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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
collagen 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 collagen 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 collagen 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 OTHER TYPES OF FILLERS
This brochure deals with the two most commonly used types
of injectable fillers, collagen 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 collagen, 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.
Collagen: Allergic reaction is the primary
risk of collagen. To help determine if you are allergic to
the substance, your surgeon will perform an allergy skin test
about a month before the procedure. After the test is performed,
the test site should be watched carefully for three or four
weeks, or as long as your surgeon advises. Any sign of redness,
itching, swelling or other occurrences at the test site should
be reported to your surgeon.
Risks not necessarily related to allergies
include 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.
Collagen injections are generally off limits for pregnant
women, individuals who are allergic to beef or bovine products,
patients who suffer from autoimmune diseases, and those who
are allergic to lidocaine (the anesthetic agent contained
in the syringe with the collagen material). For more specific
information about the contraindications and risks of collagen
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
Collagen: Because the anesthetic agent lidocaine is mixed
in with collagen, additional anesthetic is usually not used.
However, if you are especially sensitive to pain, your doctor
may use a topical cream anesthetic or a freon spray to numb
the injected area. Or, you may elect to have an injected local
anesthetic or 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
Collagen
Collagen is a naturally occurring protein that provides support
to various parts of the human body: the skin, the joints,
the bones and the ligaments. Injectable collagen, patented
by the Collagen Corporation under the trade names Zyderm and
Zyplast, is derived from purified bovine collagen. The purification
process creates a product similar to human collagen. Injectable
collagen received approval from the Food and Drug Administration
in1981. It is produced in various thicknesses to meet individual
patient needs.
Collagen is used primarily to fill wrinkles,
lines and scars on the face and sometimes the neck, back and
chest.
The procedure: Treatment with collagen can
begin after a skin test determines that you're not allergic
to the subsstance. The collagen is injected using a fine needle
inserted at several points along the edge of the treatment
site. If a local anesthesia has not been used, you may feel
some minor stinging or burning as the injections are administered.
Since part of the substance is salt water that will be absorbed
by the body within a few days, your doctor will slightly overfill
the area. You may be asked to hold a hand mirror during the
procedure to help your doctor decide when you've had enough.
After treatment: Immediately following treatment,
you may notice some minor discomfort, stinging or throbbing
in the injected area. Occasionally some bruising or swelling
will occur, but it is usually minor. Any redness that appears
in the injected site usually disappears within 24 hours. However,
in some individuals, particularly fair-skinned patients, this
redness may persist for a week or more. Tiny scabs may also
form over the needle-stick areas; these generally heal quickly.
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.
Results: As stated earlier, the duration of
results from collagen injections is variable. Collagen's longevity
depends on the patient's lifestyle and physical characteristics
as well as the part of the body treated. In general, the injected
material is likely to disappear faster in areas that are more
affected by muscle movement.
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.
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Information provided by American
Society of Plastic Surgeons. |
