The world of facial injectable treatments can be overwhelming with all the options seen in print and TV ads. New injectable materials seem to come out almost weekly! Here is a run-down of the injections we most often perform, where we use them, and some common side effects.
The vast majority of frequently used fillers are made of a material called hyaluronic acid (HA). This is a chemical structure found in our bodies, so the filler itself is usually well tolerated. By processing the molecule in different ways, we are able to manipulate the thickness, the amount of volume effect, and the longevity. Most definitely, depending on your particular area of concern, there are times where you would desire volume and longevity, but not need fine lines to be treated. On the other hand, you may desire smoker’s lines around the mouth to be improved, but not want a lot of volume or swelling in the mouth area. Hyaluronic acid fillers are so versatile particularly for this reason, and come packaged in a variety of forms: Juvederm, Volbella, Juvederm Ultra Plus and Voluma, Restylane, Restylane Silk, Restylane Refyne/Defyne, Lyft and Belotero. Your facial plastic surgeon will recommend the use of particular kinds of HA fillers based on the anatomic area, the desired outcome as well as their preference and experience.
Hyaluronic acid is a water-loving (hydrophilic) product. This leads to an expected side effect of swelling. The degree of swelling depends not only on the person, but the things you do and even eat after an injection. Keeping your hands off the area injected, using cold compresses, and keeping your head elevated the first night after facial injections can help significantly reduce the amount of swelling. Reducing alcohol intake and keeping your salt level low the first night can help also. Expect some swelling the first day after injections, but usually it drastically reduces after that. Rarely, patients are hypersensitive to this product and can exhibit a true allergic response. This appears as more significant swelling, itching, and even redness at the injected areas. Obviously if this occurs, your surgeon should be alerted, and medical treatment can be initiated. The biggest benefit to HA fillers is that with another enzyme injection, they can be dissolved, rendering this filler essentially reversible.
Aside from HA fillers, other fillers do exist in the US market and are extremely useful for certain areas. Permanent fillers, such as Artefill, can be helpful for areas that have deep folds and are unlikely to change dramatically over time, such as the nasolabial folds (lines from the nose to the mouth). The obvious downside to permanent fillers is that if there is a reaction or a less than desirable result, the process is not reversible.
Radiesse, also a popular filler, is made of a material called calcium hydroxyapatite. This material is thickner and longer lasting than HA fillers but is not dissolvable either. It is temporary, however, not permanent like Artefill. Because of the composition of this filler, it is recommended for deeper injection such as nasolabial folds (lines from nose to mouth) and possibly cheek or deep temple injections. Concerns with this filler include the risk of injecting into a blood vessel which can affect blood supply to a specific site of skin, causing serious complications, or visibility and lumpiness with injection closer to the skin than ideal. When used correctly, however, this filler can be very beneficial for deep folds and volume.
Sculptra, also categorized as a filler, is better thought of as a collagen-stimulator. This is intended for patients who need larger areas of gradually-increasing, more subtle volume. Because of the composition of Sculptra, it is hydrated with water for 48 hours before injecting and then injected in small doses throughout the tissues under the skin. The process of volumizing takes up to six weeks for each vial injected, with the recommendation being at least 3 vials to get to full correction per area treated. Benefits include a more natural-appearing result and gradual increase in volume rather than abrupt change, but that can also be perceived as a downside since results can take several months to become apparent.
So how do you determine the ideal filler for the area you are interested in treating? The best answer is to consider carefully what areas are most bothersome to you and make an appointment for consultation with a board-certified Facial Plastic or Plastic Surgeon with experience treating the face. Depending on the area of concern, the depth of the issue and the thickness of the material, your surgeon will determine the best product for injection. Each of us has cultivated years of experience with many of the fillers available on the market and has individual preferences based on those experiences. Feel free to ask questions, return for a second discussion or look at photos if you deem it helpful. Ultimately, what all of us want is a happy patient, so make sure your desires are communicated effectively to ensure your best result!!