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SOFT TISSUE FILLERS
Definitions and Terms:
Filler: a substance injected into soft tissue (the skin) to expand it for cosmetic benefit.
"Off label": a term referring to the use of a product which is approved by the FDA for use in the human body, but at this time not for the particular procedure we are using it for. It is perfectly legal and done in everyday practice. A physician has the freedom to use products "off label" if prudent in his judgment, as long he fully informs the patient and the patient understands and gives consent.
Correction: improving cosmetic defects in the skin which are usually depressions (creases, wrinkles, folds) "Filling" them can make them blend with the surrounding skin surface.
Augmentation: adding volume to areas to restore or enhance their appearance, usually the lips, cheeks, or brows.
Contouring: shaping or repositioning areas such as mouth corners or upper eyelid skin.
Properties of a good filler:
Biocompatibility: able to live in perfect harmony with surrounding tissue. Causes no adverse reaction (allergic, inflammatory etc.) No skin test needed.
Lasting effect: able to sustain the desired effect for months to years.
User friendly: easy to work with, able to inject smoothly thru small needle.
Affordability: reasonable cost for the duration of effect.
What I use:
Restylane®: Hyaluronic acid. Has replaced collagen as the ‘gold standard’ for fillers, because of its near perfect tissue compatibility and longer duration compared to collagen. Superb for all aspects of the lips and mouth. Duration approx. 3-6 months.
Radiesse®: Calcium hydroxyapatite (tiny calcium beads). Off label. Radiesse is my preferred filler because of its longer duration (approx. 1 year), at about the same cost as Restylane. Radiesse is excellent for lip border enlargement, nasolabial folds, marionette lines, creases around the mouth, mouth corners, cheekpad enlargement, glabellar (between the eyebrows) creases, and raising upper eyelid sagging skin.
Silikon 1000®: Microdroplet silicone. Off label. Safe, effective, and permanent, but must be used in proper locations with proper technique. The tissue enlargement does not come from the silicone, since such tiny amounts are injected. The droplets gradually (over 1 month) attract a coating of collagen and fibrous cells which brings in the volume increase. The results, therefore, are not immediate as with other fillers, but once obtained are permanent. Shallow, sharp creases are good candidates and typically need 2-4 sessions over 1-3 months. Considering the permanency, this is the least expensive option. I use it mostly around the mouth (not lips) and in the glabellar area.
Things to know:
Discomfort and pain with injections varies widely, depending upon material, location, amount used etc. This sometimes necessitates the use of anesthetic nerve blocks to make the treatment pleasant.
Splitting the treatment into 2 sessions (the 2nd being a touch up), usually improves the final result.
The most common reason, by far, for a less than satisfactory result….is not using enough filler!
New fillers are always on the horizon, since FDA approval is a long process. Fillers are often in wide use around the world, before gaining approval here in the U.S.
Artefill® is a permanent filler utilizing tiny plastic beads, that should become available by December 2005.
Fillers in certain locations (e.g. between the eyebrows) last far longer when combined with Botox®.
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