Filler Implants

	Collagen fills in scars and wrinkles.

Most implants used for wrinkles are produced in strips or threads, so each piece of material has two ends and is threaded through the area of tissue being filled. After the location for each incision is disinfected, a local anesthetic will be injected. Once the skin is numb, the doctor will make a tiny incision at each end of the crease or wrinkle.Then, with a special threading device, the implant material is pulled from one incision through to the other incision. Next, the ends are trimmed and a single, hair-thin stitch is placed at each end to hold the implant in place while the incisions heal. In some cases, a kind of suture is used that will simply fall out on its own. Otherwise, your doctor will need to remove the stitches in a few days.

The incisions' locations will vary, of course, with the location of the wrinkle or groove being filled. Basically, however, incisions are hidden at the top and bo tt om of the line or fold being treated.

After Your Procedure
Filler Injections

	Collagen adds volume to the lips and adds definition to the border.

One of the reasons injection fillers are so popular is that the results are virtually instantaneous.The wrinkle or sunken area will be softened and less pronounced, and your face will be subtly redefined. For a few days, you may have a li t t le temporary swelling or puffiness, so the result you first see in the mirror will improve once the swelling resolves. Some short-term redness is possible, too.

Your doctor will give you detailed instructions on how to care for your skin after your treatment. Because filler options vary so widely, the follow-up care varies, too. For most injections, you'll simply need to keep your face clean of cosmetics for a day. Ask your doctor if it's okay to apply a cold pack to reduce swelling. It's important to ask since you should not apply cold or heat to an area that has been treated with hyaluronic acids.

Filler Implants

A synthetic implant can reshape your face more distinctly than an injection. Swelling will usually be more pronounced with implants than with injections, but will be gone in a few days (and is rarely severe enough to make you want to hide at home for more than a day). Temporary bruising often appears on the skin above where an implant is placed, but this can be covered by makeup.

The improvement is seen immediately; however, the final, filled-in effect of your implants is normally apparent after about three months, when your own tissue growth has had time to make its contribution, too.You will notice that the treated areas of your face look firmer, with more defined contours. Where once there was a depression or deep groove, a smoother, younger-looking surface has appeared.

How Long Will Results Last?

	Softening of “marionette” lines, which run from corner of the lips down toward the chin, with hyaluranic acid.

As mentioned throughout this chapter, the results of temporary injectable wrinkle fillers can last anywhere from three months to a year. Some of the newer soft tissue fillers may last up to two years.These results vary from person to person, depending on how your own body responds to the substance. Overall, however, the definition of what's temporary for you largely depends on the depth of the area treated, how much material is injected, and how much of your own collagen and tissue repair your body produces. Again, this is variable, so your best guide will be what you observe in the mirror.

Permanent implant fillers are just that. Most of them will last longer than you do, unless for some reason you decide to have them removed. Occasionally, individuals request removal because they are not happy with how an implant looks, or are unusually sensitive to its feel. More often, people who feel a new sensation with an implant quickly adapt and soon do not even notice it.

Potential Risks

An allergic response to either bovine or donor collagen (derived from tissue banks) is possible, although allergy testing should forestall this problem. Now and then, filler treatments may produce a lumpy appearance in the skin.

As mentioned earlier, as autologous fat is reabsorbed by the body, it can sometimes happen in an irregular way, creating an uneven surface. Also, there is a risk of infection at the site where fat is harvested and at the injection site.

There is a small risk of inflammation or infection at the ends of thread-like implants where they meet the suture areas, but prophylactic (preventative) antibiotics may be prescribed to prevent this. Sometimes, an implant may later appear to have moved or shifted. If you sense this, see your doctor, who can remove and reinsert it.

Combining Filler Procedures with Other Procedures

Soft tissue fillers can be used to complement virtually any other cosmetic facial procedure. They are most commonly used to fill in nasolabial folds when facelifts are performed. Fillers may also be used to fill lines in the forehead when a Endoscopic Forehead Lift is done.

Questions to Ask the Surgeon?

• What are your medical credentials?
  
• What type of filler treatment is appropriate for me?
  
• Do I need an allergy skin test?
  
• What kind of pain medication is available to me?
  
• How quickly will I recover?
  
• Can you show me before-and-after photos of other patients?
  
• How should I care for my skin before and after the filler?
  
• Should I stop taking my usual medications or supplements?

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