|Injectable Fillers In Plastic Surgery - A guide
to basic understanding of procedure|
If you're considering
As we age, our faces begin to show the effects of
gravity, sun exposure and years of facial muscle movement, such as
smiling, chewing and squinting. The underlying tissues that keep our
skin looking youthful and plumped up begin to break down, often
leaving laugh lines, smile lines, crow's feet or facial creases over
the areas where this muscle movement occurs.
fillers, most commonly injectable collagen or fat, can help fill in
these lines and creases, temporarily restoring a smoother, more
youthful-looking appearance. When injected beneath the skin, these
fillers plump up creased and sunken areas of the face. They can also
add fullness to the lips and cheeks. Injectable fillers may be used
alone or in conjunction with a resurfacing procedure, such as a
laser treatment, or a recontouring procedure, such as a
If you're considering a facial-rejuvenation
treatment with collagen or fat, this brochure will give you a basic
understanding of the procedure - when injectables can help, how the
procedure is performed, and what results you can expect. It may not
answer all of your questions, since a lot depends on your individual
circumstances. Please ask your doctor if there is anything about the
procedure you don't
Injected collagen and fat are
primarily used to improve the appearance of the skin's texture. They
can help fill out deep facial wrinkles, creases and furrows,
"sunken" cheeks, skin depressions and some types of scars. They can
also be used to add a fuller, more sensuous look to the
Injectables are usually not sufficient for severe
surface wrinkles on the face, such as multiple vertical "lipstick
lines" that sometimes form around the mouth. Instead, your plastic
surgeon may suggest a resurfacing technique, such as chemical peel,
dermabrasion or laser treatments. Rather than filling in facial
lines, resurfacing methods strip away the outer layers of the skin
to produce a smoother appearance.
Deep folds in the face or
brow caused by overactive muscles or by loose skin may be more
effectively treated with cosmetic surgery, such as a facelift or
browlift. Injectables are sometimes used in conjunction with facial
surgery procedures; however, injectables alone cannot change facial
contour the way surgery can.
Keep in mind that a plastic
surgeon is a specialist that can offer you the full gamut of the
most advanced treatments ranging from cosmetic surgery, refinishing
techniques, laser therapy, injectables and the use of other fillers.
You and your surgeon may determine that a single procedure or a
combination of procedures is the best choice for you.
brochures are available on chemical peel, dermabrasion, laser
treatments, facelift and browlift. If you and your doctor think that
one of these other procedures might be more appropriate for you, ask
your plastic surgeon to provide you with a
A word about other types of fillers
This brochure deals with the two most commonly
used types of injectable fillers, collagen and fat. However, to a
lesser extent, a number of other filler materials are also being
used for facial-rejuvenation purposes. They include: Fibril, a
gelatin powder compound that's mixed with a patient's own blood and
is injected to plump up the skin (similar to injectable collagen);
and Gortex, a thread-like material that is implanted beneath the
skin to add soft-tissue support.
Each of these options has
its own set of risks and benefits. If you're considering any of
these alternative filler treatments, tell your
What to expect from
The most important fact to remember about
injectable fillers is that the results are not permanent. Injected
material is eventually metabolized by the body. You should not
expect the same long-lasting results that may be gained from
In some individuals, the results may last
only a few weeks; in others, the results may be maintained
indefinitely. Researchers believe that age, genetic background, skin
quality and lifestyle as well as the injected body site may all play
a role in the injected material's "staying power." However, the
precise reason for the variation of results among patients has yet
to be identified.
If you've had short-lived results from fat
injections, you shouldn't necessarily assume that collagen
injections will work better for you. And, conversely, if you've had
disappointing results from collagen, don't assume that injected fat
is the answer. Although it's true that some individuals' bodies are
more receptive to one substance than the other, others may find that
neither substance produces long-lasting results. Sometimes one
substance may work better than the other for a specific
Risks related to
When injectables are administered by a qualified
plastic surgeon, complications are infrequent and usually minor in
nature. Still, individuals vary greatly in their anatomy, their
physical reactions and their healing abilities. The outcome of
treatment with injectables is never completely
Collagen: Allergic reaction is the
primary risk of collagen. To help determine if you are allergic to
the substance, your surgeon will perform an allergy skin test about
a month before the procedure. After the test is performed, the test
site should be watched carefully for three or four weeks, or as long
as your surgeon advises. Any sign of redness, itching, swelling or
other occurrences at the test site should be reported to your
Risks not necessarily related to allergies include
infection, abscesses, open sores, skin peeling, scarring and
lumpiness, which may persist over the treated area. Reports of these
problems are very rare.
Fat: Allergic reaction is not
a factor for fat because it's harvested from a patient's own body.
However, there is still a small risk of infection and other
Facial rejuvenation is very individualized.
That's why it's important to discuss your hopes and expectations
with a board-certified plastic surgeon who has experience with many
different types of surgical and non-surgical facial
In your initial consultation, your plastic
surgeon will evaluate your face - the skin, the muscles and the
underlying bone - and discuss your goals for the surgery. Your
doctor will help you select a treatment option based on your goals
and concerns, your anatomy and your lifestyle.
will ask you about your medical history, drug allergies, and check
for conditions that could cause problems, such as active skin
infections or non-healed sores from injuries. Collagen injections
are generally off limits for pregnant women, individuals who are
allergic to beef or bovine products, patients who suffer from
autoimmune diseases, and those who are allergic to lidocaine (the
anesthetic agent contained in the syringe with the collagen
material). For more specific information about the contraindications
and risks of collagen use, ask your doctor for the manufacturer's
brochure for patients.
Insurance usually doesn't cover
cosmetic procedures. However, if your injectable treatment is being
performed to treat a scar or indentation from an accident or injury,
you may be reimbursed for a portion of the cost. Check with your
insurance carrier to be sure.
Where your treatment will be
Injectables are usually administered in a surgeon's
office-based facility. If, however, you are being hospitalized for a
facelift, necklift, browlift, or any other procedure, your
injections may be administered in the hospital as
Collagen: Because the anesthetic agent
lidocaine is mixed in with collagen, additional anesthetic is
usually not used. However, if you are especially sensitive to pain,
your doctor may use a topical cream anesthetic or a freon spray to
numb the injected area. Or, you may elect to have an injected local
anesthetic or sedative drugs.
Fat: Both the donor and
recipient sites are numbed with local anesthesia. Sedation can be
used as well. If you elect to use sedation, be sure to arrange for a
ride home after your treatment.
is a naturally occurring protein that provides support to various
parts of the human body: the skin, the joints, the bones and the
ligaments. Injectable collagen, patented by the Collagen Corporation
under the trade names Zyderm and Zyplast, is derived from purified
bovine collagen. The purification process creates a product similar
to human collagen. Injectable collagen received approval from the
Food and Drug Administration in1981. It is produced in various
thicknesses to meet individual patient needs.
used primarily to fill wrinkles, lines and scars on the face and
sometimes the neck, back and chest.
Treatment with collagen can begin after a skin test determines
that you're not allergic to the subsstance. The collagen is injected
using a fine needle inserted at several points along the edge of the
treatment site. If a local anesthesia has not been used, you may
feel some minor stinging or burning as the injections are
Since part of the substance is salt water that will be absorbed
by the body within a few days, your doctor will slightly overfill
the area. You may be asked to hold a hand mirror during the
procedure to help your doctor decide when you've had
After treatment: Immediately following
treatment, you may notice some minor discomfort, stinging or
throbbing in the injected area. Occasionally some bruising or
swelling will occur, but it is usually minor. Any redness that
appears in the injected site usually disappears within 24 hours.
However, in some individuals, particularly fair-skinned patients,
this redness may persist for a week or more. Tiny scabs may also
form over the needle-stick areas; these generally heal
No bandaging is needed and you are free to eat,
drink, and wear makeup with sunblock protection shortly thereafter.
There may be some temporary swelling and redness in the treated area
which should dissipate within a few days. If these symptoms persist,
contact your surgeon.
Results: As stated earlier,
the duration of results from collagen injections is variable.
Collagen's longevity depends on the patient's lifestyle and physical
characteristics as well as the part of the body treated. In general,
the injected material is likely to disappear faster in areas that
are more affected by muscle movement.
Your doctor can help
you determine how long you can go between treatments to best
maintain your results
In the medical world, the
fat-injection procedure is known as autologous fat
transplantation or microlipoinjection. It involves extracting
fat cells from the patient's abdomen, thighs, buttocks or elsewhere
and reinjecting them beneath the facial skin. Fat is most often used
to fill in "sunken" cheeks or laugh lines between the nose and
mouth, to correct skin depressions or indentations, to minimize
forehead wrinkles and to enhance the lips.
After both the donor and recipient sites are cleansed and
treated with a local anesthesia, the fat is withdrawn using a
syringe with a large-bore needle or a cannula (the same instrument
used in liposuction) attached to a suction device. The fat is then
prepared and injected into the recipient site with a needle.
Sometimes an adhesive bandage is applied over the injection
As with collagen, "overfilling" is necessary to allow
for fat absorption in the weeks following treatment. When fat is
used to fill sunken cheeks or to correct areas on the face other
than lines, this overcorrection of newly injected fat may
temporarily make the face appear abnormally puffed out or
After treatment: If a larger area was
treated, you may be advised to curtail your activity for a brief
time. However, many patients are able to resume normal activity
immediately. You can expect some swelling, bruising or redness in
both the donor and recipient sites. The severity of these symptoms
depends upon the size and location of the treated area. You should
stay out of the sun until the redness and bruising subsides -
usually about 48 hours. In the meantime, you may use makeup with
sunblock protection to help conceal your condition.
swelling and puffiness in the recipient site may last several weeks,
especially if a large area was filled.
The duration of the fat injections varies significantly from patient
to patient. Though some patients have reported results lasting a
year or more, the majority of patients find that at least half of
the injected fullness disappears within 3-6 months. Therefore,
repeated injections may be necessary. Your doctor will advise you on
how to maintain your results with repeat treatments.
Your new look
If you're like most patients,
you'll be very satisfied with the results of your injectable
treatments. You may be surprised at the pleasing results that can be
gained from this