Injectable Fillers

THE VISIBLE SIGNS OF FACIAL AGING OCCUR OVER TIME AS A RESULT OF MANY FACTORS INCLUDING SUN EXPOSURE, HEREDITY AND LIFESTYLE. One of the earliest signs of aging is a loss of facial fullness and the development of expression lines - wrinkles that appear as a result of the repeated movement of facial muscles. Softening of these facial lines and creases, and the restoration of volume and fullness in the face can often be achieved non-surgically through treatment with injectable fillers.
If you wish to enhance or restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you. Injectable fillers can plump thin lips, enhance shallow contours, soften facial creases and wrinkles, and, in some cases, improve the appearance of recessed scars.

The result is a smoother, fuller and more youthful facial appearance.
This brochure presents an overview of soft tissue augmentation with injectable fillers. The best way to learn how this type of therapy can help fulfill your personal goals for facial rejuvenation is a consultation with a plastic surgeon.

Before the operation make sure that:

• Your surgeon is a licensed physician to practice medicine in the country you are having the procedure
• Your surgeon has completed extensive training and examinations in plastic surgery
• Your surgeon is a member of a national plastic surgery society that is recognized by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

What are injectable fillers?

Injectable fillers are substances that enhance the fullness of soft tissues, primarily in the face. Some fillers are based on natural substances derived from the human body, others are synthetic forms of these substances, and some may contain synthetic, biocompatible compounds. Injection therapy may also be performed using ones own fat cells. The differences among facial fillers is not only in their composition, but also in their preferred application and the duration of their results.
Collagen is a natural protein that supports the skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of bovine collagen that, unlike human-derived collagen, require prior allergy testing. The results of treatment with injectable collagen may last 2 to 4 months.
Restylane® is a form of hyaluronic acid, a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The fullness achieved from Restylane treatment may last 6 months or longer.
Radiance® is a form of hydroxylapatite, a mineral-like compound found naturally in human bones, suspended in a gellike formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours. Radiance lasts 2 years or longer and is presently "off-label" in its use as a facial filler.
Human fat, harvested from your own body can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection. Treatment results last up to a year or more in some cases and are highly variable. Fat can be stored for your own future treatment. The duration of results from preserved fat is not as favorable as fat used at the same time it is harvested.
The options discussed in this brochure are among the current fillers preferred by plastic surgeons. Your plastic surgeon will have the latest information and will be able to advise you on the options currently available.

Where do I begin?

A consultation with your plastic surgeon is the first step to learn how treatment with injectable fillers can enhance facial fullness, and improve the appearance of facial creases, wrinkles and scars. A consultation is designed to fully educate you in a non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available for facial augmentation with injectable fillers
• The likely outcomes, duration of results and potential risks associated with the use of specific fillers
• The course of treatment recommended by your plastic surgeon

Your plastic surgeon will also answer all of your questions.

Evaluation

Your plastic surgeon will review your medical history and your goals for improvement in consultation prior to any treatment with facial fillers. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Discuss any past treatment with injectable fillers, facial shaping or Botox® therapy or other facial rejuvenation procedures
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeons instructions

Safety

By making the decision to consult with a plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.
Your plastic surgeon should have completed surgical training and examinations in plastic surgery which uniquely qualifies them to perform cosmetic and reconstructive procedures of the face and entire body.
My soft tissue augmentation

Your plastic surgeon will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers. Strategic points on your face may be marked as guides to the appropriate injection sites for the filler recommended in your individual case. The injection sites are cleansed with an antibacterial agent and icing or a topical numbing agent may be offered to make more sensitive patients comfortable. In some cases, the filler itself will contain an anesthetic agent. In other cases local anesthetic may be administered to the treatment site.
Injection takes only a few moments per site and a few minutes for a course of treatment. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Make-up may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.
An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites. With some fillers, a slightly "over-filled" appearance may be initially present. Any of these conditions will dissipate within a few hours, or at most a few days; however the duration may be as long as a few weeks with injection of ones own harvested fat.
The use of facial fillers may further enhance the outcomes of other rejuvenation procedures such as facial rejuvenation and shaping, and wrinkle reduction by injection (Botox® therapy), or surgical rejuvenation such as a brow lift or facelift. In addition, ones own fat may be extracted in conjunction with liposuction (to remove localized excess fat) and prepared for injection, or preserved for later injection.

Preparing for soft tissue augmentation

Your plastic surgeon will carefully explain:

• Your course of treatment
• The type and brand of filler recommended in your case and why
• The results you can expect
• How long you might expect results to last

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure and effects of soft tissue augmentation and any risks or potential complications.
Reported risks associated with the use of injectable fillers in soft tissue augmentation vary depending on the specific filler used and the relative permanence of the filler substance. Fillers derived from non-human sources may require a pre-treatment allergy test. Infection at the injection site is also possible. Complications from fillers generally are reported to be uncommon and temporary.
Those fillers that are not completely fluid and contain microscopic granular substances, carry a risk of "clumping" as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat. Risks will be fully discussed prior to your consent.
It is important that you address any questions about soft tissue augmentation with injectable fillers directly with your plastic surgeon.

What to expect

Injection therapy with soft tissue fillers is performed in a plastic surgeons office. Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few minutes, as the full process of consultation is not necessary to repeat, although consent is required at each visit..

Following treatment

Once your procedure is completed, you will be instructed on how to care for the treated areas of your face. You will also be reminded about:

• The expected duration of your results
• Specific concerns to look for at the injection site or in overall health
• When to follow-up with your plastic surgeon

Progress and healing

You may experience temporary numbness, redness, swelling and minor bruising at the injection sites. These can be alleviated with topical icing and should resolve within a few days. The results of your treatment are visible immediately; however, they will lessen over time as fillers are absorbed. The post-treatment side-effects of fat injections last longer than other filler substances, from several weeks to several months, in some cases.
The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect just how long your results last. The results of non-permanent fillers will diminish over time. Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time.
The results of permanent fillers can change over time; as you age naturally, these fillers may shift or clump. Surgical removal may be necessary to correct these conditions and could result in visible changes in appearance and noticeable changes in the texture of soft tissue.

Results and outlook

You may find yourself surprised at how such a relatively quick in-office procedure can produce a marked improvement in restoring facial fullness and a more youthful appearance. However, injection therapy to augment soft tissue is by no means simple.
Effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler. Choosing a plastic surgeon to treat your face with injectable fillers means that your treatment will be performed by someone who not only has training in injection therapy, but in all types of non-surgical and surgical facial rejuvenation.Restylane Vital