As we age, the underlying tissues in our face, which keep our skin and face looking youthful and supple, start to break down. This is aggravated by gravity, sun exposure, and facial muscle movements such as smiling, squinting, laughing and chewing. These factors contribute to laugh lines, crow’s feet and facial creases over the areas where muscle movements occur.
Soft-tissue fillers
Soft-tissue fillers are substances that can be injected under the skin to “lift and fill in” facial lines and creases, temporarily restoring its youthful and plumped-up appearance.
What do fillers treat and not treat?
Injectables fillers are primarily used to improve the appearance of the skin’s contours. They can help fill out deep facial wrinkles, creases and furrows, sunken cheeks, skin depressions, and some types of scars. They can also create fuller, more sensuous lips. These skin fillers are particularly helpful in the treatment of nasolabial folds (lines from the side of the nose to the mouth that accompany aging), and wrinkles or marionette lines on the chin. Some newer fillers also add thickness to the skin filling in areas of fat loss resulting from the aging process or side effects of certain drugs.
Injectable fillers are usually not practical for multiple surface wrinkles on the face, such as vertical “lipstick lines” that sometimes form around the mouth. In these cases your dermatologist may suggest a resurfacing techniques, such as a chemical peel or laser treatment. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance. Lines and wrinkles caused by hyperactivity of facial muscles of expression, such as forehead frown lines, are better treated by Botox instead. Advanced skin laxity causing sagging facial skin and droopy eyelids is more appropriately treated by surgery, such as facelift or browlift, which are performed by plastic surgeons.
Injectables fillers can be used on their own or in conjunction with other cosmetic procedures – such as Botox injections and laser surgery – to achieve optimal results in rejuvenating the aging face.
Types of soft-tissue fillers available
Injectables fillers are classified as temporary or semi-permanent, based on how long they remain within the skin before being cleared by the body. Temporary fillers generally last several months, while semi-permanent fillers last more than one year.
Temporary fillers
These injectables substances are safe, and improve facial creases and volume loss. Their temporary nature means that pre-treatment conditions are restored after some time, with adjustments in facial contours following subsequent treatments. This is most suitable for first-timers at skin fillers.
The need for repeated maintenance treatments may disappoint patients, as the desired results may only last a few months. However, the advantage is that you and your dermatologist can safely make changes to your appearance without the risk of permanency, while maintenance treatments allow for flexibility as your face changes.
The temporary soft-tissue fillers are often hyaluronic acid based.
Hyaluronic acid based fillers
The amount of hyaluronic acid in our skin decreases as we age, resulting in a loss of volume and poor water retention. This unique, starch-like molecule is present in all living tissue (plant and animal). In the skin, this molecule is continually broken down and replaced. Hyaluronic acid based fillers result in localized swelling, due to more water binding to this acid. The body then gradually and completely clears the hyaluronic acid over several months. Some common trade-brands include:
Restylane and Perlane: These products use a non-animal based, stabilized hyaluronic acid, and are versatile products for fine lines, lips and deeper furrows. No pre-treatment skin testing is required. They last from 6 months and beyond.
Semi-permanent fillers
These fillers get incorporated into the tissue and do not break down. They create some lasting fullness as well as additional filling over time, by stimulating the skin to produce its own fibrous (scar) tissue. This adds to the fullness, but in a rather unpredictable way.
While it is understandable that most people would prefer permanent correction of lines and wrinkles and lasting lip enhancement, use of semi-permanent fillers comes with a much higher incidence of undesirable effects. Avoiding these problems is difficult in mobile areas like the lips, and more dependent on a skilled injection technique.
Radiesse is one of the newest tissue fillers on the market, and these injections are popular for patients bothered by lines near the mouth, or “jowling” at the sides of the nose and mouth. The advantage of this tissue filler is that it lasts the longest among the options available today; up to three years or more in some people. For many people, Radiesse is the answer to staving off the need for a facelift. It successfully softens folds around the sides of the mouth and lip lines. It should not be used to make lips fuller.
What can I expect from filler injections?
It is important to understand that fillers stay in the skin temporarily. The injected substance is broken down by the body over weeks, months, or years, depending on the material injected. Other factors which may affect the durability of the injected fillers are the patient’s age, genetic background, lifestyle, and injected site. As a result, a repeat procedure – or in some cases, a “top-up” – may be required to restore facial contours after some time.
Where will my treatment be performed?
Injectable fillers are usually performed on an outpatient basis in a dermatologist’s minor surgical treatment clinic. However, if this treatment is being combined with laser surgery, then this will be done in the day surgery unit.
Is anesthesia needed?
Some injectable fillers are mixed with the anesthetic agent lignocaine, and additional anesthetic is not usually used. However, if you are especially sensitive to pain, your dermatologist may use a topical anesthetic cream or an ice pack to numb the injected area prior to the injection. Pain after treatment in infrequent, and typically consists of mild soreness. This discomfort goes away very quickly.
How long will the procedure take?
Depending on the size of the area treated, the procedure itself may take a few minutes to an hour. You may be required to arrive an hour before your procedure, for application of the topical anesthetic cream.
When can I return to my normal activities?
Immediately following treatment, you may notice some minor discomfort, stinging, or throbbing in the injected area. You may return to your activities immediately, as there is usually no downtime. However, there may be side effects, such as some short-term redness, minor swelling, and occasionally a small bruise, which may require, and you are free to eat, drink, and wear cosmetic makeup with sunscreen protection shortly after the procedure.
When will I see results?
With most injectable fillers, the results are seen immediately.
How long will the effects last?
The effects of temporary fillers usually last about 6 months or more, depending on the type of filler used and the rate at which the body clears the filler. This varies between individuals. Semi-permanent fillers can last 1-2 years.
Is skin filler safe?
The injection of fillers is very safe when performed by an experienced and qualified dermatologist. However, individual patients differ in their responses to “ foreign substances”, and some outcomes may not be predictable. Patients may experience some short-term redness, minor swelling, and occasionally a small bruise. The swelling and redness usually goes away within three days.
An allergic reaction is extremely rare nowadays. Other risks common to all injectable fillers may consist of infection, ulcers, skin peeling, lumpiness, nodule formation, and scarring. However, reports of these problems are very rare.