Injectable Filler Information on Restylane, Fat Transfer, by Board Certified Plastic Surgeon in Los Angeles County
If You're Considering Injectables...
As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling,
chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving
laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.
Soft-tissue fillers, most commonly injectable hyaluronic acid (Restylane) or fat, can help fill in these lines and creases,
temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased
and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction
with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.
If you're considering a facial-rejuvenation treatment with Restylane or fat, this brochure will give you a basic understanding
of the procedure - when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all
of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure
you don't understand.
Knowing Your Options
Injected Restylane and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial
wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more
sensuous look to the lips.
Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that
sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion
or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a
smoother appearance.
Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery,
such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone
cannot change facial contour the way surgery can.
Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from
cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine
that a single procedure or a combination of procedures is the best choice for you.
ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your doctor think
that one of these other procedures might be more appropriate for you, ask your plastic surgeon to provide you with a copy.
A Word About Others Types of Fillers
This brochure deals with the two most commonly used types of injectable fillers, Restylane and fat. However, to a lesser extent, a
number of other filler materials are also being used for facial-rejuvenation purposes. They include: Fibril, a gelatin powder compound
that's mixed with a patient's own blood and is injected to plump up the skin (similar to injectable collagen); and Gortex, a thread-like
material that is implanted beneath the skin to add soft-tissue support.
Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments,
tell your doctor.
What to Expect From Treatment
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually
metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.
In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers
believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected
material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.
If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better
for you. And, conversely, if you've had disappointing results from Restylane, don't assume that injected fat is the answer. Although
it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance
produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.
Risks Related to Injectables
When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still,
individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables
is never completely predictable.
Restylane: infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of
these problems are very rare.
Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small
risk of infection and other infrequent complications.
Planning For Treatment
Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified
plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.
In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and
discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy
and your lifestyle.
Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as
active skin infections or non-healed sores from injuries. Restylane injections are generally off limits for pregnant women, patients
who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent injected prior to the Restylane
material). For more specific information about the contraindications and risks of Restylane use, ask your doctor for the manufacturer's
brochure for patients.
Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or
indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.
Where Your Treatment Will Be Performed
Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift,
necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.
Types of Anesthesia
Restylane: A local anesthetic is usually injected before the Restylane injection. However, if you are especially
sensitive to pain, your doctor may use a topical cream anesthetic to numb the injected area. Or, you may elect to have additional
sedative drugs.
Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you
elect to use sedation, be sure to arrange for a ride home after your treatment.
The Treatments
Hyaluronic acid
Restylane creates beauty with a gel based on a natural substance called hyaluronic acid. It gives natural volume in your skin to
lift and produce new firmness, resulting in a healthy, vital appearance.
Hyaluronic acid exists naturally in all living organisms and is a universal component of the spaces between the cells of body
tissues (extracellular space). It is a polysaccharide that has an identical chemical structure, no matter whether it is found in
simple bacteria or in human beings.
Hyaluronic acid was first used commercially in 1942 when Endre Balazs applied for a patent to use it as a substitue for egg white
in bakery products. He went on to become the leading expert on hyaluronic acid and made the majority of discoveries relating to
hyaluronic acid over the next fifty years.
In the last two decades, the therapeutic and aesthetic uses of hyaluronic acid have been extended to a number of areas, including
the treatment of joint pain, use in fertility clinics and tissue augmentation. In the past few years, biotechnology has been used to
develop hyaluronic acid derivatives with tailor-made molecular sizes, which will further increase the potential applications of this
remarkable molecule.
Restylane is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.
The procedure: Achieving the look you desire is as easy as it is quick. The result is instantaneous. No previous
skin test is needed, which means that you can have the treatment immediately. The session often takes less than thirty minutes.
The time differs somewhat depending on the correction you want to have performed. During treatment, Restylane is injected into the
skin in tiny amounts with a very fine needle. When injected into the skin, Restylane produces volume that smoothes the wrinkle or
fold, shapes the facial contour or enhances the lips in a natural way. The result is immediate. The method of injecting Restylane
is fast and safe and leaves no scars or other traces on the face.
Pain reduction: For wrinkle treatments, pain relief is not required by all patients; however it can be easily
arranged at your request. Prior to your procedure, a topical anaesthetic cream can be applied to the area to be treated. You can
also choose to have a local anaesthetic injection.
After treatment: Immediately after the treatment, you can expect a slight redness, swelling, tenderness and an
itching sensation in the treated area. This is a normal result of the injection.The discomfort is temporary and generally disappears
in a few days. When it comes to lip augmentation, the swelling may last longer. Some patients experience swelling for about a week.
During this time, the lips can look somewhat uneven. This means that the result directly after the treatment should not be regarded
as the final result. If the discomfort continues or if other reactions occur, you should always contact your practitioner.
No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be
some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact
your surgeon.
A touch-up treatment within 2-4 weeks after the initial treatment may be necessary to achieve an optimal correction.
Your doctor can help you determine how long you can go between treatments to best maintain your results.
Fat
In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves
extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is
most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations,
to minimize forehead wrinkles and to enhance the lips.
The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat
is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction
device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over
the injection site.
As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill
sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the
face appear abnormally puffed out or swollen.
After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time.
However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both
the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should
stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with
sunblock protection to help conceal your condition.
The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.
Results: The duration of the fat injections varies significantly from patient to patient. Though some patients
have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears
within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with
repeat treatments.
Your New Look
If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at
the pleasing results that can be gained from this procedure.
Content courtesy of PlasticSurgery.org
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