Web Log – July 2011 – Injectable Fillers

Injectable fillers for facial rejuvenation has become a frequently performed treatment.  This month, I will discuss the types of fillers and the advantages and disadvantages of using them.

Have you ever thought about exactly why we look older as we age?   As it turns out, Plastic Surgeons and other related specialties think about this quite a bit.  One of the most noticeable changes is in the skin surface – pigment and texture irregularities.  That is why it is best to avoid sun exposure, use sun screen, and visit your friendly esthetician for skin products, microdermabrasion, and laser photofacials.  The skin also loses elasticity and sages.  Tightening procedures like facelifts improve this problem.  Finally, there are changes in fat distribution.  It is controversial exactly how this occurs, but suffice to say that older faces seem to have fat in all the wrong places.  That is where fillers come in to play.  They can supply volume where it is missing.

The gold standard in volume replacement is fat.  This my favored filler, but it is best performed in an operating room and often requires several sessions for the best effect.  The desired effect, once achieved, is durable and the fat seems to improve the condition of the overlying skin.  Another filler is Sculptra.  It was originally used to replace volume in patients with HIV associated atrophy of the facial fat.  The substance is relatively expensive, has a delayed effect, and lasts a couple of years.

The most commonly injected fillers, however, are hyaluronic acid based.  Hyaluronic acid is a “ground substance” molecule that is found in our tissues where it provides bulk and holds fluid.  It is relatively inexpensive and can be injected under a local anesthetic in an office setting.  There is usually little bruising and the effect is immediate.  The effect however, is far from permanent.  It seems to last 6 months to greater than a year in the face, except in the lips where it is usually gone by 6 months.  While that time frame does not sound very appealing, it does make sense if one puts it into proper perspective.  Women frequently spend significant sums of money to color their hair or paint their nails and accept that these improvements are temporary.  If the price is right ( and that is an individual judgement ), then temporary filler injection is really no different.  In addition to limited time effect, fillers may also cause contour irregularities (bumps) which are normally short lived, but under rare circumstances may cause more serious problems.

My preferred hyaluronic acid filler is Juvederm because I like how it injects.  Restalyne is another similar product which is excellent as well and preferred by many.  Radiesse is hyaluronic acid with small spheres of calcium hydroxyapatite ( the salt found in bone ) which lasts longer, but has been associated with greater granuloma ( serious bump ) formation.  It is not for use in lips for this reason.  Juvederm is most commonly injected into the lips, nasolabial folds ( crease from the nose to the corners of the mouth ), and marionette lines ( creases from the corners of the mouth to the lower border of the mandible ).  Juvederm can be injected into the hollows below the eyes, but there can be problems with seeing and feeling the material.  Juvederm can be dissolved with an injection of hyaluronidase.

Another big reason why fillers are often injected is that you do not have to be a Plastic Surgeon to do it.  A Plastic Surgeon, however, is experienced in aesthetic judgment and can perform all the appropriate options for rejuvenation with the proper perspective.  In addition, filler injection by a Plastic Surgeon typically costs no more than by another provider; prices are fairly standard because patients will go elsewhere for a better price.  So, if you look in the mirror and are considering a filler, schedule a consult for a full evaluation.

Mark D. Wigod, MD, FACS

Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region

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