What are Injectable Fillers?
Injectable fillers are composed of a variety of materials. The most frequently used injectable fillers are the hyaluronic acid based dermal fillers with brand names such as Juvederm and Restylane. Hyaluronic acid is a naturally occurring sugar molecule that is a key component of the structural matrix that holds all the cells in your skin together. It forms a gel-like matrix by cross-linking large numbers of hyaluronic acid subunits and water, and forms highly organized proteoglycan (or protein and sugar) complexes with the most abundant protein in our body, collagen. In addition to its structural role, hyaluronic acid performs many crucial functions, some of which include tissue regeneration, wound healing, induction of collagen formation, and free radical scavenging. As we age, the amount of hyaluronic acid present in our skin, especially the epidermis (the top layer of our skin) decreases dramatically.
Hyaluronic acid is a popular skin care ingredient and has garnered the beauty industry’s undivided attention. It is often heavily advertised as the key ingredient of many skin care products. Unfortunately, topical application of products with a hyaluronic acid concentration of 1% (the industry standard) is not able to deliver significant amounts of this complex large polymer (many cross-linked molecules) into your skin. And this is why injection of hyaluronic acid fillers is incredibly appealing.
The purpose of injectable fillers is to restore volume by instantly filling areas of the face that appear deflated and droopy due to the natural aging process. Fillers improve the 3D contour of the face and can also be used in younger individuals to confer structural changes to improve overall facial harmony. Fillers can be used to sculpt and contour the jaw line, nose, cheeks, forehead, chin, etc. It is an ideal option for those individuals who are uncertain about committing to more invasive procedures such as rhinoplasty, facial fat grafting, and chin augmentation.
Hyaluronic acid-based fillers are temporary. We will review the average life span of the different fillers and permanent filler options below. It is important to note that hyaluronic acid fillers can be dissolved immediately with an enzyme solution. Also, over the years, we have found that injection of hyaluronic acid induces the surrounding skin to increase collagen production. This process is hypothesized to result in the filled area remaining voluminous for periods longer than the filler life span.
The most severe complication from injection fillers result from unintentional injection into a blood vessel. This can lead to vision abnormalities, blindness, stroke, and soft-tissue necrosis. In the hands of an experienced injector who possesses an extensive understanding of facial anatomy, this complication is completely avoidable. Plastic Surgery is the only surgical specialty that produces surgeons who are allowed to operate “from head to toe” at accredited academic hospitals. Our team includes highly trained board-certified academic plastic surgeons who are experts in facial anatomy.
Am I a good candidate for Filler Injections?
- You want to rejuvenate your face, neck, or hands, and do not require nor desire invasive surgical procedures to achieve this.
- You want to change the 3D contour of certain parts of your face.
- You are not pregnant, breastfeeding, on blood thinners, known to develop hypertrophic scars or have an inflammatory skin condition.
As we age, our skin loses elasticity and the once highly organized patterns of collagen and elastic fibers become disorganized and haphazardly arranged. This violates the once highly effective water barrier your skin provides and you become more susceptible to transepidermal water loss, or evaporation of water from your skin occurs more easily. Your skin loses moisture and also the production of collagen and hyaluronic acid decreases substantially. Additionally, your skin and soft tissue structures succumb to the ever-present insult of gravitational pull and slowly descends. It is important to note that photoaging from UV exposure accounts for 80% of the deleterious effects aging has on our skin. Hence, sun protection is of paramount importance.
The facial changes that occur with aging can be described as volume loss, downward migration of the once tightly suspended structures such as the fat pads under your eyes and cheeks, and thinning of your skin and bones. Wrinkles develop across your neck, your nasolabial folds (smile lines) deepen, the fat pads in your cheeks descend and shrink creating eye bags, your lips lose volume, your eye brows droop, and you develop wrinkles perpendicular to the direction your facial muscles contract. Typically, the beginning of this aging journey becomes visibly apparent in your mid to late twenties. If you are experiencing the aging process and would like to intervene with a simple and quick procedure, fillers may be right for you.
It is important to note that injectable fillers are not able to achieve adequate results for those individuals requiring dramatic rejuvenation. You may require surgical intervention such as a brow and forehead lift, or a face and neck lift with facial fat transfer to treat your target areas.
If you are young but are interested in optimizing the 3D contour of your face, fillers may be right for you. Lip fillers remain extremely popular with young patients. Liquid rhinoplasties are becoming increasingly popular and offer a quick fix for those individuals whose nasal form can be improved with filler injection. Your plastic surgeon or nurse practitioner (we have an in-house expert injector) can contour your face with fillers as you do with your makeup. Remember to bring photos of yourself with makeup looks you love to your initial consultation with us.
- Juvederm Plus is for moderate to severe wrinkles, nasolabial folds. Injection site side effects* last <14 days. Results last up to 12 months.
- Voluma XC is for deep injection to the cheeks and paranasal area. Results last for up to 18 months. Injection site side effects last 2-4 wks.
- Vollure XC is for moderate to severe wrinkles, nasolabial folds. Injection site side effects last <14 days. Results last up to 18 months.
- Juvederum Ultra XC is for mild to moderate wrinkles, mild nasolabial folds, lips and the surrounding area. Injection site side effects last <14 days. Results last 6-9 months.
- Volbella XC is for fine lines, medium depth skin depressions, the lips, and the surrounding area. Results last for up to 12 months. Injection site side effects last <30 days.
- Volift is injected deep into your skin to treat deep wrinkles and depressions, improve facial contour, increase facial volume including the lips. Results last up to 15 months.
- Volite is for improving skin quality and is injected very superficially into the top layer of your skin. Improves skin hydration and elasticity for 6-9 months.
*Injection site side effects include redness, swelling, pain, tenderness, firmness, lumps/bumps, bruising, discoloration, and itching.
Autologous Fat Transfer
Autologous means the substance is from your own body. Fat is harvested through liposuction and transferred in small amounts for facial rejuvenation. This is the only filler that requires surgery. Your plastic surgeon may opt to inject botulinum toxin to certain facial muscles to weaken them and protect your newly transferred fat while it incorporates into your face.
- Most dermal fillers are infused with a numbing agent, most patients experience mild to moderate pain (especially with lip and deep injections).
- You do not need to take time off work, unless you undergo fat transfer.
- You may experience mild bruising, swelling, and tenderness. These symptoms typically resolve within 1-2 weeks. Most patients find the bruising and swelling are mild enough to conceal with makeup.
- Avoid strenuous activity, alcohol, heat, extensive sun exposure for the first 24 hours.
- Avoid the dentist and air travel for the first 2 weeks.