasive lasers like the Laser Genesis.
  2. Hair transplant is the ultimate, preferably FUE (follicular unit extraction). NeoGraft is automated FUE technology. For prevention of further loss of hair, use Rogaine 5% and finasteride (a prescription medication).
  3. Floss at least once a day. Use a Sonic toothbrush. Teeth whitening kits can be purchased at any pharmacy.
  4. Fillers, such as Restylane, Juvederm, Sculptra, Artefill, and more are excellent fillers, each with different indications. These are called “liquid facelifts,”especially Sculptra. Fat can also be used, but must be used very discriminatingly to prevent irregularities and lumps.
  5. Brow lift, which is a surgical procedure. This can be done under local or general anesthesia according to the extent of the procedure
  6. Upper lid lift, called a blepharoplasty. Usually done under local anesthesia. Very rewarding providing it is done just right and not too aggressively.
  7. Lower lid Blepharoplasty. Can be done through an incision inside of the lids or through the skin just beneath the lashes. Bags can be removed at the same time. Lasers are good for the fine wrinkles.
  8. Botox is the champion for these. Also skin care and lasers, like the Fraxel’s.
  9. Fillers in the lips to add volume. Fat can be used also. My preference here is Juvederm because of its longevity and the fact that it is reversible with an enzyme called hyaluronidase.
  10. Face lift is best. Some improvement can be achieved with fillers on each side of the jowl and in the face and micro-liposuction of the jowl itself.
  11. Facelift is best. Sometimes the problem is only fat and liposuction works very well.
  12. Ears can be surgically reduced.
  13. A rhinoplasty (nose job) is best. Some minor improvement can be achieved with fillers at the base of the nose to elevate the tip. The cartilage usually needs to be trimmed, however.

Website: Finger & Associates
Phone: 912-354-4411

Posted on November - 28 - 2011

How long do Sculptra Injections last?

I have been injecting Sculpta since 2004, and it is one of my favorite products for re-volumizing the face. However, I find that most people in their 60’s and older do not create collagen as well as younger people, and the collagen doesn’t last as long. Their studies are for 25 months and it apparently lasts that long. The question is: does all of the Sculptra last that long? I don’t think so. Most of my patients get their two or three treatments and come back in for a touch up between one and two years. At two years they may need much more volume replaced. Understand that people who are very thin, such as runners, are on the brink of deflation constantly, so they may need more frequent treatments as well as more Sculptra product. I prefer not to treat smokers, as they don’t have the blood supply to make collagen well. Also, I put virtually everyone getting Sculptra injections on a whole food vitamin C, such as Pure Radiance C made by Pure Synergy or the whole food vitamin C by New Chapter. Vitamin C is required for the production of collagen at almost every stage. Sculptra is one of my favorite products, and using these parameters, it is a very effective product to volumizer the face, and loss of facial volume is one of the most important factors that contribute to our looking older.


E. Ronald Finger, MD

Savannah Plastic Surgeon

Website: Finger & Associates
Phone: 912-354-4411

Posted on October - 30 - 2011

What should I do: get a facelift, fillers, or both?

 Patients ask me this question all the time. While there’s no pat answer, because each patient’s case is different, here’s some overall rules of thumb.

Facial volume loss: one of the reasons you look older

First, think about what happens when you age. Everyone knows that we lose elasticity as we get older and skin sags, but few realize another primary cause of looking older: facial volume loss. Inevitably, our faces deflate – less so, if we’re considerably overweight.  In fact, isn’t it ironic that as we get older we lose the fat around our face and usually gain it around the middle and other places?

A facelift pulls the tissues upward and tightens sagging. The result: the face looks tighter but the shape still isn’t that of a youthful person.

Just consider the appearance of a young person’s face. Their cheeks are plump and circular. In a youthful person’s face, the cheek usually starts at the lower lids, goes to the nose, down to the level of the lips, and then circles back to the eyes.

With time though, a depression in the tear trough forms and deepens. The tear trough starts at the inner area under the eye, goes downward and spreads outward on the face. As a result, the once round, full cheek is deflated and becomes smaller. We also get hollows underneath the lower eyelids and depressions and shadows in various areas of the face. This is where fillers come in: they restore the lost of volume. Often times the result is dramatic, so much so that many plastic surgeons refer to injectables as a ”liquid facelift.

There are many injectable filler options, such as Restylane, Juvederm, Artefill, and Sculptra. As part of the overall procedure, these products are often used in conjunction with each other and in addition to Botox. These products are best used in different ways and in different places, and their specific applications vary somewhat, too.

Surgical Facelift: When a Liquid Facelift is Not Enough

With the passage of enough time, you’ll need to address the problems of lost volume and skin elasticity.

And given enough passage of time, both fillers and a facelift are necessary to look your best and youngest.  

Often when one starts seeing a plastic surgeon at a young age, the fillers are used first, and this may delay a facelift for many years. However, if the sagging is advanced or someone has excessive sun exposure and skin damage, it may be best to start with a facelift first, understanding that fillers will be an excellent complement at a later date or even during the actual face lift. Of course, as I said at the start, everyone is different and their problems should be addressed according to their needs.

Website: Finger & Associates
Phone: 912-354-4411

Posted on May - 02 - 2010

Lip Augmentation or Enhancement with Injectables or PermaLip implants

Lip Augmentation or Enhancement with Injectables or PermaLip Implant

Most everyone agrees that thin lips are not attractive. Unfortunately as we grow older the cutaneous lip elongates, meaning the distance from the nose to the red part of the lip, called the lip or vermillion.  When this happens, the lip, meaning the red part, turns in and thins.  Notice how in a young person the upper teeth are much more visible than in someone in the forties or older.  This is because the lip is fuller and cutaneous lip is shorter.  The usual solution is to inject a product into the lips to fill them out.  This is called a lip augmentation or enhancement.  The most common product used in my practice is one of the hyaluronic acid products like Juvederm or Restylane.  While Restylane is most commonly used under the eyes in my practice, I prefer the Juvederm UP (ultra plus) in the lips because of its longevity.  It often lasts in excess of one year in that location.  In other locations, such as the nasolabial creases and other areas of high animation, it may not last as long.

 A new product that has recently come along is the PermaLip implant.  It is a silicone implant for both the upper and lower lips.  They come in different lengths and three different sizes.  If one wants to be larger or smaller, they can be replaced with another size at any time or removed.  These are a permanent solution to the thin lips, and both my patients and I think they look very natural.  As in the injections mentioned above, a dental block is necessary for anesthesia.  The PermaLip implants are inserted through a very small incision at the corner of the lips.  The procedure takes about 20 minutes.  Post-operatively, we suggest an ice pack for a few hours and minimal lip motion until the next day.

E. Ronald Finger, M.D.

Savannah, GA

Website: Finger & Associates
Phone: 912-354-4411

Posted on April - 04 - 2010

My new book, “Why Grow Old,” now available!

I have finally placed my experience, research and knowledge of both plastic surgery and anti-aging between two covers, a six year effort.  The name of the book is Why Grow Old, published in 2010.  So far, it can be purchased at the New Youth Medical Spa in Savannah, GA.

New Youth Medical Spa
5356 Reynolds Street
Savannah, GA 31405.

Email: or complete this form.
Phone: 800-868-9301 or 912-354-4411

Price:  $24.95.

Why should you read this book?
This is a scientific health book for the non-scientist, non-physician.  This is not a diet book, but is a comprehensive book on why we grow old from our cells to our bodies as a whole, and how we can thwart and even reverse the aging process. It is a guide to nutrition, supplements, hormones, skin care, exercise and plastic surgery toward feeling and looking your best. Discussed are many important aging processes that are related to how we live and our habits that most people have never read about or heard of.

Subjects discussed in this book:

  • Causes of aging on a molecular level
  • How to turn back the clock
  • Effects of poor nutrition and bad habits on health and appearance
  • Anti-aging supplements and foods
  • How to grocery shop for health
  • Skin and how to keep it youthful forever
  • A hormone guide for both men and women
  • Exercise—how and why
  • Plastic surgery—a thorough discussion of all procedures, both surgical and non-surgical and information to help assure your best results.

Chapter Titles

  1. Causes of Aging
  2. Nutrition and Supplements
  3. Hormones and Aging
  4. Aging and Your skin
  5. Exercise—How and Why
  6. Plastic Surgery: a comprehensive review of both surgical and non-surgical procedures

Appendix 1: Choosing effective nutrient supplements
Appendix 2: Whole for sources for each nutrient and the nutrient’s function
Appendix 3: Now to grocery shop for optimum health

Who is Dr. Finger?
Dr. E. Ronald Finger is a plastic surgeon in Savannah, GA.  He was born in Marion, South Carolina and is a graduate of Emory University, Atlanta, GA. and Medical College of South Carolina in Charleston. After an internship at Grady Memorial Hospital, he completed his general surgery residence at Tampa General Hospital and his plastic surgery residency at Wilford Hall Medical Center, Lackland AFB while in the USAF. In 1973 he was discharged as a Lt. Colonel, became certified by the American board of Plastic Surgery, married his present wife, Cheryl, and moved to Savannah, GA. Shortly thereafter, he opened the first outpatient plastic surgery center in Georgia and became well known, nationally and internationally, for his plastic surgery. Dr. Finger then opened the first medical spa in the coastal area in 1998 and developed the New Youth Skin Treatment System, a cosmeceutical line designed to make your skin look like a child’s.  New Youth products are sold nationally and abroad.

E. Ronald Finger, MD

912-354-4411/ 800-868-9301

Savannah, GA

What are people saying?

I picked up your book, Why Grow Old,” over the weekend and could not put it down as I am totally of the belief that we can age without growing old. I have been practicing ant-aging for many years. I find it fascinating to learn about and read all that I can to stay up on the latest findings. I found your book very enlightening and comprehensive. It covers all areas and in great detail. This an invaluable tool for anyone on the path to slowing down the aging process and getting and staying healthy. I found it easy to read and understandable, I finished it today. Thank you so much for taking the time and energy you invested in this magnificent book.


Educational, informative and as Dr. Finger says, “Good health is beautiful.” A must read for everyone concerned with their health and well being.

Barbara A.

I found Dr. Finger’s book interesting and understandable from a lay persons view. With his book as my guide, I have developed a health improvement plan I am confident will help me maintain a high quality of life for many years to come.

Henry H., Retired VP
Age 77

It is so informative and interesting. I especially enjoyed reading about how to eat right and to execise and how to protect yourself from sun damage and how to take care of your skin. It is always important to get a reminder of how to do things right. We may know how, but we become lazy or forget. There is so much information in the book that you can’t remember it all, but it is a great book to keep coming back to for looking things up. I know I will.

Kerstin Clark
Savannah, GA

Website: Finger & Associates
Phone: 912-354-4411

Posted on October - 27 - 2009

Chin Implant Augmentation

We have many requests for chin augmentation for those with “weak” or small or retrusive chins.  When looking at a profile of a person, the chin should protrude to about the vertical level of the lower lip, or slightly behind.  When the chin is set back from that position, it is hereditary and the result is an improper jaw/neck ratio.  This often makes the neck look fatty or droopy and the lower lip protrude too much.  The symmetry of the face and neck is off balance.  Oddly, many of these patients also have a large nose, and reducing the size of the nose while augmenting the chin makes a remarkable improvement.

Chin implants are usually made of silicone and are inserted through an incision just under the chin.  They must be sized before hand so they protrude in relation to the defect.  Many times the implant must be longer than usual, extending much further to the sides.  This is why the planning stage must be carefully performed.  The procedure can be done under local anesthesia or a light general anesthesia.  Recovery requires a light dressing and one can expect significant swelling for two to three weeks.  Because of the swelling, the final appearance will not be seen for at least 3-4 months, although at one month the appearance will be much better than prior to surgery.


An easier, faster, but temporary alternative is injection with a product like Sculptra, Juvederm, or other injectables.  Sculptra will last about two years and the others about a year, and injections require no anesthesia.  The injections also give you an idea of whether you like the new appearance.  If you want something permanent at a later date the implant can be inserted.

Website: Finger & Associates
Phone: 912-354-4411

Posted on September - 22 - 2009

Sculptra Before and After Photos

Before and one year after Sculptra injections

Before and one year after Sculptra injections

Before and two years after sculptra injections

Before and two years after sculptra injections

Note in the before photos, the face is deflated or devolumized, and this is from loss of fat. This adds years to a person’s appearance. This loss of the volume results in loss of support, which causes sagging. In fact much of the sagging we experience with age is actually from the loss of subcutaneous fat rather than loss of elasticity, as most people think. Sculptra injections can replace much of the volume, as you can see in the post-injection photos. The areas most like to turn the clock back are in the mid-cheek, the hollows under the eyes, the smile lines, lines in the upper lip, the chin, and the tear trough (the oblique depression from the inner part of the lower eyelid downward and laterally to the mid-cheek. Other areas injected are the temples and the forehead. Note that when these areas are “re-inflated” with Sculptra injections the entire face has a younger shape and appearance. The re-volumizing from Sculptra (now called Sculptra Aesthetic) typically lasts about two years.

Website: Finger & Associates
Phone: 912-354-4411

Posted on September - 12 - 2009

Lip rejuvenation

Cosmetic surgery for the lips, non-surgical and surgical, for facial rejuvenation


Upper Lip – The aging lip typically is thinner and longer (from the nose to the red part of the lip, called the vermillion).  Also as we all notice, the corners turn down in many people even though they may be very upbeat and happy.  The procedures available to correct these problems are:


  1. Upper lip lift – The lip vertical length is shortened by removing an individualized amount of tissue in a crease immediately beneath the nose. The most common ideal height, or vertical length, is 14 mm.  This also roles the vermilion (the pink part of the lip) outward and upward for a more full and youthful appearance, but without the Hollywood unnatural look.
  2. Commissure (the corner of the mouth) lift – This is accomplished by removing a triangle of skin just above the commissure.  This does leave a faint scar, but helps remove the “down in the mouth” appearance.  Patients feel that others think they look happier and the small scar is a small price to pay.
  3. Increasing the lip thickness – this is done by injecting ones own fat in the lip, which is unpredictable, or one of the injectable products which are temporary.  Articol is a permanent injectable product approved by the FDA, but not for the lips.  However, some surgeons use it there anyway and report good results.  There are now permanent implants made from silicone, which are permanent and removable if patients want a larger or smaller size.  I believe this will be the lip augmentation procedure of the future, but time will tell.  Local anesthesia is necessary for the implant and some swelling should be expected post-operatively.
  4. All of the above may be needed and can be performed at the same time.

Website: Finger & Associates
Phone: 912-354-4411