The visible signs of facial aging occur over time as a result of sun exposure, heredity and life style.
One of the earliest signs of aging is a loss of facial fullness and the development of wrinkles. Softening of these facial lines and the restoration of volume and fullness in the face often can be achieved non-surgically with injectable fillers.
If you would like to restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you.
Injectable fillers can:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
- Improve the appearance of recessed scars
How To Choose The Best Filler For You
It is important to understand the difference between Botox, a muscle relaxer, and Juvederm, Restylane, Collagen, etc. which are fillers. The easiest way to visualize the difference is to think of a crease as a valley between two mountains. Botox prevents the mountains from being pushed together, and fillers fill in the valley.
While not as involved as surgical cosmetic procedures, soft tissue augmentation is a medical procedure. You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.
Filler Candidate Checklist:
- You are physically healthy
- You don’t smoke
- You have a positive outlook and specific, but realistic goals in mind for the improvement of your appearance
What it won’t do:
Soft tissue augmentation does not stop the aging process. If you wish to change the elements of your face, surgery such as a facelift, brow lift or eye lift may be the answer.
Non-surgical rejuvenation treatments such as injectable fillers cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate.
If someone has a crease that is apparent only when frowning or squinting, Botox should be all that is necessary. Botox is most often used on the forehead, crows feet, and frown lines. It can also be used to treat neck bands. (Its most recent FDA approval is for armpit sweating and sweaty hands. For these conditions, results can last 6 months or longer.) Botox works on creases in two ways. First, it weakens the muscles that cause the creases. Second, and even more important, as the muscles get weaker, the patient gets out of the habit of creasing and using those muscles. In this way, Botox actually prevents the progression and deepening of creases:
Injectable Wrinkle Fillers:
The differences between fillers has to do with thickness and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of possible bumps. Bumps are more likely in thinner skin such as the lower eyelids, and crows feet. Zyderm (a type of Collagen), and Restylane Fine Line are the least thick and can be used around the eyes, but they are also the shortest lasting. Juvederm Ultra Plus is one of the longer lasting hyaluronic acid fillers. It can be used for deeper creases. Juvederm Ultra Plus can last between 3 and 6 months.
Fillers can also be used to improve or enhance facial structures such as:
* Filling in acne scars
* Enhancing cheek bones to make them fuller and more defined
* Enlarging lips for a fuller, softer pout
* Correcting lip deformities or asymmetry
* Non-surgical nose-job to fill in dips and valleys in the nose bridge
* Filling in hollows under the eyes that contribute to dark circles
Four Other Fillers That Deserve Mention:
Radiesse is considered the longest lasting filler, It is made from a similar material that bone is made from. Although it is not permanent, it can last up to one year in many cases. It is ideal for the nasolabial folds that get deeper as we get older.
Sculptra is a volumizer, and fills larger areas of the face, such as sunken cheeks. It requires more than one treatment, each about one month apart. It is also an injectable filler, but its effect is is more like a tissue expander, filling in larger areas. Imagine a balloon being blown up under the skin. It is not a balloon of course. It is made from the same material that dissolvable sutures are made, and is not permanent.
Silikon 2000 (Silicone) and Artefill (polymethyl methacrylate aka PMMA) are permanent synthetic products that the body cannot metabolize or remove. While they have unique benefits, they also have unique risks in that once injected, they are permanent, and cannot be removed.
Botox vs. Fillers:
In summary, as we get older, our creases also age. They become deeper and deeper, even when we are not frowning, squinting, or using facial muscles. If creases are only apparent when we squint, only Botox is needed. If creases are visible at rest, and not made worse by squinting, then fillers are necessary. If creases are present at rest, and get worse with facial expressions, then Botox AND fillers will be necessary.
What happens during soft tissue augmentation?
Step 1. Your plastic surgeon will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers.
Step 2. Strategic points on your face may be marked as guides to the appropriate injection sites for the filler.
Step 3. The injection sites will be cleansed with an antibacterial agent and icing or a topical numbing agent may be offered to make more sensitive patients comfortable.
In some cases, the filler itself will contain an anesthetic agent. In other cases local anesthetic may be administered to the treatment site.
Step 4. Injection takes only a few moments per site and a few minutes for a course of treatment.
Step 5. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Makeup may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.
Filling wrinkles or recessed scars involves multiple injections. In some cases where deeper injection of fillers is required, a local anesthetic may be used prior to treatment.
Common sites for deeper tissue fillers are the nasolabial folds and marionette lines, or to enhance fullness in the cheeks.
An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites.
With some fillers, a slightly “over-filled” appearance may be initially present. These conditions will resolve within a few hours, or at most a few days. The duration may be as long as a few weeks with injection of one’s own harvested fat.
Important facts about the safety and risks of tissue fillers
The decision to have soft tissue augmentation is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.
Complications from fillers are uncommon.
The risks vary depending on the specific filler used and the relative permanence of the filler substance and include:
- Fillers derived from non-human sources may require a pre-treatment allergy test
- Infection at the injection site
- Fillers that are not completely fluid and contain microscopic granular substances carry a risk of “clumping” as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat
- Acne-like skin eruptions
- Antibodies to filler material may reduce the effectiveness of future injections
- Bleeding, bruising and swelling
- Filler material may migrate from the original site and produce temporary paralysis of other muscle groups or other unintended effects
- Skin might die (skin necrosis)
- Skin rash, itching and swelling
- Skin redness
- Skin sensitivity
- Under or over correction of wrinkles
Choose a professional. Although tissue augmentation is a quick, in-office procedure that can produce a marked improvement in restoring facial fullness and a more youthful appearance, effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler.
Choosing a plastic surgeon to treat your face with injectable fillers means that your treatment will be performed by someone who not only has training in injection therapy, but in all types of non-surgical and surgical facial rejuvenation.
The results of soft tissue augmentation using injectable fillers are apparent immediately. Your initial appearance after treatment with any filler may include:
- Mild swelling or bruising
- Temporary numbness or redness
- An “over-filled” appearance to treated areas
These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days.
Where fat is the injected filler, these conditions may persist for a few weeks.
The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect how long your results last.
Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time.
The results of permanent fillers can change over time; as you age naturally, these fillers may shift or clump.
Surgical removal may be necessary to correct these conditions and could result in visible changes in appearance and noticeable changes in the texture of soft tissue.
Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few minutes, as the full process of consultation is not necessary to repeat, although consent is required at each visit.