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Dermal Fillers and Injectables

The perfect wrinkle filler - is there one?

From implants and injections to lotions and potions. They all claim to fill those dreaded lines on our face but what's the difference and which one is right for you?

Ageing is a fact of life, however, it is not age itself that bothers people, but rather the visible signs of ageing that can make us feel old. The health of our skin – whether on our face or on our body - plays a huge part in how old we feel and is seen as the most common indicator to others of our age. As the body's largest organ, skin is hugely influenced by our body's general well-being – if our body is not healthy, this is often reflected by our skin.

The A - Z on fillers and injectables

We've been searching for the perfect wrinkle filler for ages. For over 30 years, injectable fillers and implants have been widely used to "replace" the collagen your skin loses over time. These injections and implants are placed just beneath your skin where your body accepts it as its own. Remember there is always an exception to the rule and so some fillers can cause an allergic reaction. Injectable fillers and soft implants are performed on an outpatient basis. Filler injections, sometimes referred to as a "lunchtime" procedure or "liquid facelife", usually take less than twenty minutes of your time. Filler injections are relatively painless and are performed with a local anesthetic. They are injected under your skin, beneath the wrinkle. Several injections may be required, depending on the depth and length of the wrinkle. Soft implantation procedures for lip augmentation or to fill nasal labial areas are done under a local anesthetic. A small incision is placed at either end of the treatment site. Then, the implant is inserted through the incision and gently positioned. The incisions are closed with a suture. The procedure takes about twenty to thirty minutes. The current trend tends towards fillers produced from a crystal-clear gel form of hyaluronic acid, a sugar that occurs naturally in the body. Collagen is the oldest and best-known cosmetic filler. Newer natural and synthetic products are available, each with its own advantages and disadvantages.

Bovine Collagen Fillers

Bovine collagen is processed from the skin of cows. Approved in the 1980s as a wrinkle treatment, bovine collagen is still in wide use as a cosmetic filler. Bovine collagen is effective, and less expensive than other treatments. It can cause allergic reactions, so allergy skin testing is generally done before beginning the injections. Collagen injections are usually broken down naturally by the body. Injections need to be repeated two to four times per year to maintain results.

Human Collagen Fillers

Human collagen, mass-produced from cultures of human cells, became available in 2002. Human collagen causes dramatically fewer allergic reactions, so skin testing is usually not needed. It is more expensive than bovine collagen, and injections also need to be repeated every three to six months.

Hyaluronic Acid Fillers

Hyaluronic acid is a naturally occurring polysaccharide (chain of sugars). It's a normal part of the support structure under the skin. Age depletes hyaluronic acid in the skin, but injections can replace it. Various natural and synthetic hyaluronic acid (HA) products are available. In the newest products, the HA molecule is modified to break down more slowly. Cosmetic results can last nine months or longer. Allergic reactions are very rare. In my opinion, if you're going for fillers, this is the one to go for. Most commonly used/recommended filler in this catagory is Restylane™ - see below.

Fat Transfer (Microlipoinjection)

Ever wish you could move that fat from your thighs to somewhere it might look a little better? Fat transfer, also called microlipoinjection, is one of the safest wrinkle treatment methods available because it uses the patients own fat. In the procedure, the doctor draws a small amount of fat from the thigh or buttocks with low-power liposuction. The doctor then injects the fat into the targeted facial areas. The procedure can provide very long-lasting results. While a large amount of the fat may be reabsorbed by the body within several months of the procedure, as much as a third of the total injected volume can remain in the body for years.

Poly-L lactic Acid (Sculptra) Fillers

When injected under the skin, poly-L lactic acid (PLLA) stimulates skin cells to make collagen. Poly-L lactic acid is nontoxic, and has been widely used as a component of suture material for years.
PLLA is FDA-approved for cosmetic treatment of certain skin conditions in HIV patients. It is often legally used "off-label" to treat wrinkles in otherwise healthy people. It's considered "semi-permanent," meaning results can last for months to years.

Calcium Hydroxyapatite (Radiesse) Fillers

In 2006, the FDA approved calcium hydroxyapatite for cosmetic injection. This cosmetic filler is made of the minerals that give bone its strength and texture. These minerals are ground into tiny particles and suspended in water solution, which is injected under the skin. In the trial that led to its approval, calcium hydroxyapatite worked significantly better and lasted longer than collagen injections to reduce severe wrinkles.

Polymethyl methacrylate (PMMA) Fillers

Polymethyl methacrylate is a new, permanent cosmetic filler. PMMA has been used for decades as a cement for bone surgery and in the making of dentures, and was recently FDA-approved as an injectable cosmetic filler. In cosmetic surgery, tiny PMMA microspheres suspended in some biological fluid or bovine collagen are injected under the skin to reduce wrinkles or scars permanently. Artecoll® uses PMMA microsperes suspended in bovine collagen. It is necessary to establish allergic reactions to bovine collagen before undergoing this treatment. Although PMMA is biologically compatible, MMA is considered to be an irritant and a possible carcinogen. Personally I'll leave the cement for the bricks in my house.

No downtime

Injecting fillers into the grooves of wrinkles on the face at a superficial level can do much to decrease the signs of facial ageing. The procedure takes a few minutes and the patient can return to work – even though the injected site might be a little red and puffy for a few hours. The mild swelling is usually gone within a day or two.

Treatment, effects and side-effects

An HA filler is injected into the wrinkles and holds shape for 6 - 12 months. More viscous products, used for deeper wrinkles and folds, can last up to 18 months. After the treatment, some common injection-related reactions may occur, such as swelling, redness, pain, itching and tenderness at the implant site. These typically resolve spontaneously a few days after the injection.

Other types of reactions are very rare, but about 1 in 10 000 treated patients experience localised inflammatory reactions of a hypersensitive nature. These reactions either starts a few days after injection or after a delay of two to four weeks, and are generally described as mild to moderate and self-limiting, with an average duration of two weeks.

Choose the best surgeon

If you're thinking of undergoing a treatment, it's a good idea to choose a reputable surgeon who will give you a clear idea of the treatment and how it works. Costs vary from doctor to doctor and remember, this is your face we're talking about, so don't count your pennies when looking for a good surgeon. Word of mouth is also a good indicator . . . women have a tendency to talk when they're impressed . . . . or not! Contact a reputable surgeon or doctor in your area.
For more information, visit the Association of Plastic and Reconstructive Surgeons of South Africa (APRSSA) website.

For more information on brand specifics fillers, check out this link.

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