What are Cosmetic Fillers?
Many aspects within the field of plastic surgery are changing. One of the biggest changes is our understanding of what causes facial aging. First, we thought the process was mostly limited to skin and, therefore, most of the procedures were skin rearrangement procedures and tightening. Now, we know that aging actually involves all layers of the soft tissue within the face. We now know that facial aging is actually the result of fat loss and fat descent as well as skin and muscle laxity.
Regarding soft tissue fillers, what we are mostly concerned about, in terms of facial aging, is fat loss and fat descent as we get older. Once we believed that all wrinkles and skin excess were caused from skin stretching. Now, we know that many wrinkles, skin excess, as well as the general appearance of aging are caused by the volume loss of fat and soft tissue underneath the skin. Just like when you remove the volume (water) of a grape you are left with a wrinkled raisin. By injecting volume, many wrinkles can be eliminated or at least reduced.
Soft tissue fillers are growing dramatically as physicians find that many signs of aging can be improved by injecting volume. Ten years ago all we basically had was collagen. While collagen is still extremely useful for fine wrinkles it did not fill in larger areas and had several draw backs. One of the major draw backs was its longevity. It only lasts 2-3 months. Another draw back was that patients needed to be allergy tested 3 weeks before the injection.
With advancing technology these problems have been improved. The newer soft tissue fillers last longer and do not require allergy testing. How much longer? Which filler is best for what area? These two issues are what is exciting in this aspect of plastic surgery. This is what the bulk of this educational presentation is directed toward.
Benefits
There are many of the benefits of soft tissue fillers. Here is a summary:
- Fills in wrinkles of the forehead and between the eyes.
- Fills out the temple hollow.
- Plumps up the upper lid and eyebrow giving appearance of a brow lift
- Fills in hollow of upper eyelid giving a more youthful appearance
- Fills in the crease below the lower eyelid.
- Camouflages lower eyelid bags by filling in the crease.
- Fills in the tear trough located under the eye close to the nose.
- Does a remarkable job of creating fuller cheeks.
- Improves upper lip crease (naso-labial fold)
- Provides excellent lip augmentation that can be adjusted according to patient desires.
- Fills in fine wrinkles above and below the lips.
- Fills in Marionette lines.
- Diminishes acne scars.
- Can help to fill in depressed scars.
- Is quick with minimal discomfort.
More of it can be added until the desired results are achieved. It is safe and relatively low cost.
Why do we need soft tissue fillers?
As mentioned above, the last ten years have uncovered many major developments in the field of plastic surgery. Many of these developments were focused on what really is the cause of facial aging. No longer is the appearance of aging attributed primarily to sagging skin. Now, the focus is on what goes on beneath the skin and within the skin itself.
As we age the skin loses its elastic properties and stretches. The stretching part can be markedly improved by skin tightening. The elastic component is more difficult to correct and, to date, only minor advancements have been made. These include chemical peeling or laser resurfacing, a good skin care regimen, retinoic acid, AHA, and staying out of the sun for prolonged periods of time. This is where significant developments have been made and will continue to be made.
As we age we notice that the cheek fat that was once firmly perched on top of the cheek bones begins to descend. This descent goes primarily to two places. One, above the upper lip creating a more pronounced upper lip fold (naso-labial fold). The second place is over the jaw line resulting in jowling.
When these two problems become significant, correction is most effectively treated with a face lift by a skilled plastic surgeon. Soft tissue fillers, however, do a very good job of filling in the wrinkles and depressions left behind by the descending or loss of facial fat.
1. Forehead Wrinkles
As we age, the forehead wrinkles become more and more evident. This is not because the muscles have gotten larger but because the subcutaneous fat over the muscles has gone away. With the fat gone, there is no longer a nice, cushy buffer between the skin and muscle. Therefore, the muscle acts directly on the skin; hence, the wrinkles.
2. Temple hollowing
Another sign of aging is the gaunt look that begins to develop within the temple area. Eventually, you can see the outline of the skull as the fat descends or goes away.
3. Eye Brow and Upper Eyelid Sag
As described above, This is an area that patients of your Dr often ask for skin removal or brow elevation. While this may be the case, fat loss is often to blame as well. Both the appearance of brow sag and the excess of upper eyelid skin are caused primarily by the same problem; loss of soft tissue volume. The reason why the brows appear to sag in the older woman is because without this plump fat BELOW the eyebrow there is a deep, hollow crease. This gives a sunken, aged appearance.
Ironically, aggressive removal of the excess skin will accentuate this hollowness. Some surgeons still remove fat from the eyelid which is almost never necessary except in some ethnic groups such as asians.
4. Lower Eyelid Bags, Lid/Cheek Crease
With the descent of the cheek fat, the fat leaves the lower eyelid as it heads south. This exposes the underlying skull bone and creates a crease. You can feel this by pushing down on this area with your fingers. Sometimes, this crease is present even in young patients. When this crease occurs there is often an excess of fat just above the crease, i.e. bags. There are many factors involved in this area with the aging process but, soft tissue loss, is a significant factor.
5. Loss of Cheek Mound
Cheek fat descends with age. Some of the fat simply goes away. This accounts for the loss of cheek fullness and gaunt look of the face. The fat ends up above the upper lip creating an unattractive lip fold or it descends over the jaw line creating a jowl.
6) Naso-Labial Crease
The deepening of this crease is caused by the exact process that causes loss of cheek fat. As the cheek fat descends it gathers in this fold. Just below this fold forms a deeper crease.
7. Lip Augmentation
LIps are different than the other areas of the face. Soft tissue fillers are used in other areas to rejuvenate but fillers in the lips are also performed to enhance the sensual component of the lip. This is why the lips are unique. Consequently, this is the reason why it is the most common area augmented with fillers. One should not underestimate the rejuvenation effects of soft tissue fillers on the lips. Lip augmentation is an excellent way to make the entire face look younger. This is because as we age our lips get smaller.
8. Marionette Lines
Marionette lines are extensions of the naso-labial folds. They extend from the corner of the mouth down to the jaw line. It is named because these lines look like the lines formed by the moving mouth of a marionette puppet. It is not uncommon to see these lines in young people as well. Filling these wrinkles in with soft tissue fillers can effectively improve or eliminate these lines.
Are you a good candidate?
Aging is a progressive process causing us to wrinkle and to lose facial fat. Good candidates are simply people who have suffered the effects of aging and subsequent wrinkling. With the advancing properties of the soft tissue fillers, the effects of aging can be postponed. This can delay the need for surgical correction.
Not all wrinkles should be treated with a soft tissue filler. Wrinkles that occur with smiling or facial movement are best treated with BOTOX® Cosmetic.
The typical patient who will benefit from soft tissue fillers are those with
1. Forehead wrinkles
2. Hollowing of the Temple
3. Volume loss of the Brow and Upper lid. Soft tissue filling may delay the need for surgical correction here.
4. Sunken crease underneath the lower lid.
5. Lower lid bags.
6. Loss of cheek fullness
7. Deep crease above upper lip (naso-labial crease)
8. Small lips.
9. Someone desiring more dramatic, sensual lips.
10. Marionette lines
11. Depressed scars of the face
12. Depressed acne scars.
Possible complications
The most common complication is inadequate augmentation of the desired area or incomplete removal of the wrinkle. This is easily treated by adding more volume. Other possible complications include too much augmentation, allergic reaction, lumpiness, infection, bruising, swelling, and skin changes.
Recovery time
Recovery time depends on the amount and location of the injection. Typically, the swelling will subside in two days. Many patients go back to work immediately. With fat transplantation, the swelling will last considerably longer. The swelling will last up to 6 weeks but the majority will be gone by 2 weeks.