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.
ASPRS 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.
Injectable collagen or fat can help
improve the skin's texture by filling
in the laugh lines and facial creases
that often occur with aging.
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 or
Collagen Specialist,
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, 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 or Collagen
Specialist 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.
We 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 usually be performed in a surgeon's office-based
facility.
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 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 substance. 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.
Years of squinting and other facial
muscle movements can take their toll
on the eye area, leaving crow's feet
and other noticeable lines
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 sun block 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.
After treatment, the skin around the eye
area appears smoother and more taut.
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.
Lines and creases that form around the
mouth are usually caused by gravity
and a breakdown of tissues beneath
the skin.
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 over correction 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 sun block 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.
The lower face appears firmer and
smoother after treatment with injectables.
Lines around the mouth are filled in and
nearly imperceptible.
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.
With regular follow-up treatments,
your refreshed look can be easily
maintained.
This symbol designates surgeons who are Active members of the
American Society of Plastic and Reconstructive Surgeons. They are
certified in the specialty of plastic surgery by the American Board of
Plastic Surgery and are dedicated to the highest standards of patient
welfare and surgical excellence.
© Copyright 1996, American Society of Plastic and
Reconstructive Surgeons
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