Fillers

Fillers are a treatment that helps to reduce signs of ageing and restore volume and fullness to the face. As we age, we naturally lose subcutaneous fat, resulting in facial muscles working closer to the skin surface, making smile lines and crow’s feet more prominent. The facial skin also stretches a bit, contributing to this loss of facial volume. Additional factors affecting facial skin include sun exposure, heredity, and lifestyle.

However, with the help of fillers, you can easily and effectively combat these signs of ageing. Fillers can help to plump up thin lips, improve shallow contours, soften facial creases and wrinkles, enhance the appearance of recessed scars, reconstruct contour deformities in the face, and reduce or eliminate the shadow of the lower lids. Additionally, fillers can be of great help to those with early signs of ageing, or as a value-added part of facial rejuvenation surgery.

But what fillers cannot do is replace surgical procedures such as facelift, brow lift, or eyelid lift. Minimally invasive rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results but can help to delay the time when consideration for a facelift becomes appropriate. It’s important to remember that skin fillers are temporary treatments for facial ageing and ongoing treatments will be needed for long-term results.

But who is a good candidate for fillers? You may be a good candidate for fillers if you are physically healthy, a non-smoker, have a positive outlook and realistic goals in mind for enhancing your appearance, and are committed to maintaining good skin health.

During your consultation for fillers, your surgeon will evaluate your overall health status and any pre-existing health conditions or risk factors. Your plastic surgeon will discuss your options, examine and measure your face, take photographs, and recommend a course of treatment. Your surgeon will also discuss the likely outcomes of using soft tissue fillers and any risks or potential complications.

It’s very important to understand all aspects of your treatment and prepare for the consultation by writing down all your symptoms with a timeline, medications, and health history, so you can systematically discuss your concerns. It’s also a good idea to write down your questions.

What are the risks of fillers?
The decision to use fillers is extremely personal. You must decide if the benefits will achieve your goals and if the risks and potential complications of fillers are acceptable.

Your plastic surgeon will explain any risks.

Serious complications from fillers are rare. Potential risks vary depending on the specific filler used and its relative duration and include:

• Acne-like skin eruptions
• Asymmetry
• Bleeding from the injection site
• Bruising
• Damage to the skin resulting in sores and potential scarring
• Infection at the injection site
• Lumps
• Palpability of the filler under the skin’s surface
• Skin necrosis (wound formation or skin loss due to disruptions in blood flow)
• Skin rash with itching
• Skin redness
• Bumps
• Under- or over-correction of wrinkles

In very rare cases, fillers can inadvertently be injected into blood vessels instead of under the skin. This can block blood flow. What happens if your blood flow is blocked varies depending on where the block is. If your skin is affected, you may have skin loss or sores. If your eye is affected, you could lose sight or become blind.

These risks and others will be fully discussed.

It’s important that you address all your questions directly with your plastic surgeon, including complications that require urgent care. Although good results are expected from your procedure, there is no guarantee that you will be satisfied with your results. Since significant complications can arise from filler injections, it is important that you turn to a licensed plastic surgeon who understands the risks and is trained and prepared to handle any complications that may arise.

In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers dissipate over time. To maintain your correction, you may need to consider repeating the injection treatment periodically.

What types of fillers do you use?
There are several different types of fillers. We use:

• Hyaluronic Acid
• Juvederm, Perlane, and Restylane

Hyaluronic acid injections can be used to improve skin contour and reduce indentations in the skin due to scars, injury, or lines. You may see potentially dramatic improvements for:

• Acne scars
• Cheek depressions
• Crow’s feet at the corner of the eyes
• Deep smile lines that run from the side of the nose to the corners of the mouth (also known as nasolabial furrows)
• Frown lines between the eyebrows
• Marionette lines at the corners of the mouth
• Redefining lip border
• Scars including burns, acne, and those caused by wounds
• Smoker’s lines; vertical lines on the mouth
• Some facial scars
• Worry lines that run across the forehead

Hyaluronic acid is a natural substance found in the body. High concentrations are found in soft connective tissue and in the fluid surrounding your eyes. It is also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and has now become one of the most popular types of injectable fillers. If the term sounds familiar, it’s because the same substance is often injected into the aching joints of people with arthritis to relieve pain and provide extra cushioning.

Summary

Fillers differ in chemical composition, longevity, and have varying degrees of softness. Softer fillers, for example, are used in the lips, while stronger fillers might be desired to enhance cheekbones.

Your surgeon will determine with you the best type and volume of filler needed for your specific problem areas.

For many people, the use of fillers can be a simple office-based procedure that neatly enhances their appearance. These skin fillers are highly predictable and have relatively minimal risks and side effects. These fillers are injected by the surgeon.

How can fat injections be used as fillers?
Some patients may wish to consider fat injections, which use fat harvested from the patient’s own body that can then be reinjected to enhance facial fullness, fill creases, or build up shallow contours.

How fat injections are used

Fat injection requires a more extensive procedure than soft tissue fillers.

A “donor area” must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft.

The grafted fat must then establish a blood supply to survive. About 50% of the injected fat will survive, and the surviving fat will be permanent.

Results of fat injection

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. Typically, several fat transfer procedures will be needed to achieve desired results.

The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon’s treatment room or in an operating room.

What are the steps in a filler treatment?
A filler treatment includes the following steps:

Step 1 – Facial assessment and mapping

If you choose to use prepackaged soft tissue fillers, the plastic surgeon will evaluate your facial appearance and skin tone and examine the areas of your face to be augmented.

Strategic points on the face may be marked as appropriate injection sites for the filler.

Step 2 – Cleansing and anaesthesia

The injection sites will be cleansed with an antibacterial agent.

Pain at the injection site can be alleviated by using a very cold instrument to cool the skin, an anaesthetic ointment to numb the skin, or injection of local anaesthesia.

Although not pain-free, the injections are generally well tolerated.

Step 3 – The injection

Injection takes only a few moments per site. The process of injecting, massaging, and evaluating the result is performed, and additional filler is added as needed.

Depending on the number of areas to be treated, the entire process can be as short as 15 minutes, or as long as an hour.

Step 4 – Clean up and recovery

Once the results are deemed satisfactory, any markings will be cleaned off.

You may be offered an ice pack to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.

What can I expect after filler treatment?
Recovery time varies for each patient and for each type of filler injected. You can resume most activities immediately, but it is generally recommended that you avoid intense physical activity for the first 24-48 hours to minimise swelling and bruising. Be sure to discuss your specific recovery plan with your doctor before scheduling your injections.

Your initial appearance after treatment with fillers may include:

• An “overfilled” look in treated areas
• Swelling or bruising ranging from mild to severe
• Temporary numbness or redness
• Noticeable lumps or hard areas at the injection sites
• Hypersensitivity reaction that may seem like an allergic reaction with hives and swelling

Most conditions can be alleviated with cold and massage and will improve within a few hours or just a few days. Some reactions may require more aggressive treatment with medications or injections.

Although not common, visual disturbances may occur. When accompanied by pain or weakness on one side of the body, it is extremely important that you contact your surgeon and seek care immediately.

When your own fat is the injected filler, the healing process is longer and may take a few weeks.

What results should I expect after filler treatment?
The results of soft tissue augmentation with fillers are immediately apparent and will last from several months to several years depending on the filler used and the patient injected. Maintaining good overall health and maintaining healthy and strong skin with suitable products and skin treatments will enhance the results and longevity.