Injectable fillers also known as wrinkle fillers, dermal fillers or facial soft tissue fillers are soft gel substances that are injected under the skin to fill in deep facial lines and creases. They are also used for correction of defects or depressions in the face resulting from age or trauma, to restore volume loss from aging in areas such as the under the eye and cheeks, or to enhance the lips or cheeks. When performed by an experienced plastic surgeon and with appropriate filler for the specific application, soft tissue augmentation and dermal filling provide predictable and consistent aesthetic outcomes. Immediate results with minimal risks an almost no downtime together with the current trend toward less invasive nonsurgical rejuvenating procedures makes them increasingly popular. However, it should be kept clear that when used for correct indications they can temporary eliminate signs of aging and postpone more invasive surgical procedures but cannot replace them. To learn more about current approach to facial rejuvenation, please follow the link.

Depending on the type of filler and the depth at which it is injected fillers can be used :

• for correction of moderate to severe facial wrinkles and skin folds. Most commonly treated are the nasolabial folds (which run from the nose to the corner of the mouth), marionete lines (that run down from the corners of the mouth to the jaw), vertical lines on the upper lip.
• to increase the size of the lips as well as to improve the definition of the cupid’s bow or vermilion border. Anybody considering permanent lip augmentation should preliminary try augmentation with absorbable filler to get an idea about the outcome.
• to fill in the lines and hollowness underneath the lower eyelids called the tear troughs
• to rejuvenate and add volume to cheeks or chin
• to improve contour deformities and recessed scars
• to rejuvenate the hands
• to correct inverted nipples

In recent years, the number of available fillers increased dramatically, expanding the range of options available to patients. The injectable substances vary considerably in physical properties and clinical performance. Based on the source they may be classified as autologous, biological, or synthetic and based on duration of cosmetic benefit they may temporary (short, medium or long lasting) or permanent.

To reliably achieve successful outcomes, the physician must have a thorough understanding of facial anatomy and the injection technique to be employed. In addition different characteristics, capabilities, risks, and limitations of the injected material must be well known in order to provide optimal care and avoid complications. At the initial consultation,  the relative merits of injectable fillers and other competing or complementary surgical treatments must be discussed with the patient. Duration of effect, advantages and drawbacks for each option should be clearly presented. The physician must also have the ability to prevent unnecessary discomfort during treatment, and must be able to identify and manage complications, should they arise during or after treatment. Our goal is to provide individualized treatment, taking into account factors such as the patient’s social schedule, aesthetic preferences, desires and complications tolerance. Attention to differences in skin thickness and texture, area to be treated and age, warrant a customized approach for a natural result and high patient satisfaction rate.

The most popular fillers are those made from cross-linked hyaluronic acid (HA), which is naturally occurring substance in our bodies. It attracts water and hydrates the skin. A major advantage of HA fillers is that they can be quickly and easily reversed by the injection of hyaluronidase (an enzyme which breaks down hyaluronic acid) into areas in which elimination of the filler is desired. The biocompatibility, long-lasting (but not permanent) effects, broad range of facial aesthetic applications, low incidence of complications, reversibility, and versatility are characteristics of HA fillers that guarantee good results and a high level of patient satisfaction. Therefore, only limited subsets of physicians and patients are willing to accept the higher complexity and risks associated with the use of permanent fillers.

Different injectable fillers last different periods of time in different patient, since each patient, metabolizes filler differently. The results of objective scientific studies have shown that hyaluronic acid fillers last from 6-12 months. In areas of increased activity such as around the mouth fillers are absorbed faster compared to the other sites.

All of the injectable fillers are placed by an injection and carry the usual risks of bruising, swelling, minimal pain and local infection. With appropriate use, the most popular, hyaluronic acid fillers have less than 1% incidence of adverse reactions. In addition, complications are rarely serious and usually resolve without treatment. Resolution can also be significantly accelerated by injection of hyaluronidase. In contrast to these fillers, longer lasting and permanent fillers may produce undesirable effects and complications that are more difficult or impossible to manage. More serious adverse reactions include areas of excess fullness or nodules, allergic reactions, granulomatous or inflammatory reactions, migration of filler, severe infection. Complications associated with fillers may require injection of corticosteroids, treatment with systemic corticosteroids or antibiotics, surgical intervention or incision of the affected area with a large bore needle and expression of the filler.