Dermal Fillers
Soft Tissue Fillers, also known as injectable implants, dermal fillers, or wrinkle fillers, are medical device implants helping to create a smoother and/or fuller appearance in the face, including nasolabial folds, cheeks and lips and for increasing the volume of the back of the hand.
Dermal fillers help diminish facial lines and restore volume and fullness in the face, being particularly helpful in patients with early signs of aging, or as a value-added part of facial rejuvenation surgery. As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle. Dermal fillers can be used to:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
- Improve the appearance of recessed scars
Most soft tissue fillers have a temporary effect, because they contain materials that are absorbed by the body over time. Some soft tissue fillers also contain lidocaine, which is intended to decrease pain or discomfort related to the injection. Absorbable (temporary) dermal filler materials may include:
- a) Hyaluronic acid: Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect. In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately 6 – 12 months.
- b) Calcium hydroxylapatite: Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones. For wrinkle filling in the face or for the hand, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle in the face or under the skin in the back of the hand. The effects of this material last approximately 18 months.
- c) Poly-L-lactic acid (PLLA): PLLA is a biodegradable, biocompatible man-made polymer. PLLA is a long lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.
- d) Fat injections as dermal fillers: Some patients may want to consider fat injections, which uses fat harvested from the patient’s own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours. Fat injection requires a more extensive procedure than “off-the-shelf” soft tissue fillers. A “donor area” must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft.
The grafted fat then has to redevelop a blood supply in order to survive. In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon’s treatment room or in an operating room.
It should be noted that non-surgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results with surgical procedures, but may help delay the time when consideration of a surgery such as a facelift, brow lift, or eye lift becomes appropriate.
Before the procedure
There is no need for special preparation. For women, it is recommended to come without any make-up or to remove it just before the injection.
It is very important to minimize the bleeding risk, at the treated areas, by avoiding aspirin for 15 days before and after the session. We must also respect the following contra-indications:
- any skin inflammation or infection (herpes) or an active inflammatory condition, (cysts, pimples, rashes, or hives) or infection – soft tissue filler injection should be delayed until this inflammatory condition has been managed;
- bleeding disorder;
- severe allergies or with a history of anaphylaxis (acute allergic reaction);
- allergy to collagen or eggs (concerning soft tissue fillers that contain collagen or egg-derived products);
- allergy to animal products (concerning soft tissue fillers that contain animal materials);
- allergy to lidocaine (concerning soft tissue fillers that contain lidocaine);
- allergy to bacteria (concerning soft tissue fillers that contain hyaluronic acid material derived from bacteria fermentation);
- joint, tendon, or vascular disease affecting the hand (concerning hand rejuvenation).
From a general point of view, don’t hesitate to mention to your physician any health problem you may have, to allow him to counterbalance the indications and get optimal results.
The procedure
The treatment consists on a series of injections. Strategic points on the patient’s face may be marked as the appropriate injection sites for the filler. Pain at the injection site may be ameliorated by use of a very cold instrument to chill the skin (i.e. ice), anesthetic ointment to numb the skin – Eutectic Mixture of Local Anesthesia (EMLA) cream 5%, or injection of local anesthesia with Lidocaine
Injection usually takes only a few minutes per site. The process of injecting, massaging, and evaluating the result is performed, and additional filler added as needed. Depending on the number of areas to be treated, the whole process may be as short as 15-30 minutes, or as long as an hour.
An ice pack may be offered to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.
After the procedure: the follow-up
Usually, the after injection period is uneventful. The patients can go back to their normal life after the injections. Some rare undesirable but transitory effects may occur, like:
- Redness at the injected points, rarely persisting more than 3 to 6 days
- Ecchymosis (bruises), rarely observed and may stay a couple of days
- Edema: a swelling, more often around the eyes, may appear progressively within 4 to 5 days and then decrease within a few days or weeks.
- Sensibility failure: an impression of tension or fixity at the forehead, mouth or neck, depending on the treated area, as well as a modified sensibility, related to the feeling of a “cardboard” skin, may stay for a few days.
- Ocular or facial fugacious pains: such pains have been described in the treated region but remain exceptionally rare.
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The result
The expected results of soft tissue augmentation using dermal fillers are apparent immediately and in most cases are impressive. The patient’s initial appearance after treatment with any filler may include: a) An “over-filled” appearance to treated areas, b) Mild swelling or bruising, c) Temporary numbness or redness
These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days. When the patient’s own fat is the injected “filler”, the healing process is longer and may take a few weeks.
The continued aging of any patient’s face and variables in the absorption of fillers will affect how long the results last.
Imperfect results
Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers do dissipate over time. To maintain your correction, you will need to consider repeating the injection process at intervals.
In case of undesirable results from Hyaluronic Acid (excess of Hyaluronic Acid injected, appearance of lumps or nodules), an enzyme, Hyaluronidase can be injected intralesionally and dissolve the excessive hyaluronic acid.
Possible complications
Complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:
- Acne-like skin eruptions
- Asymmetry
- Bruising, bleeding from the injection site, swelling
- Damage to the skin that results in a wound and possible scarring
- Infection at the injection site
- Lumps
- Palpability of the filler under the surface of the skin
- Skin rash with itching
- Skin redness
- Under- or over-correction of wrinkles
These risks will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.
My Way …. “Metron Ariston”
Non-surgical Facelift (7-spot Face lift)
If the aging signs are visible, witnessing your face losing significant volume, however you are not ready or willing to undergo surgery, there is an effective alternative.
My “Seven-spot” non-surgical facelift can instantly take several years off someone’s face, making you look considerably younger, reversing the creation of shadows and restoring the reflection of light that gives the appearance of youth, energy and vibrancy.
Under local anesthesia, appropriate volumes of dermal fillers are injected in strategic places in medial and lateral cheek, as well as in the jawline and jowl areas. The results are visible instantly and adequate volume is maintained for up to 2 years in many patients.
Dermal Fillers in male rejuvenation
Hyaluronic acid-based fillers are getting popular among men who increasingly seek non-invasive aesthetic treatments that keep them looking youthful. Especially the lines in the nasolabial folds tend to become deeper with age. Practically, as the skin ages, facial expressions can cause deeper wrinkles, a process that can be remarkably reversed with the use of dermal fillers.
Furthermore, following recent trends in male aesthetics, many men seek enhancements of masculine features such as defined cheeks, chin and/or jawline to boost their self-confidence. I strategically inject hyaluronic acid-based fillers in the cheek area to give the cheeks a lift, without much increase in size, and to enhance definition.
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
Source:
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery