LIPO TRANSFER AND FILLERS
The use of injectable facial fillers is one of the fastest growing areas in the field of cosmetic surgery. Many advances in have been made in the last 5 years that have led to safer, more predictable and longer lasting fillers.
As one ages, the face loses volume. This creates more prominent wrinkles and skin folds while features become less distinct. Dynamic wrinkles caused by facial movement such as smiling and frowning appear. Injectables were designed to subtly reduce these signs of aging.
Injectables include two basic classes: Fillers, to restore lost volume, and Botulinum toxin injections, to lessen the appearance of wrinkles with smiling, frowning, concentrating and looking surprised. Most fillers work by filling the lip or wrinkle with volume and are gradually digested by the body. While botulinum toxin injections work by weaken the underlying muscles to decrease their overlying dynamic movement.
FDA approved Injectable fillers include Hyaluronic Acid Fillers, Fillers with microscopic beads and Poly Lactic Acid.
For those wishing to avoid the injection of any foreign material, Lipotransfer, the harvesting and reinjection of your own fat, may be an option.
This is the use of your own fat taken from one area and reinjected into facial lines and wrinkles after preparation. This organic natural filler has the longest lasting result due to the partial permanent ingrowth of a percentage of the fat cells at the injection site. There is new research currently being performed on the role of ADASC( Adipose Derived Adult Stem Cells) in these long lasting results. They are present in high concentrations in abdominal adipose tissue routinely used in LipoTransfer. The effect these ADASC have on new vascular growth and therefore oxygen support of the fat cell is what is felt to provide such longevity to the natural results.
The adipose tissue is harvested by tumnescent anesthesia liposuction. The fat is processed in the surgery suite and then immediately injected. Often only mild oral sedatives and local anesthesia injections are needed. The recovery is rapid with return to normal daily activity the next day except for strenuous exercise or heavy lifting. Ice compresses aid in the prevention of bruising which is generally no more than for artificial filler injections. Discomfort usually requires nothing more than Tylenol.
Hyaluronic Acid Fillers: These were the first of the new fillers to be FDA approved. Hyaluronic acid is a naturally occurring carbohydrate which occurs in skin. It is a clear gel with a thick consistency. Since skin testing is not required, injections may be done on the same day as the initial consultation. Manufacturers have manipulated particle size (thickness) and crosslinked molecules to offer both normal and longer duration products.
Restylane and Juvederm are examples of normal duration products that are injected in more superficial lines and have easier flow characteristics. Perlane and Juvederm Ultra Plus are examples of longer duration products are usually injected into deeper lines and folds.
The newest advance has been the addition of local anesthetic, Lidocaine, to the filler to reduce discomfort upon injection. Hydrilla is an example of this advance. By combining a local anesthetic with the filler, the injection process is more comfortable for the patient, although most surgeons use local anesthetic injection routinely before filler administration.
Fillers With Microscopic Beads: This class includes Radiesse. Radiesse contains calcium based microspheres suspended in a water-based gel. Since skin testing is not required treatment may be received on the same day as consultation. The advantage is its longer duration of effect since the body reabsorbs the microspheres at a slow rate.
Poly Lactic Acid Fillers: Sculptra is substance known as L-Poly Lactic Acid which is similar to the material used to make a type of suture that is used to close lacerations. This material does not require allergy testing. Following injection the body produces new collagen in the area injected. The reaction is not immediate but increases over the next 3-4 weeks after injection.
Who is a Candidate?
Facial fillers are administered over a wide age range.
Younger patients seeking fuller, plumper lips.
Older patients seeking wrinkle reduction and fuller lips.
Men who wish reduction of folds around the mouth to look younger.
Fuller and plumper lips.
Softening of superficial and deep wrinkles.
Softening of wrinkles which appear during facial movement (smiling, frowning, concentrating and looking surprised).
This procedure is usually performed in the office.
A topical anesthetic cream and local anesthetic injections are administered prior to injecting fillers.
Ice may be applied before and after injection.
Immediate swelling may create the appearance of over treatment – this swelling generally resolves in several hours.
Recuperation and healing
For most patients, fillers can be injected in the lips or wrinkles and they can return to work the next day.
Occasionally a patient swells dramatically, especially in the lips. A first time patient may want to schedule the initial injection on a Friday.
Bruising may occur but can usually be covered with makeup. It is a good idea not to schedule filler injection right before an important social function