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Professional Cosmetic Surgery and Healthy Ageing Clinic

Mr Jeya Prakash M.S. F.R.C.S.(Ed) 94 Harley Street London W1G 7HX
020 7224 1622

Feel Younger Look Natural

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Fillers

1.   Introduction
2.   History of Fillers
3.   What are fillers?
4.   What are the types of fillers?
5.   Aim of fillers
6.   Indications
7.   Contraindications
8.   Special Instructions
9.   Duration of treatment and Anaesthesia
10. Procedure
11. Risks and Complications
12. Recovery
13. Longevity
14. Limitations of end results

 

Introduction

A youthful vibrant face is characterised by fullness and smooth contours rather than a gaunt or hollowed out appearance. But with time, wear and tear on the muscles due to normal everyday facial expressions, the effects of gravity and environmental exposure break down the underlying tissues that support the skin. Laugh lines, crow’s feet and other facial wrinkles, as well as soft tissue depletion can give an older and aged look. In most cases, volume enhancement alone can give a significant rejuvenation to a tired looking face. Fillers achieve this volume enhancement with no down time and minimal pain. Even though the results are temporary in most cases, this is on of the most sought after treatments by both the young and old alike. Younger women look to augment lips or breasts with fillers while older women in addition to this look to achieve a more youthful look by means of filling out the lines and hollowness in the face. In combination with Botox  dynamic sculpting of the face can be achieved to give overall improvement to the appearance and contour of the face, thereby lifting years off it in any one session.

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History of Fillers

The history of using fillers dates back to 1893. Synthetic silicon fillers have been in use since late 60s. Cattle collagen fillers then came into the market in late 70s. This was followed by the usage of hyaluronic acid fillers in the 1980s. Structural fat grafting as fillers was refined in late 1980s and used extensively. A mixture of collagen and synthetic substance such as hydroxyapatite was on the market in early 1990. Pure synthetic chemical substance like hydrogel came in late 1990. Recent addition has been complex cross linked hyaluronic acid with local anaesthetic.

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What are fillers?

Fillers are a means of volumetric replacement for static lines and deficient soft tissue, hollowness in various areas of the face and other parts of the body such as hand, buttock and breast. Fillers are derived from natural sources (hyaluronic acid), synthetic sources (chemical) , ground substances(animal collagen) or a complex of cell and tissue (autologous).

Fillers can achieve 3d volumetric replacement and 3d facial rejuvenation and  static sculpting in other areas. The most commonly used fillers in the market today are Juvederm Ultra and Restylene.  

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What are the types of fillers?

Classification I

Temporary fillers: The results last from 6 – 12 months approximately. Eg of temporary fillers are various types of H.A. based(Restylene, Juvederm Ultra, Belataro), collagen based fillers (Evolence).

Permanent Fillers:  The results can last from 3-5 years, sometimes even longer. Eg of permananet fillers are Hydrogel based (Bio-alcamid), silicon based, hydroxyapatite based(Radiesse), Methacrylate microspheres based (Artecol).

Semi permanent fillers (Autologous fatfill) : The results can last from 1 – 10 years depending on the individuals age group, quality of life and type of cells used. 

Classification II

Superficial Fillers: These are used for fine lines in the face and around the eyes. Generally temporary fillers are recommended for these areas.

Mid Fillers:
These are used for the lips, smile fold and back of the hand. Generally temporary and semi permanent fillers and occasionally permanent fillers are recommended for these areas.

Deep Fillers: These are used for cheek, chin, brow, temple, breast, and buttock areas. Ideally it is best to start with temporary fillers in these areas and move on to semi permanent and permanent fillers depending on the satisfaction with the results.

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Aim of fillers

  • Reduce static lines.
  • Increase the volume and improve the shape.
  • Rehydrate the skin and increase protection from the effects of the sun.  Rehydrated skin improves skin lustre.

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Indications

  • Lack of volume
  • Lack of contour to loss of underlying fat
  • Mild to moderate static lines
  • Depressed and acne scars

Contraindications

  • Individuals looking for permanent cure
  • Individuals allergic to fillers
  • High expectation patient

Special Instructions

There are a number of fillers currently available in the market. While the choice is mind boggling, only certain kind of results give longer lasting results in certain areas and they all have varying degree of longevity and possible complications. Please ensure you have a good consultation prior to treatment and explain your particular priorities and concerns so that the surgeon can choose the right kind of filler for you, for a satisfactory result.

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Duration of treatment and Anaesthesia

Most fillers can be administered at the surgeon’s clinic and you should usually be able to return to work on the same day, albeit with some swelling and on occasion some bruising. Moderate pain is expected. Some fillers have local anaesthetic as part of their composition and no outside means of numbing the area are required. In fillers that do not have local anaesthetic an LA cream can be applied for 20 minutes prior to treatment to numb the area for the injections. In rare cases local anaesthetic injections are administered prior to fillers for a greater degree of numbness, the down side of this is that it makes the area wobbly and thereby more difficult for precise administration of the fillers.

Procedure

The area to be treated is cleaned with antiseptic wipes. The filler injection is then applied at the site of deficiency. The number of punctures and the injection method depends on the type of fillers being used. Following the injection and bleeding from the area is cleaned and cold packs are placed to stop the bleeding and reduce bruising and swelling.

The number of syringes or amount of fillers used depends upon the degree of deficiency and the amount of improvement required.

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Recovery

Initially the treated area will be very swollen and might be bruised. The bruising will settle in 2 days time. It can take up to 3 days for the swelling to go down fully. The full results can be seen at the end of 3 days. Most people prefer to have lip or other large volume facial fillers nearer to the weekend so that it settles prior to returning to work, the following week.

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Longevity

The Longevity of fillers varies depending on the individual, the type of filler used, the area that was treated and the amount of filling done.  Longevity of results is reduced in  areas with high mobility (lips, nasolabial fold, deep static frown lines) .  Depending on the choice of filler the results can last from 3 months to 9 months.

Limitations of end results

  • Cannot correct dynamic lines
  • Results are not permanent
  • Cannot dramatically improve quality of skin

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