What are facial dermal fillers?
fillers are substances that are injected just below the
surface of the skin to fill in lines, wrinkles, and scars. Unlike
face lifts that stretch the skin, fillers add volume for a more
natural youthful appearance. Fillers can also increase the fullness
of the lips (see section on lip
enhancement) and lessen the downward slant of the corner
of lips. The most common areas treated are the smile lines around
the nose and mouth, fine lines above the mouth, frown lines
between the eyes, and acne scars.
There are two classes of dermal fillers:
Permanent and temporary. The
main permanent dermal filler in use today is silicone. There
are a variety of temporary dermal fillers currently in use and
several will be discussed below: Hydroxyappetite (Radiesse),
hyaluronic acid (Restylane
and Hylaform), sculptra,
fat, and collagen. Temporary
fillers are absorbed by the body over time, usually in 2-6 months
and require repeated treatments to maintain the effect.
Silicone Dermal Fillers
The use of silicone fillers has
been controversial in the past because of the risk of bumpy scars
called granulomas that can form even decades after treatment. New
formulations of silicone and new injection techniques have reportedly
eliminated granuloma formation but long term studies are still in
progress. The FDA has not approved silicone for this particular
use. One advantage of silicone is you do not repeat treatments once
the desired look has been achieved.
is an abundant natural protein found in the body that provides
structural support to skin, muscle, tendons and bone. In the
skin, fibers of collagen are woven together to provide texture,
resiliency and shape. Collagen is one of the substances lost
during the normal aging process. Collagen injections are performed
in an office setting and require no recovery time. They usually
take less than an hour to perform. The main risk of collagen
injection is an allergic reaction. Some of the collagen products
are made from animals and require allergy testing prior to use
(see below). The effect lasts between 3-6 months. Combinations
of fillers are used to achieve a natural, full look.
Bovine (cow) collagen
Zyplast — Requires skin testing
(for deeper wrinkles)
Zyderm — Requires skin testing (for fine
Human (foreskin) collagen
Cosmoderm — No skin testing (for fine lines)
Cosmoplast — No skin testing (for deeper
Radiesse (Formerly called "Radiance")
is made of a synthetic substance containing microspheres of
calcium hydroxylapetite. There are no allergic reactions associated
with this filler. With proper technique and local anesthesia,
the injections are not very painful. There may be some bruising
after the procedure but most patients return to normal activities
the next day. One of the advantages of Radiesse is that it can
last up to 3 years. Radiesse has been used for lip
is natural cosmetic dermal filler that is made of non-animal-based
hyaluronic acid. The fact that it is non animal based decreases
the risk of animal based disease transmission or allergic reaction.
No pre-testing required. Restylane has been approved by the
FDA for use in moderate to severe facial wrinkles and folds,
such as nasolabial folds. There is usually no recovery after
Restylane injection. The effect lasts approximately six months.
is another hyaluronic acid based dermal filler that has recently
been approved by the FDA for treatment of facial wrinkles. Hylaform
is made from avian (bird) origin, and individuals who have allergies
to avian products should not use this filler. It is believed
that it last up to six months. It can be combined with bovine
and non bovine type injections to address many parts of an aging
This procedure is unique because
it removes fat from one area of your body and transfers it to the
area of concern. The main advantage of lipotransfer is that it eliminates
the risk of an allergic reaction. Lipotransfer is a two step procedure.
First, liposuction is performed using local anesthesia to collect
the “donor” fat. Fat is then injected into the face,
just below the second layer of the skin (dermis) or into the muscle.
Bruising, swelling, and redness are common afterward and usually
last a few days. No good studies have been performed to evaluate
how long fat fillers last. Patients report variable results from
3 months to 3 years.
What are the risks of fillers?
Each filler is unique and has
its own risk profile. In general, however, risks include allergic
reactions, infections, pain, and scar formation. You should talk
to your physician to decide if fillers are right for you. Fillers
can be expensive and you may require repeat treatments.
How much do dermal filler treatments cost?
Fillers are expensive but the
pricing varies depending on the number and types of areas being
treated and the amount of filler material required. Treatments can
range from several hundred to several thousand dollars. Remember
that temporary fillers last at most 3-9 months.
How does Restylane work?
Restylane contains hyaluronic acid in
the form of a crystal-clear gel. It is injected into the skin to lift the lip,
wrinkle or fold. Once in your skin, it creates volume, resulting in a healthy and
vital appearance. When injected into the lip it can restore a more natural and/or
sensuous look. In contrast to other biodegradable implants, Restylane is not
extracted from animals. This means no risk of allergic reaction. Therefore, it is
perfectly safe to use instantly without pre-testing.
What areas respond the best to treatment?
Fine lines on the upper and lower lip
that are not severe enough to require laser resurfacing smooth and fill nicely with
Restylane. Deeper wrinkles and folds in the cheek areas (nasolabial, melolabial and
lines at the corners of the mouth) also respond well using Restylane. Lip enhancement
has up to twice the longevity of standard collagen implant treatments.
Is Restylane safe?
Yes. Hyaluronic acid occurs naturally
in the body and therefore it also dissolves naturally with time and is integrated
into your body’s tissues. The synthetic, biodegradable hyaluronic acid known as
Restylane has been used in Europe and Canada for many years and is now approved in
the United States. Your doctor will tailor your Restylane treatments according to
the depth of the wrinkles and desired lip enhancement.
What are the treatments like?
The treatment is performed by
injecting Restylane under your skin. Since no pre-test is needed, your procedure
can usually be done in less than one hour. Many patients like the added comfort
provided with an anesthetic cream, while others prefer an anesthetic block. This
makes the treatment relatively painless.
How long does it last?
Depending on the area treated, most
folds and wrinkles require one treatment. The repeat maintenance treatment is not
usually required for approximately 6 months or longer. By experience these products
last almost twice as long as regular collagen injections. The great thing about
Restylane is that you can replenish your natural beauty whenever you feel the need.
Unlike permanent implants, Restylane always leaves you a choice when the effect of
the treatment has worn off. A touch-up can be performed any time you like after the
How will I look after my treatment?
Following your injections, normal
activities can be resumed immediately. Discomfort is minimal. The treatment site
may have a little swelling, which may last a few hours. There may be some slight
bruising which can be covered with make-up. Depending on the area treated,
correction can last up to six months or longer. If the lips are treated, initial
swelling and tenderness may occur within the first several days, but subsides after
two or three days.
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