Injectable Fillers

Posted by Dr. Tawisak in Face, Skin on Dec 9th, 2009 | no responses |

Soft tissue augmentation, a technique that uses Injectable Fillers to enhance facial contours, can help reverse visible signs of aging as a result of sun exposure, heredity and life style.

What are Injectable Fillers? Injectable fillers refer to the substances used when performing soft tissue augmentation. Tissue augmentation can plump thin lips, enhance shallow contours, soften facial creases and wrinkles, or improve the appearance of recessed scars.

There are 5 types of injectable fillers including Collagen, Hyaluronic Acid, Hydroxylapatite, Human fat, and PMMA.

What is Collagen?

Collagen is a natural protein that supports the skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of bovine collagen that, unlike human derived collagen, require prior allergy testing. The results may last 2 to 4 months.

What is Hyaluronic Acid?

Hyaluronic Acid is a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The results may last 6 months or longer.

What is Hydroxylapatite?

Hydroxylapatite is a mineral-like compound found naturally in human bones, suspended in a gel-like formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours.

What is Human fat?

Human fat, harvested from your own body, can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection.

What is PMMA?

PMMA (polymethylmethacrylate) fillers contain 20% tiny PMMA microspheres suspended in 80% purified collagen gel. An FDA-approved PMMA filler is recommended for the correction of facial wrinkles known as smile lines.

Treatment results last up to a year or more in some cases and are highly variable. (Fat can be stored for your own future treatment. The duration of results from preserved fat is not as favorable as fat used at the same time it is harvested.)

Surgery Length: 10 – 30 Minutes
Anesthesia: Anesthetic Agent or Local Anesthetic
Hospital Stay: —
Stay in Thailand: —
Recovery: 5 – 10 Days
Procedure Cost: —

What Tissue Augmentation Can Do

Injectable fillers can:

Plump thin lips
Enhance shallow contours
Soften facial creases and wrinkles
Improve the appearance of recessed scars

There are several main areas of the face injectable fillers can help to rejuvenate. Line filling can help get rid of wrinkles around the mouth; Lip augmentation can enhance the lips; and Nasolabial Folds can smooth out wrinkles between the nose and mouth. Tissue augmentation can also be performed to ehance the cheeks.

What it won’t do: Soft tissue augmentation does not stop the aging process. If you wish to change the elements of your face, surgery such as a facelift, brow lift or eye lift may be the answer.

Non-surgical rejuvenation treatments such as injectable fillers cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate.

Best Candidates for Tissue Augmentation

Tissue Augmentation is a good option for you if:

You are physically healthy
You don’t smoke
You have a positive outlook and specific, but realistic goals in mind for the improvement of your appearance

Are Injectable Fillers Right for Me?

If you would like to restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you.

While not as involved as surgical cosmetic procedures, soft tissue augmentation is a medical procedure. You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Preparing for Tissue Augmentation

The success and safety of your soft tissue augmentation procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Prior to surgery, you may be asked to:

Get lab testing or a medical evaluation
Take certain medications or adjust your current medications
Stop smoking well in advance of surgery
Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

What to do on the day of surgery
The use of anesthesia during your surgery
Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Injectable fillers may be performed in an accredited office-based surgical center, outpatient or ambulatory surgical center, or a hospital.

If your procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery

Tissue Augmentation Procedure Overview

Step 1. Your plastic surgeon will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers.

Step 2. Strategic points on your face may be marked as guides to the appropriate injection sites for the filler.

Step 3. The injection sites will be cleansed with an antibacterial agent and icing or a topical numbing agent may be offered to make more sensitive patients comfortable.
In some cases, the filler itself will contain an anesthetic agent. In other cases local anesthetic may be administered to the treatment site.

Step 4. Injection takes only a few moments per site and a few minutes for a course of treatment.

Step 5. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Makeup may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.

Filling wrinkles or recessed scars involves multiple injections. In some cases where deeper injection of fillers is required, a local anesthetic may be used prior to treatment.

Common sites for deeper tissue fillers are the nasolabial folds and marionette lines, or to enhance fullness in the cheeks.

Tissue Augmentation Results

An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites.

With some fillers, a slightly “over-filled” appearance may be initially present. These conditions will resolve within a few hours, or at most a few days. The duration may be as long as a few weeks with injection of one’s own harvested fat.

The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect how long your results last.

Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time.

Will There be Scars?

No, there should not be any scarring, injectable fillers and tissue augmentation are generally used to fill recessed scars.

Tissue Augmentation Recovery

The results of soft tissue augmentation using injectable fillers are apparent immediately. Your initial appearance after treatment with any filler may include:

Mild swelling or bruising
Temporary numbness or redness
An “over-filled” appearance to treated areas

These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days.

Where fat is the injected filler, these conditions may persist for a few weeks. If you require subsequent follow-up procedures, these may take only a few minutes

You will be given specific instructions that may include: How to care for the surgical site(s), medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period:

Will I be prescribed medication after the procedure?
Will I have dressings/bandages after procedure?
When will they be removed?
When can I resume normal activity and exercise?
When do I return for follow-up care?

When You Return Home

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Following your physician’s instructions is key to the success of your procedure. It is important that the surgical areas are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Possible Risks of Tissue Augmentation

The decision to have soft tissue augmentation is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

Possible risks of injectable fillers include:

Fillers derived from non-human sources may require a pre-treatment allergy test
Infection at the injection site
Fillers that are not completely fluid and contain microscopic granular substances carry a risk of “clumping” as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat
Acne-like skin eruptions
Antibodies to filler material may reduce the effectiveness of future injections
Asymmetry
Bleeding, bruising and swelling
Filler material may migrate from the original site and produce temporary paralysis of other muscle groups or other unintended effects
Skin might die (skin necrosis)
Skin rash, itching and swelling
Skin redness
Skin sensitivity
Under or over correction of wrinkles

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Note: It’s very important to ask your plastic surgeon questions about your tissue augmentation. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

A special note about the FDA and injectable fillers: The U.S. Food and Drug Administration reviews and approves pharmaceutical fillers in the same manner as medical devices. However, some fillers may be used on an off-label basis, meaning they are approved medical treatments but not directly reviewed for a specific application. The options discussed in this brochure are among the current fillers preferred by plastic surgeons. Some are available for general use, others are not; regulatory status may be subject to change.

Injectable Fillers Terms and Definitions

Collagen: A natural protein used as an injectable filler for soft tissue augmentation.
Cupid’s bow: The middle portion of the lip which has the upturn.
General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
Human fat: Fat harvested from your own body and used as an injectable filler for soft tissue augmentation.
Hyaluronic acid: A natural substance found in the body used as a filler.
Hydroxylapatite: A mineral-like compound found naturally in human bone used as a filler.
Injectable fillers: Substances used to restore volume and a more youthful appearance.
Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
Liposuction: Also called lipoplasty or suction lipectomy, a procedure that vacuums out fat from beneath the skin’s surface to reduce fullness.
Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
PMMA: A widely used implant material formed into tiny microspheres and suspended in a collagen gel for use as a wrinkle filler.
Soft tissue augmentation: The use of injectable fillers to restore volume and your youthful appearance.
Vermillion: The red pigment of your lips.