Injectable fillers are substances that are injected through small needles into the skin to fill depressions caused by wrinkles, depressed scars or facial volume loss. Areas amenable to treatment with fillers include lips, wrinkles around the mouth created by smiling, folds beneath the corners of the mouth created by frowning, lines between the eyes, grooves under the eyes, fine lines on the cheeks or around the mouth, and central cheek depressions. Acne, chicken pox and other depressed scars can also be improved.
What cosmetic fillers are available?
Over the years a variety of filler agents have been successfully used. Each filler is a different material and the duration of filling may vary between the different substances.
Bovine collagen (Zyderm® and Zyplast®) was approved by the FDA 2 decades ago. It was the first filler agent to become very popular in the US . Typically it was used for smile lines and other wrinkles, lip enhancement and scar correction. Because bovine collagen is derived from cow collagen, there is a higher rate of allergic reactions then collagen derived from human cells and for this reason, it is used much less today. Results, after treatment, typically last 2-6 months. We no longer use this product at the Aesthetic Skin and Laser Center.
Human collagen (Cosmoderm® and Cosmoplast®) is used much like bovine collagen. Typically human collagen is used to treat smile lines and other wrinkles, lip enhancement and scar correction. These materials are among the more popular filler agents for lip enhancement or for the patient who likes collagen, but prefers not to have bovine collagen. In contrast to bovine collagen, human collagen treatment does not require skin tests. Results typically last 2-6 months. This is available at the Aesthetic Skin and Laser Center.
Among the newer filler agents are those containing hyaluronic acid. The FDA has approved a number of hyaluronic acid products including Restylane®, Hylaform®, Juvederm Ultra and Juvederm Ultra Plus. Skin tests are not required. The material is soft and natural appearing. These fillers are very popular for the treatment of smile lines, frown lines and for lip enhancement. Results typically last 6 -12 months.
Radiesse is a filling substance made of calcium hydroxyapitite. It is best suited for lines around the mouth. It typically lasts about one year.
Sculptra ® is included in the category of fillers, but is better called a skin volume enhancer. The injected substance is poly L-lactic acid. The material is used to treat sunken cheeks that result from the aging process. A series of injections over several months is required and the final improvement will take up to six months. The clinical benefit can also last up to 2 years. This substance is currently approved for use in patients with HIV lipoatrophy.
What kinds of side effects or adverse reactions could occur?
Reactions to filler agents are rare and generally resolve with time. Some common injection-related reactions might occur, such as swelling, redness, pain, itching, discoloration and tenderness at the implant site. They typically resolve spontaneously within several days after injection into the skin. Other types of reactions are very rare, but occasional patients do experience localized reactions thought to be of a hypersensitivity nature.
What should I expect during and after treatment?
Generally, we recommend that you come about one hour prior to your appointment so that we can treat the area to be injected with a topical anesthetic cream prior to injection. You may experience slight to moderate discomfort upon injection of the filler, but most patients find the treatment very tolerable. After the treatment, mild redness, swelling and tenderness may develop and persist for a few hours to 1-2 days. Occasional bruising may develop, which usually resolves after a few days. Bruising can usually be avoided by refraining from aspirin, anti-inflammatory medications (ibuprofen, naprosyn) and supplements such as vitamin E, gingko biloba, garlic, ginseng and St. John’s Wort for at least one week prior to the procedure.
What are some possible complications?
Side effects associated with injection are bruising at the site of treatment and transient swelling which is usually very mild for 24 to 48 hours. Rarely, lumpiness or inflammation around the injection site may develop and persist for weeks after a procedure. Allergic reactions are very rare (one in 5000 for hyaluronic acid). Very rarely, injection of fillers may compromise blood flow to the skin, causing scab formation and possible development of a scar.
Can fillers be used together with Botox and laser treatments?
Yes, these modalities often compliment one another and recent studies support the safety and effectiveness of a combined approach to facial rejuvenation.
Do I need a consult with the doctor before scheduling a treatment?
Yes. The doctor will need to evaluate you and discuss your concerns so that she will be able to best satisfy your needs. You will be given the opportunity to ask any questions that you may have and the doctor will go over the risks and benefits of filler treatments with you.