What are injectable fillers?

Injectable fillers are substances used to increase the volume of soft tissues, especially in the face. These fillers can be used singularly or in combination with other procedures such as botulinum toxin. Some fillers are based on natural compounds of the human body; others are synthetic products containing several biocompatible substances. The differences among fillers are not only related to their composition but also to the preferred areas for injection and the duration of their effect.

Collagen is a natural protein included in the support structure of the skin. The products based on human dermis-derived collagen are used to contour the lips, inject the rhytides and scars. There are products containing bovine collagen which need prior allergy testing. The results of collagen injections will begin to fade after three or four months.

Hyaluronic acid is a natural substance found in the human body. Synthetic hyaluronic acid is a gel with various density degrees. The different types of hyaluronic acid are used to fill fine and deep wrinkles. Hyaluronic acid is also used to restore facial prominences and to thicken (augment) the lips. Because is colourless, hyaluronic acid is suited to all skin types, regardless the complexion . The effect of hyaluronic acid treatment will diminish after 6-12 months.

Semi-permanent fillers are recommended for deep facial creases; they can be used to restore facial volume or to correct lipoatrophy (the loss of facial fat). Their effect lasts a year or more.

Among these semi-permanent fillers, calcium hydroxylapatite is a mineral component of bones; it is used as a gel. Poly L-lactic acid is a synthetic biocompatible , biodegradable product, commonly used as absorbable suture. As a filler is injected in one or more stages several weeks apart until the desired volume is obtained.

Polymethylmethacrylate microscopic spheres are suspended in a collagen solution and injected to fill facial creases. These are considered permanent filler.

You should know that semi-permanent and permanent fillers are not recommended for very mobile areas (such as lips) or regions with fine structure (the lids). These fillers can be efficiently used to contour and augment the chin, cheeks and nose.

Human fat obtained from your own body can be also used as injectable filler. The fat must be harvested from the abdomen, hips or buttocks using liposuction techniques. Once injected into soft tissues, the fat must get a proper blood supply in order to survive and to confer a long term correction, although some of the component cells will be absorbed. The remaining fat and its volumetric effect are permanent, but will diminish with aging. Extracted fat can be frozen and saved for future treatments but the results obtained using this type of fat are not as good as ones using fresh fat.

Where do I begin?

A consultation with your plastic surgeon is the first step to find out how injectable fillers may be used to rejuvenate the face by restoring lost volume, filling the rhytides and improving contour. You will be informed about the available options for facial rejuvenation and the recommended treatment according to your wishes, the expected outcomes, duration of results and potential risks.

Evaluation

The success of your treatment requires that you honestly share your expectations, disclose your fully medical history and any previous treatments with fillers or other rejuvenation methods, use of alcohol, tobacco, recreational drugs. You should follow precisely your doctor’s recommendations.

You have to tell your doctor if you have the Herpes virus; it is necessary in this case to follow a specific treatment to avoid developing herpetic lesions at the injection site.

Not everyone injecting fillers is a plastic surgeon. For your own safety, make sure your doctor is a board-certified plastic surgeon.

The procedure

Your plastic surgeon will evaluate carefully your skin tone and overall facial aspect. For your comfort, in the areas to be injected the doctor will apply ice and a local anaesthetic. Many types of filler already contain some local anaesthetic. The injection points will be marked and disinfected. In most cases, treatment takes about 20-30 minutes. After completing the procedure, ice will be applied to prevent any minor pain. Make-up may be reapplied but avoiding to exert any pressure on the treated areas.

The effects of injectable fillers are immediately visible; the injected areas though may develop slight edema, bruises and temporary numbness. All these resolve within a few days.

Hyaluronic acid fillers are the only ones whose effect can be reversed by injecting hyaluronidase; this will accelerate filler’s resorption in a few days comparing with the expected duration of six to twelve months.

Poly-L-lactic Acid treatment requires several stages to obtain the desired results. Furthermore, you will have to massage the injected zone for one to two weeks.

If your own fat was used you will notice at the injection site some swelling and bruising for a few days to several weeks.
Preparing for injection

The treatment is performed in a plastic surgeon’s office. Previous to inject, your doctor will describe carefully the recommended treatment, type and brand of the selected filler, expected results and how long they are going to last. You will be asked to sign an informed consent in order to certify that you have fully understood the procedure, including possible risks and complications.
The risks associated with using injectable fillers vary depending on every product type. An infection may develop at the injection site. Some fillers obtained from animal tissue require prior testing to exclude possible allergies. The component particles of semi-permanent fillers may form granulomas which can be felt beneath the skin. In rare cases, these granulomas may need to be surgically removed.

After treatment

Once the procedure is finished you will be instructed how to care for the treated areas. You will be reminded the duration of the effect, the necessary precautions in the first days, the scheduled follow-up visits.

As your filler is resorbed you will need another injection. If you choose not to continue the treatment you will return to your original aspect. The wrinkles will reappear; the injected zones will lose their volume.

Results

You will be surprised by the effects of this rapid procedure. For safety reasons, using these substances require serious anatomy knowledge. Therefore choosing a plastic surgeon to inject these fillers warrants that your treatment is performed by somebody experienced not only in injection therapy, but also in all types of facial rejuvenation, surgical or non-surgical.

Your surgeon, your choice

The decision to have cosmetic or reconstructive surgery is important, as well as choosing the right surgeon. Not all the doctors performing these procedures are plastic surgeons. Make sure your doctor is a board- certified plastic surgeon, member of the Romanian Plastic Surgeons Association.