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Fillers - Iranian Society of Plastic and Aesthetic Surgeons

Fillers

Fillers

Also known as dermal fillers and soft tissue fillers, or simply“fillers” are used to fill up defects in the soft tissues, typically wrinkles, folds and dents in the face. Some fillers are intended to add volume, for example to the cheekbone or the chin and are often used for lip enhancement.. Common areas to inject fillers are in the face, neck, and hands, resulting in a fuller, smoother and more youthful appearance. Dermal fillers are among the most popular aesthetic procedures because they carry immediate results, very few risks and little recovery time.

There are many products on the market. The most important distinction is between non-permanent fillers, which disappear spontaneously after a while, and the permanent fillers, which stay embedded in the tissues forever. Most non-permanent fillers are quite safe to use, but it is advisable to demand fillers that are generally accepted, or FDA approved, such the ones based on hyaluronic acid, collagen and calcium hydroxyapatite microspheres. Always demand to know which product your physician is going to use.

Fillers are injected directly into the area to be treated, often after application of a topical anesthetic cream. The effect is immediate, and lasts between two to 18 months, depending on the type of product and the treated area.

What dermal fillers can do

  • Plump thin lips
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Improve the appearance of recessed scars
  • Reconstruct contour deformities in the face
  • Decrease or remove the shadow of the lower lids

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

What dermal fillers can’t do

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach. Nonsurgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate. It is important to remember that dermal fillers are temporary treatments for facial aging and that ongoing treatments will be needed for long-term results.

Who is a good candidate for dermal fillers?

You may be a good candidate for dermal fillers if you:

  • Are physically healthy
  • Don’t smoke
  • Have a positive outlook and realistic goals in mind for the improvement of your appearance
  • Are committed to maintaining good skin health

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach.

What is the cost of dermal fillers?

The average cost of dermal fillers vary.

Cost is always a consideration in elective procedure or treatment. The cost of dermal filler injections may vary based on the expertise and qualifications of the person performing the treatment, the type of procedure used, time and effort the procedure or treatment requires, as well as the geographic location of the office. Many plastic surgeons offer patient financing plans, so be sure to ask.

Your satisfaction involves more than a fee.

When choosing a plastic surgeon for dermal filler injections, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the procedure.

consultation

During your dermal fillers consultation be prepared to discuss:

  • Your goals
  • Medical conditions, drug allergies, and medical treatments
  • Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
  • Any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other non-surgical facial procedures, as well as any prior facial surgery

Your surgeon may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Discuss your available options
  • Examine and measure your face
  • Take photographs
  • Recommend a course of treatment
  • Discuss likely outcomes of using soft tissue fillers and any risks or potential complications

Your plastic surgeon will carefully explain:

  • Your course of treatment
  • The type of filler recommended in your case and why
  • Expected results
  • The longevity of the result

What questions should I ask my plastic surgeon about dermal fillers?

  • Are you certified by the American Board of Plastic Surgery?
  • Are you a member of the American Society of Plastic Surgeons?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure? If so, at which hospitals?
  • Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for this procedure?
  • What will be expected of me to get the best results?
  • Where and how will you perform my procedure?
  • How long of a recovery period can I expect and what kind of help will I need during my recovery?
  • What are the risks and complications associated with dermal fillers?
  • How are complications handled?
  • How can I expect my skin to look overtime?
  • What are my options if I am dissatisfied with the cosmetic outcome of my procedure?
  • Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?

What types of dermal fillers are available?

There are three types of fillers commonly used: temporary, semi-permanent, and permanent. Hyaluronic acid-based fillers are temporary, while other types of fillers offer longer-lasting results.

Temporary Fillers

  • Collagen-Based Fillers: Collagen is a naturally occurring protein that adds strength and structure to the skin. Collagen was the first filler on the market, but the arrival of hyaluronic acid-based fillers has decreased its popularity.
  • Hyaluronic Acid-Based Fillers Like collagen, hyaluronic acid is a naturally occurring substance and primarily used to promote fullness and volume.
  • Calcium Hydroxylapatite: Heavier and denser than hyaluronic acid, this filler is injected deeper, underneath the skin, and does not usually cause immune or allergic responses because the material is usually found in bones.

Semi-Permanent Fillers
Longer-lasting dermal fillers typically contain thicker substances, such as the biodegradable synthetic filler known as poly-L-lactic acid. These types of soft tissue fillers are used to treat deeper facial lines, and though they offer semi-permanent results, it’s possible that you’ll need an occasional “touch up” several weeks after your initial injections.

Permanent Fillers
Permanent fillers are made of polymethylmethacrylate (PMMA), which are microspheres that are not absorbed by the body. The filler also contains collagen and is only recommended for thick-skin areas such as the nasolabial folds. It is not recommended for any areas around the eyes or for the lips.

Silicone Injections – Patient Safety Warning
Silicone injections are an unsafe and unacceptable option to use as a filler. These injections are not FDA approved and often offered by unlicensed individuals and should be avoided. Always consult with a board-certified plastic surgeon, preferably an ASAPS member, if you have questions about a particular type or brand.

What are the brand names for fillers?

There are a number of soft tissue filler brand names, but some of the most common are:

  • Hyaluronic Acid-Based Fillers: Restylane®, Restylane® Lyft, Restylane® Silk, Juvederm, PREVELLE Silk, Hydrelle, Belotero
  • Collagen-Based Fillers: Cosmoplast, Cosmoderm, Evolence
  • Semi-Permanent Fillers: Sculptra, Radiesse
  • Permanent Fillers: Bellafill

How can fat injections be used as dermal fillers?

Some patients may want to consider fat injections, which use fat harvested from the patient’s own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

How fat injections are administered

Fat injection requires a more extensive procedure than “off-the-shelf” 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 then has to redevelop a blood supply in order to survive. About 50% of the fat injected will survive, and the surviving fat will last forever.

Fat injection results

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. Typically, multiple 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 risks of dermal fillers?

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

Severe complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

  • Acne-like skin eruptions
  • Asymmetry
  • Bruising, bleeding from the injection site, swelling
  • Damage to the skin that results in a wound and possible scarring
  • Infection at the injection site
  • Lumps
  • Palpability of the filler under the surface of the skin
  • Skin rash with itching
  • Skin redness
  • Under- or over-correction of wrinkles
  • Blindness
  • Skin necrosis (ulceration or loss of skin from disruption of blood flow)

These risks and others will be fully discussed prior to your consent.

What are the steps of a dermal fillers procedure?

A dermal fillers procedure includes the following steps:

If you choose to utilize packaged soft tissue fillers, the plastic surgeon, or his specially-trained nurse, will evaluate your facial appearance and skin tone and examine the areas of your face to be augmented.

Strategic points on your face may be marked as the appropriate injection sites for the filler. Photographs may be taken of the areas to be treated.

The injection sites will be cleansed with an antibacterial agent.

Pain at the injection site may be ameliorated by use of a very cold instrument to chill the skin, anesthetic ointment to numb the skin or injection of local anesthesia.

While not painless, the injections are usually easily tolerated.

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

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

Once the results are deemed satisfactory, any markings will be cleansed 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 should I expect during my dermal fillers recovery?

Immediately after injection
You will likely see the results of your injections immediately following the procedure, though it’s not uncommon for patients to experience swelling or minimal bruising in the area of the injection site. Your physician may give you an ice pack or cold compress to help stem swelling. The period of swelling will depend largely on the type of soft tissue filler you received, though most swelling, bruising, and redness should dissipate within one week to ten days.

Recovery time frame
One of the most enticing features of soft tissue fillers is their minimal recovery time. In the approximate week it takes for swelling and bruising to disappear, your doctor may advise you to avoid wearing hats or other headgear and only use small amounts of makeup.

Results

Partial or complete correction of wrinkles and folds. Enhancement of facial features.

The results of soft tissue augmentation using dermal fillers are apparent immediately 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 appropriate products and skin treatments will improve the results and longevity.

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