WHAT IS A FILLER?
A youthful face is accentuated by convexities that reflect light while aging one is marked by concavities that create dark shadows. I often liken rejuvenating a face to shadow chasing.
There are basically two types of fillers: permanent and temporary. Injectable fillers can be utilized to augment cheek and jawbones, smooth out wrinkles, fill out hollows, plump up lips, enhance noses, rejuvenate hands and smooth out irregularities, et cetera. More unique areas that may be treated include earlobes, balls of the feet, transverse cervical lines (“necklace” lines), etc.”Liquid facelift” is a marketing term used to describe the end appearance after undergoing multiple and strategic filler injections in and around the face to minimize the appearance of jowls, tissue sagging , folds and untoward shadowing.
DERMAL FILLERS ARE COMMONLY USED FOR:Facial droop, folds and wrinkles: Dermal fillers are an excellent ally to BOTOX® Cosmetic and Xeomen® injections because they correct a different type of wrinkle. The latter correct Swinkels caused by muscle activity where is fillers and lasers treat those static wrinkles occurring from natural aging, environmental factors and the sun. Combine the two treatments with laser skin resurfacing, and virtually all your wrinkles can be erased.
Restoring facial volume: As we age, our face naturally loses volume and what fat we have migrates downwards because of gravity. This imparts a drawn out and tired appearance. Dermal fillers can be used to fill in areas that have lost volume, restoring a youthful fullness to your face.
Lip augmentation: The lips also tend to lose volume as we age, which is especially important to women. Thin lips can convey an older, less inviting appearance. Dermal fillers are a fantastic choice for restoring needed volume to lips. Of course, adding volume to the lips will not shorten an otherwise long upper lip or drooping lower lip. Surgical alternatives must be explored in these cases.
Facial reshaping: Some people do not have the facial shape they desire, and in many cases this can be at least partly corrected with dermal fillers which can give the appearance of higher cheekbones or a stronger chin.
PERMANENT Fillers:Fat transfer – Injecting the patient’s own fat which has been harvested via low-pressure liposuction. Because the fat is the patient’s own tissue, there is absolutely no tissue reaction and, more often than not, it is more economical in the long run. In addition to the fill, fat has the added benefit of providing an improved skin appearance because of the rich source of stem cells it contains.
Polyacrylamide gels (PAG) – Such as Bio-Alcamid® and Aquamid® represent the latest in permanent filler technology and, despite the fact that they are available in Europe and beyond, are not yet FDA-approved for US usage. PAG’s possess distinct advantages over other currently available fillers. They not only produce very natural results, but are permanent, safe and removable. As with everything, there are bad reports of these substances floating around the web and in professional journals. However, as with any filler, the injection technique of the practitioner is of paramount importance in avoiding complications. Small amounts should always be injected in multiple layers-one should never inject “lakes” of foreign filler material in any one spot. I have had no complications from injecting Aquamid® to date.
TEMPORARY FILLERS:Hyaluronic acid derivatives (HAD) last anywhere between 3-8 months. Among the more common friends available to the US consumers/patient are Restylane®, Perlane®, Juvederm® and Belotero®. Initially, they were more painful to inject than collagen, but new products, such as Juvederm Ultra 2 through 4™ and Restylane® will help tackle that problem since it is one of the first HAD to come premixed with a numbing agent. Other HAD’s available in the US which come premixed with a numbing agent include Restylane™, Captique™ and Hyalform®
Belotero® – A relative new HAD to come to the shores. It can be used to produce beautiful results especially around the eye area since it minimizes any Tyndall effect from appearing.
This is a bothersome complication whereby the substance swells up due to its water retention capacity which, in turn, imparts a swollen, puffy look around the eyes along with a bluish tinge.
Paradoxically, this can have an aging effect which is contrary to the original intent of the patient! One of the advantages of HAD is that it is easily reversible with an enzyme called hyaluronidase (Wydase).
Collagen-based products (Zyplast™, Zyderm™, Cosmoplast™, Isolagen™, etc.) – Last anywhere from 6 weeks to 3 months. They produce very acceptably nice results, but they have been essentially supplanted by the Hyaluronic acid derivatives (HAD), which are sugars naturally found in the body. This is because HAD’s last longer and can be removed with the simple injection of an enzyme.
It is a very reliable filler that is proven to be very good, due to its resiliency against compression, for very effective voluming for the cheeks, jawline, chin, etc. it is associated with an extra day or two of swelling, however, but this generally does not prevent a patient from adhering to their normal social activities and obligations.
As with any filler injection, swelling, bruising, puffiness and bleeding may occur. The side effects are completely normal and typically go away within a few days. One should consider filler injection similar to a surgical procedure in that bruising can be a side effect which can’t be minimized by eschewing aspirin, aspirin containing products and any other substances that may promote bleeding. We have a comprehensive list of such substances which we can provide to our patients prior to the scheduled injection procedure.