INJECTABLE FILLERS

If you’re considering injectables…

As we age, our faces show the effects of gravity, sun exposure and the 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, or your own fat, can help fill in these lines and creases, 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.

If you’re considering a facial rejuvenation treatment with fillers or fat, this information will give you a basic understanding of the procedures – when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don’t understand.

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KNOWING YOUR OPTIONS

Injected fillers and fat are primarily used to improve the appearance of the skin’s texture. They can help fill out 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 a chemical peel, dermabrasion or laser treatment. 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 procedure. However, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist who can offer you a full range 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 either a single procedure or a combination of procedures is the best choice for you.

GETTING THE ANSWERS YOU NEED

Individuals considering fillers can feel a bit overwhelmed by the number of options and techniques being promoted today. Your plastic surgeon can help you decide which treatment is the right treatment approach for you, considering effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience.

This discussion deals with commonly used types of injectable fillers and fat. At present, there are over eighty injectable fillers used worldwide. Some are approved for use in the United States while others are not.

Each filler has its own set of risks and benefits. If you’re considering any of these or alternative filler treatments, discuss these with your plastic surgeon.

A WORD ABOUT INJECTABLE FILLERS

Fillers are sold inside a sterile syringe. You should know that the typical filler syringe has 0.7 cc’s (cubic centimeters) of the filler. Most patients are not familiar with the metric system measure of volume, so to help you so you understand how much filler you are buying in a syringe, there are 5 cc’s in a teaspoon. If you take a teaspoon of a liquid and divide into 5 equal parts, each part is 1 cc. If you then divide each 1 cc in half, you will have 0.5 cc’s. In other words, a syringe of filler contains a little over 1/10th of a teaspoon of the filler. Not a lot, so you can see why fillers work best for fine, small defects and wrinkles. Any large areas require something different such as fat, or even implants as their “filler.”

WHAT TO EXPECT FROM TREATMENT

The most important fact to remember about injectable fillers is that the results are not permanent. Since 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. Age, genetic background, skin quality and lifestyle, as well as the injected body site-all play a role in the injected materials “staying power.”

If you’ve had disappointing results from other fillers, don’t assume that injected fat is the answer. Although it’s true that some individual’s bodies are more receptive to one filler than another, you may find that neither filler produces long lasting results. Sometimes one filler may work better than another for a specific problem but the outcome of treatment with injectables is never completely predictable.

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 face will be evaluated-the skin, the muscles and the underlying bone- and we will discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals, concerns, anatomy and lifestyle.

Lidocaine (an anesthetic agent) is sometimes contained in the syringe with the filler material.

WHERE YOUR TREATMENT WILL BE PERFORMED

Injectables are usually administered in a surgeon’s office.

TYPES OF ANESTHESIA

If you are especially sensitive to pain, you may use a topical cream anesthetic or an ice compress to numb the injection area. For small fat grafts, both the donor and recipient sites can be numbed with local anesthesia.

THE TREATMENTS

The fillers are injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is water that will be absorbed by the body within a few days, there is usually a slight overfill of the area.

Immediately following treatment, there may be some minor discomfort, stinging or throbbing in the injected area. Occasionally, some bruising or swelling may occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. You may be given an ice bag for use on your treated areas.

RISKS RELATED TO INJECTABLES

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature, such as a small bruise. Individuals vary greatly in their anatomy, their physical reactions and their healing abilities. Any sign of redness, itching, swelling or other occurrences at the injection site should be reported to your surgeon.

Other risks include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

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

A filler’s longevity depends on the patient’s lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement.

Fat injections involve extracting fat cells from your abdomen, thighs, or elsewhere and reinjecting it beneath the facials skin. Fat is most often used to fill in “sunken” cheeks or laugh lines between the nose and mouth or to correct skin depressions or larger indentations, or to enhance the lips.

As with other fillers, “overfilling” is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face abnormally puffy or swollen.

If a larger area was treated, you need to curtail your activity and keep the area iced down for at least 48 hours in order to maintain as many viable fat cells as possible. You can expect some swelling, bruising or redness in both the donor and recipient sites. The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a 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 NEW LOOK

If you are 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.

Injectable collagen or fat can help improve the skin’s texture by filling in the laugh lines and facial creases that often occur with aging.
Years of squinting and other facial muscle movements can take their toll on the eye area, leaving crow’s feet and other noticeable lines.
After treatment, the skin around the eye area appears smoother and more taut.
Lines and creases that form around the mouth are usually caused by gravity and a breakdown of tissues beneath the skin.
The lower face appears firmer and smoother after treatment with injectables. Lines around the mouth are filled in and nearly imperceptible.
With regular follow-up treatments, your refreshed look can be easily maintained.