Fillers and Autologous Fat
When treating wrinkles, one must distinguish between static wrinkles, which are lines that over time become more and more prominent, such as the nasolabial folds or even sleeping lines, and dynamic or mimetic wrinkles, which arise through respective actions of the muscles of facial expression. The vertical frown lines between the eyebrows are classic dynamic wrinkles. They are best treated with botulinum toxin. The fine lines and the static wrinkles which often start developing in the 30s are a sign for loss of skin moisture. They are usually best treated with hyaluronic acid.
To restore volume in the case of sunken cheeks or deep folds, such as prominent naso-labial folds, there are several options including hyaluronic acid, calcium hydroxylapatite (Radiesse®) and autologous fat. The latter is the ideal material to correct deep rings under the eyes. Hyaluronic acid is the material of choice for treating lips. In addition, both hyaluronic acid and autologous fat are used in body contouring to smooth away irregular contours and especially in hand rejuvenation.
I always use non-permanent or resorbable fillers. These are materials that over a variable period of time are totally removed by the body. While they must be re-administered regularly, this is not necessarily bad as the appearance can be periodically adjusted to the age and wishes of the patient. The greatest advantage of resorbable fillers is that they are well-tolerated and have a much lower complication rate than permanent fillers.
What is hyaluronic acid?
Hyaluronic acid is a natural tissue component of all mammals and is also found in some bacteria. The product we use is synthesized by streptococcal bacteria. It is a long-chained sugar molecule which is able to bind large amounts of water. We take advantage of this binding capacity, using non-linked products which flow easily for a skin booster effect, and cross-linked products which are more stable and come in a wide range of viscosities and concentrations as fillers to restore volume. Hyaluronic acid is well-tolerated and completely degraded by the body - thus it is a resorbable filler. The duration of effect varies depending on which form of hyaluronic acid is used for quite variable indications. Hyaluronic acid as a skin booster should be repeated every 4 months. The products used for treating folds and wrinkles often must be re-injected after 6 months. When used to add volume, as in sunken cheeks, the treatment effects may last as long as 2 years.
I use the licensed products Belotero®, Juvéderm®, Restylane® and Hyal-System® to restore volume, to treat folds and wrinkles and for the skin booster effect.
What is calcium hydroxylapatite (Radiesse®)?
The filler calcium hydroxylapatite consists of calcium and phosphate ions (microspheres) in a gel matrix. It is a synthetic product, but is completely degraded by the body (resorbable) and has a long duration of effect. The filler is well tolerated and stable for up to 2 years. Calcium hydroxylapatite causes mild burning when it is injected and then more swelling than hyaluronic acid.mIt achieves its positive action through the binding of the microspheres to the connective tissue fibers causing collagen neogenesis in the subcutaneous tissue.
I use the only licensed product in this field Radiesse® for treating deep wrinkles and folds as well as to restore volume.
What is autologous fat?
When treating with autologous fat, the body's own fat is re-injected as a filler. The fat is obtained through liposuction - either as a nice side effect of a planned liposuction for body contouring, or as a specific procedure just to harvest fat. Harvesting autologous fat is thus a „mini-liposuction“ at just one body site - often the thighs - but fat is removed in a symmetrical fashion! Here it is often possible to „kill 2 birds with one stone.“ The body's own fat is naturally well tolerated as a filler and usually provides good long-term results, generally lasting more than 2 years because the fat cells become incorporated into the injection site. We freeze and store the fat that we extract; it is thawed for the follow-up treatments at 4 and 8 weeks, but also can be thawed at a much later date, if you need it. The main uses of autologous fat are to restore volume in the face, especially for sunken cheeks and around the eyes, as well as on the body to correct contour defects and add volume and finally for hand rejuvenation.
What do we do?
The treatment of fine early lines and loss of moisture in the skin has been revolutionized by the hyaluronic acid skin booster. In this procedure, very soft hyaluronic acid is injected using a fine blunt cannula in a fan-shaped pattern to treat a broad area, or with a fine sharp cannula to produce small local deposits.
Fine wrinkles and folds are best treated with a fine sharp cannula, injecting at multiple points or in a linear pattern.
The tower technique with hyaluronic acid is used to treat deep folds, such as prominent nasolabial folds, and loss of volume on the cheeks and at the corner of the mouth. Here we use a thin sharp cannula to create small towers of hyaluronic acid which are placed close together in a vertical fashion at the base of the problem area. They support and stabilize the subcutaneous tissues and overlying skin.
The windmill technique makes possible a gentle but complete volume restoration of the face using long, thin and blunt cannulas. A tiny entry point on the upper lateral cheek area is used to treat circles under the eyes, cheeks, nasolabial folds, lips, corner of the mouth, chin and cheek lines and even the temples. The filler is injected through the blunt cannula moving in a clockwise fashion - hence the name windmill - treating the facial anatomic regions and tissue levels in a uniform fashion. Hyaluronic acid, autologous fat and calcium hydroxyapatite all can be used in the windmill approach.
Is anesthesia needed?
The windmill technique requires a short twilight sleep. The other injection techniques can be carried out without anesthesia, with topical anesthesia using an anesthetic cream, or with local anesthesia. Some hyaluronic acid products already contain lidocaine, providing their own local anesthetic effect. When larger areas are treated, especially in the whole face approach, an anesthetist is generally part of the team to make your entire experience more comfortable by employing twilight sleep.
What happens afterwards?
Immediately after the treatment, you can notice a positive augmentative effect of the injected filler. In addition, there is redness and swelling, which usually disappears after 1-2 days. Soft massages and cold packs hasten the disappearance of these symptoms. The long-term effect of the injection can first be evaluated after 14 days. In the interval, it is often surprising how a minimal „too little“ or „too much“ will self-correct as the treated tissues become simultaneously less swollen but also re-hydrated. Small bruise marks may appear, but can usually be easily covered with make-up.
Volume restoration of the cheeks, lips and rings under the eyes produces a more youthful, healthy and natural appearance. Treating wrinkles and folds with hyaluronic acid makes the facial expression softer and more youthful. The hyaluronic acid skin booster makes the entire skin glow, as wrinkles disappear and the tissue becomes richer in fluids.
Which combinations are reasonable?
Regular treatment with botulinum toxin produces long-term smoothening of the facial skin so that fine dynamic wrinkles do not have a chance to develop or become prominent - botulinum prophylaxis. The structure and pigmentation of the skin can also be enhanced by treated with a fractionated laser or an intense pulsed light.
What else can one do?
A healthy life style also has a positive influence on the skin. Too little sleep, lots of stress, and too much sun exposure, as well as alcohol and nicotine, all accelerate skin aging and should be avoided as much as possible. In addition good skin care is absolutely essential.
In a personalized consultation, I will be happy to discuss with you which filler techniques are most appropriate for you. If you wish, I will be happy to show you examples of before and after pictures from other patients I have helped.