AESTHETIC MEDICINE AND SURGERY
Fillers are injectable drugs which are used to improve facial appearance. In particular, they can help to:
- correct skin imperfections related to ageing by filling and smoothing out wrinkles, grooves and depressions due to tissue resorption;
- enhance the aesthetic appearance of ill-defined features, such as lips or areas surrounding the cheek bones which are not in harmony with the rest of the face.
The safest and most commonly used fillers are biological, resorbable and not permanent, as they are metabolized and digested by the body. Conversely, permanent (or very slowly resorbed) fillers are synthetic products, which pose a greater risk of rejection, displacement and infection.
Hyaluronic acid is the most popular biological resorbable filler; a natural polysaccharide present in all human tissues, whose concentration tends to diminish with the ageing process. It is a visco-elastic gel homogeneously integrated into the tissues. Its complete lack of immunogenicity (no antibody response) makes it one of the most used substances in different sectors of medicine. The filling effect – the reduction of wrinkles – and the resultant natural softness are related to its physical and molecular properties. Hyaluronic acid increases skin hydration significantly, as it draws and retains a large number of water molecules. It stimulates collagen formation, which is responsible for skin elasticity and firmness. Therefore, it has two positive effects: filling and forming the tissues, which happens immediately; and skin hydration and nourishment which is delayed and long lasting. Numerous studies have demonstrated that regular treatments with low-molecular hyaluronic acid counteract the negative effects of skin ageing (natural, ultraviolet damage and smoking).
The primary uses of fillers are:
- lip enhancement: size and definition
- nasolabial fold treatment (folds between nose and mouth)
- labiomental crease treatment (folds between mouth and chin)
- forehead line treatment
- facial contouring (zygoma)
Thorough clinical assessment is necessary before treatment:
- Accurate and up-to-date medical history regarding diseases or allergies and possible contraindications to treatment:
- herpes in an active phase
- coagulation disorders (anticoagulant medications)
- definition and evaluation of the aesthetic imperfection (wrinkle, groove, depression) to ascertain there is a valid indication
- assessment and agreement of patients’ expectations both in aesthetic and psychological terms.
How the treatment is performed
Injections of hyaluronic acid are performed on an outpatient basis. A numbing cream is applied to reduce sensation before treatment. Very rarely, in selected cases, nerve blocks are performed. Some minor discomfort can be experienced depending on the injection site and personal sensitivity.
The filler can be injected either superficially into the skin to fill fine wrinkles, or more deeply, to correct skin depressions and marked wrinkles.
Immediately after the procedure some mild redness may be experienced at the site of the injection, which usually subsides in a few minutes. Some minor swelling can be observed at the site of the injection, which usually subsides in a few hours. Sometimes small bruises may occur, which heal in within 4-5 days, and which can be concealed with make-up. Use of ice-packs can prevent and limit their onset.
After thorough disinfection it is possible to apply hydrating creams and make-up.
Treated areas must not be massaged vigorously after the injection, as the filler may be dislocated and its resorption accelerated.
The injected areas must not be exposed to the sun for at least seven days after the procedure, especially if bruises have appeared.
Duration of results
Results depend on the severity of the initial imperfection and the degree of correction is commensurate to the amount of filler injected. Throughout the procedure, it is crucial to assess the degree of enhancement achieved so as to avoid unnatural overcorrections. Nonetheless the treatment can be repeated shortly after to refine the results.
Being a natural substance, slowly and gradually resorbed by the body, hyaluronic acid has limited permanence in the skin. The duration of results varies from patient to patient and is influenced by many factors: age, skin quality, site of infiltration, lifestyle, smoking or non-smoking, alcohol consumption and ultraviolet radiation . Typically results last from six to 12 months. Previous treatments and pre-existing filler deposits provide a base on which to perform a subsequent, more effective and longer-lasting corrections. As such, regular treatments can be used to maintain the correction desired.
Complete resorption of hyaluronic acid provides two important advantages: 1) if the aesthetic result, for some reason, is no longer required, it will take only a number of months for spontaneous return to the pre-treatment condition. 2) there is no risk of a “foreign body reaction” as opposed to non-resorbable fillers.
It is noteworthy that hyaluronic acid can be completely removed if needed, adding to its safety profile. In fact, if the aesthetic result is not to the patient’s liking, it is possible to inject an enzyme (hyaluronidase), able to degrade hyaluronic acid instantly.
Combination with botulinum
In cases of deep and marked expression lines, it is advisable to use botulinum initially to reduce muscle contraction and secondarily a filler. In this instance the filler lasts longer, as reduced mobility – by virtue of botulinum – limits its resorption.