Injectable Fillers

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Injectable fillers can help improve the skin's texture by filling in the laugh lines and facial creases that often occur with aging.

 

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Years of squinting and other facial muscle movements can take their toll on the eye area, leaving crow's feet and other noticeable lines

 

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After treatment, the skin around the eye area appears smoother and more taut.

 

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Lines and creases that form around the mouth are usually caused by gravity and a breakdown of tissues beneath the skin.

 

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The lower face appears firmer and smoother after treatment with injectables. Lines around the mouth are filled in and nearly imperceptible.

 

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With regular follow-up treatments, your refreshed look can be easily maintained.

If You're Considering Injectables...

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Soft-tissue fillers, most commonly injectable collagen, hyaluronic acid, or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.

 

Knowing Your Options

Fillers are primarily used to improve the appearance of the skin's texture. They can help correct deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.

 

A Word About Other Types of Fillers

This web page explains commonly used injectable fillers such as hyaluronic acid, collagen and fat. However, to a lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include agents such as polymers, porcine collagen, or calcium hydroxylapatite. Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments, tell your doctor.

What to Expect from Treatment

The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.


Risks Related to Injectables

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

Hyaluronic Acid: side effects are typically mild or moderate in nature and last for less than 7 days.  Adverse events inclde redness, pain, firmness, swelling, lumps/bumps, bruising, itching, and discoloration.

Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.


Planning for Treatment

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.

Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer's brochure for patients.

Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.


Where Your Treatment Will Be Performed

Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.

Types of Anesthesia

Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

Collagen Injection

Collagen is a naturally occurring protein that supports tissue of the skin, joints, bones and ligaments. Injectable collagen can be derived from purified bovine collagen, porcine collagen or human sources. The purification process ensures the product is similar to human collagen. Injectable collagen is produced in varying concentrations to meet individual patient needs.

Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest. First, a skin test determines if you are allergic to the substance. If you are not allergic, the collagen is injected at several points along the edge of the targeted area. Local anesthesia can be used to control discomfort as the injections are administered.  Because part of collagen is salt water that will be absorbed within a few days, your doctor may slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.

After treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact your surgeon.

The duration of your results will vary.  In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement.  Your doctor can help you determine how long you can go between treatments to best maintain your results.


Fat Injection

Fat-injection procedure is also known as autologous fat transplantation or micro-lipoinjection. Fat cells are extracted from the patient's abdomen, thighs, buttocks or elsewhere and reinjected beneath the facial skin. Fat can fill in sunken cheeks or lines between the nose and mouth, correct skin depressions, minimize forehead wrinkles or enhance the lips.

After cleansing and treatment with local anesthesia, fat is withdrawn using a syringe with a large-bore needle or a liposuction cannula. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.  Slight overfilling may be necessary to allow for fat absorption that occurs. When fat is used to augment the cheeks, this overcorrection may cause the face to appear abnormally full.

While some treatments require a brief recovery period, many patients resume normal activity right away. Expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. Stay out of the sun until redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.  In some cases, swelling and puffiness in the recipient site lasts several weeks, especially if a large area was filled.

While some patients report results lasting 1 year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.


Your New Look

If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.

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