Areas of the face that benefit from tissue filler injections include smile lines around the mouth and eyes, the nasolabial fold between the nose and corners of the mouth, marionette lines that run downward from the corners of the mouth, frown lines between the brows, and some recessed scars from acne or other causes. In addition, it can be used to fill out the orbitomalar septum, nasojugal groove, and lateral malar hollows. The injection process usually takes 15 to 30 minutes and the results are immediate.
Tissue fillers are also used for lip augmentation in patients who either want fuller lips than they were born with or want to restore the fullness they had when younger. Small vertical lines above the upper lip also can be filled.
The volume of collagen-containing supportive tissue beneath the skin naturally shrinks with age and this shrinkage is especially visible in the face. As this tissue volume decreases, wrinkles and creases become apparent and make people look older. An effective way to reduce the appearance of wrinkles is injection of a tissue filler, which is one of the most popular in-office procedures at BodyAesthetic Plastic Surgery.
Types of Tissue Fillers
Some injectable fillers are made from natural substances found in the human body; some are synthetic forms of these substances; and others contain synthetic, biocompatible materials.
Perhaps the most effective and long-lasting filler is a patient’s own fat transferred from another part of the body to fill lines or sunken areas in the face. Some patients undergoing liposuction or another type of body contouring choose to have some of the fat transferred to facial areas.
Current tissue filler favorites available at BodyAesthetic include:
Juvederm Ultra, which is composed of hyaluronic acid, a polysaccharide found naturally in the skin, eyes, joints, and muscles. Injectable fillers made from hyaluronic acids produce longer-lasting results than collagen, but they are not permanent. Juvederm Ultra is indicated for injection into the middle to deep dermis of the skin for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). It is frequently used in other areas, such as frown lines, nasolabial folds, marionette lines, lips, acne scars, filling out the cheeks and filling in deep hollows around the eyes. Juvederm has 24 mg/ml of hyaluronic acid, and approximately 90% of the hyaluronic acid is cross linked. The greater the amount of cross linked hyaluronic acid, the longer the product will last once it is injected. Another characteristic that determines how long a hyaluronic acid lasts is the degree of cross linking. The greater the degree of cross linking, the greater the longevity of the hyaluronic acid. Juvederm Ultra’s degree of cross linking is 6%. Juvederm Ultra persists for at least 9 months. Interestingly, it has been shown that hyaluronic acids do cause some collagen formation with repetitive injections, which means that there is some permanent correction caused by the Juvederm.
Juvederm Ultra Plus, which is composed of hyaluronic acid, a polysaccharide found naturally in the skin, eyes, joints, and muscles. Injectable fillers made from hyaluronic acids produce longer-lasting results than collagen, but they are not permanent. Juvederm Ultra Plus is indicated for injection into the middle to deep dermis of the skin for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). Juvederm Ultra Plus is thicker than Juvederm Ultra, so it is injected deeper than the Juvederm Ultra and is used for deeper folds. Juvederm Ultra Plus has 24 mg/ml of hyaluronic acid, and approximately 90% of the hyaluronic acid is cross linked. The greater the amount of cross linked hyaluronic acid, the longer the product will last once it is injected. Another characteristic that determines how long a hyaluronic acid lasts is the degree of cross linking. The greater the degree of cross linking, the greater the longevity of the hyaluronic acid. Juvederm Ultra Plus’s degree of cross linking is 8%. Juvederm Ultra Plus persists for at least 12 months. Interestingly, it has been shown that hyaluronic acids do cause some collagen formation with repetitive injections, which means that there is some permanent correction caused by the Juvederm.
Juvederm Voluma XC is a new hyaluronic acid filler that is used to increase the volume, contour, and fullness in the cheek (malar or midface) region. A youthful face is characterized by full, high, round cheeks. As a person ages they lose volume in the midface, which causes sagging of the cheeks and gives a flat appearance to the face. It also makes the nasolabial folds more prominent and can worsen the appearance of the jowls. Adding volume back to the midface (cheek region) can help to restore the youthful curve to the cheeks, decrease the nasolabial folds, and improve the jowls.
A simple way to get an idea of the improvement that can be achieved with fillers to the midface is to look in the mirror with a relaxed face, then look in the mirror with a full smile, and compare the difference seen in the cheeks when relaxed and smiling. Adding volume back to the cheek region can give a similar result.
Juvederm Voluma XC is composed of a modified hyaluronic acid utilizing Vycross technology that is used to add volume to the cheek area. This a non-surgical procedure performed in the office in which the hyaluronic acid is injected into the cheek region to increase volume and fullness. Voluma XC is approved for deep injection into the subcutaneous fat and/or supraperiosteal region of the cheek creating the lift of the cheeks and restoring volume. Since Voluma XC contains lidocaine, it significantly reduces the pain and discomfort associated with the injections. The results last for approximately two years after the treatment, making it the longest lasting hyaluronic acid filler. Following treatment with Voluma, patients feel the treatment takes 5 years off of their appearance. Hyaluronic acid fillers have been shown to cause collagen formation, which means that future treatments need less volume of product to achieve the desired results.
In general, side effects after a treatment with Voluma resolve quickly and are not usually severe. These side effects can include swelling, bruising, redness, pain/tenderness, firmness, lumps/bumps, itching and discoloration. If filler is injected into a blood vessel, it can cause occlusion or blockage of the blood vessel. This has been seen with all types of fillers, including hyaluronic acids. The technique of withdrawing and aspirating the needle while injecting can significantly reduce the risk of injection into a blood vessel.
Juvederm Volbella, XC is specifically formulated to add subtle volume to thin or flat lips and soften the appearance of lip lines. We all have lines in our lips, but they tend to deepen with age; also, vertical lines can appear around the edges of the lips, contributing to an aged appearance. Volbella is designed to minimize the prominence of lines on and around the edges of the lips for a more youthful looking expression.
Formulation-wise, Volbella is a finer filler than Juvederm Ultra or Juvederm Voluma. Thanks to its unique formulation, the product adds volume to the lips in a way that looks completely natural, never overdone. After treatment with Volbella, the lips appear plumper and shapelier without looking overcorrected or obviously augmented.
The results of treatment with Volbella appear almost instantly and can last up to a year. According to data from the product’s manufacturer, Allergan, 80% of people treated experienced improved satisfaction with their lips one year after their injections.
Restylane, which is composed of hyaluronic acid, a polysaccharide found naturally in the skin, eyes, joints, and muscles. Injectable fillers made from hyaluronic acids produce longer-lasting results than collagen, but they are not permanent. Restylane is indicated for injection into the middle to deep dermis of the skin for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). It is frequently used in other areas, such as frown lines, nasolabial folds, marionette lines, lips, acne scars, filling out the cheeks and filling in deep hollows around the eyes. Restylane has 20 mg/ml of hyaluronic acid, and approximately 80% of the hyaluronic acid is cross linked. The greater the amount of cross linked hyaluronic acid, the longer the product will last once it is injected. Another characteristic that determines how long a hyaluronic acid lasts is the degree of cross linking. The greater the degree of cross linking, the greater the longevity of the hyaluronic acid. Restylane’s degree of cross linking is less than 2%. Restylane persists for at least 6 months. Interestingly, it has been shown that hyaluronic acids do cause some collagen formation with repetitive injections, which means that there is some permanent correction caused by the Restylane.
Collagen (from cows) was the most popular tissue filler available for many years, but its use has diminished because bovine collagen requires allergy testing that takes a month before injections can begin. Newer forms of collagen (CosmoDerm and CosmoPlast) eliminate the need for allergy testing so injections can be done immediately.
What To Expect After Receiving A Tissue Filler
Tissue filler injections are administered in the office under local anesthetic. The injections are not painful and require little or no downtime. Results are immediate with most filler products. You may experience some redness, tenderness, or itching at the injection site, but this should be gone within a few days. The most common complication of fillers is bruising at the site of injection. Some medications make you more prone to bruising, so it is beneficial to avoid these medications for a week prior to your injections. Examples of these medications include: aspirin, non-steroidal anti-inflammatory medications (ibuprofen, motrin, naproxen), vitamin E, omega 3 fatty acids, and fish oil.
At BodyAesthetic Plastic Surgery we use only those injectable fillers that we believe are safe over the long term and have been approved by the FDA for facial use. Your surgeon will explain the type of filler recommended for you and why. He will also discuss the results you can expect and how long those results should last.
New types of tissue fillers are being introduced all the time as their popularity increases, so you may want to ask about what’s new or coming in the near future.
