Surgical Procedures - Skin Treatments

INJECTABLE FILLERS

The size, shape and definition of lips can be enhanced by the injection or surgical insertion of biological or synthetic products. Injectable fillers can also improve the appearance of facial lines.

Plump, pouty, well-defined lips are a sign of youth and, for many, an expression of sensuality. As we age 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. Lips become thinner and lose volume, projection and colour. Our faces, in particular, show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting.

Soft-tissue fillers can help fill in lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers can 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 resurfacing or recontouring procedures. Most temporary soft tissue injectables function in essentially the same ways (quick to perform, can be topped up, safe, last for months, few side effects), but there are some minor differences. Permanent injectables and implants can last indefinitely. Side effects of all the injectables can include short term swelling, redness, bruising, itching, lumpiness and soreness.

The number of injectables on offer for improving lips and lines are numerous and always increasing, although the 'optimal' injectable material has yet to be invented. We prefer to steer patients towards options that have long track records of safety and effectiveness, though the desire for 'what's new' is a strong one. Patients should seek advice from doctors who offer options that give maximal, predictable results with minimal and well-understood side effects.

What can and should be done in your case will depend on a consultation with your doctor (Please read The Consultation ). However, if you're considering a facial-rejuvenation treatment, the following introductory paragraphs will, we hope, be helpful.

YOUR OPTIONS

Injectables can help fill out deep facial wrinkles, creases and furrows, sunken cheeks, skin depressions and some types of scars. They can also add a fuller, more sensuous look to the lips. Injectables are usually not sufficient to correct severe surface wrinkles on the face, such as the multiple vertical 'lipstick lines' that sometimes form around the mouth. In this case, your plastic surgeon may suggest a resurfacing technique (see SCAR REVISION, LASER RESURFACING, SKIN MANAGEMENT). Again, deep folds in the face or brow may be more effectively treated using surgery (See face life & brow lift). Injectables are sometimes used in conjunction with facial surgery procedures but cannot change facial contours as surgery can. Keep in mind that your plastic surgeon is a specialist who can offer you the full gamut of the most advanced treatments including cosmetic surgery, refinishing techniques, laser therapy, injectables and other fillers. You and your surgeon must agree together what procedure or combination of procedures is best for you.

TYPES OF FILLER

There are three main types:

Temporary Injectables

(Collagen, Hyaluronic Acid and Fat)
Permanent Injectables

(Polyacrylamide Gels,Isolagen, Artecoll)

Below we cover all these. Other materials that are also being used for facial-rejuvenation include Fibril, a gelatin powder compound that's mixed with the patient's own blood and then injected to plump up the skin.

Each of these options has its own set of risks and benefits. Consult your doctor if you're considering any of these alternative filler treatments.

WHAT TO EXPECT

The improvements that temporary injectable fillers make may last only a few weeks with some individuals; in others, they may continue indefinitely. Age, genetic background, skin quality and lifestyle, as well as the site of the injection, may all play a role in the injected material's staying power. Other fillers may be called 'permanent'. However, the precise reason for the variation of results among patients has yet to be identified. Some individuals are more receptive to one substance than another, others may find that neither substance produces long-lasting results.

RISKS WITH INJECTABLES

Provided a qualified plastic surgeon administers the injectables, complications are infrequent and usually minor. However, individuals vary greatly in their anatomy and their physical reactions so outcomes are never completely predictable.

PLANNING

Step one is to discuss your hopes and expectations fully with a plastic surgeon or experienced cosmetic doctor. He and his skin care team have experience with many different types of surgical and non-surgical facial procedures. In this initial consultation about facial rejuvenation he will examine your face - the skin, the muscles and the underlying bone - and will help you select an treatment option tailored to you alone. He will need to know your full medical history including any drug allergies, and will check for conditions that could cause problems, such as active skin infections or unhealed sores from injuries. Collagen injections are not generally suitable 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 anaesthetic agent that is injected with the collagen material. For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer's brochure written for patients. Insurance usually does not cover cosmetic procedures. However, if the 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 insurer.

Where

Injectables are usually administered in a surgeon's clinic. If, however, you are being hospitalised for a cosmetic surgery procedure, your injections may be administered in the hospital.

TEMPORARY INJECTABLES

COLLAGEN

Collagen is a naturally occurring protein that supports various parts of the human body: the skin, the joints, the bones and the ligaments. In skin and connective tissues it provides fullness and 'rubbery-ness'. 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. It is produced in various densities to meet individual patient needs.
Risks
Allergic reaction is the primary risk since approximately two in 100 people will exhibit an allergic reaction. To help determine if you are allergic to collagen, your surgeon will perform an allergy skin test about a month before the planned procedure. The test site should then be watched carefully. Any sign of redness, itching, swelling or other occurrences should be reported to your surgeon. Other rarely-encountered risks (not necessarily related to allergies) include infection, abcesses, open sores, skin peeling, scarring and lumpiness which may persist in the treated area.

Anaesthesia
Because the anaesthetic lidocaine is mixed in with the collagen additional anaesthetic is not normally needed. However, if you are especially sensitive, your doctor may use a local cream anaesthetic or a freon spray to numb the injected area. Alternatively you may elect to have an injected local anaesthetic or sedative drugs.

The procedure
Once the skin test has determined that you are not allergic to collagen the substance can be injected using a fine needle inserted at several points along the edge of the treatment site. You may feel some minor stinging or burning as the injections are administered. Since part of the injected solution is salt water which 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 decide when sufficient filler has gone in.

After treatment
You may notice some minor discomfort, stinging or throbbing in the injected area and, occasionally, some minor bruising or swelling occurs. Any redness usually disappears within 24 hours but may not go quickly, particularly in fair-skinned patients. If any of these symptoms does persist, contact your surgeon. Tiny scabs may also form over the injection areas but these generally heal quickly. No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter.

Result
Collagen's longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. Corrections are temporary, however, and will gradually break down and be reabsorbed by the body on average within 3-5 months. In general, the injected material is likely to disappear faster in areas where there is more muscle movement. To maintain the original correction, the injection must be repeated at regular intervals. Your doctor can help you determine the treatment frequency you need to maintain your improved appearance.

HYALURONIC ACID FILLERS

Hyaluronic acid is also a naturally occurring protein that is part of the connective and supportive tissues in our bodies. Its structure is identical in all living organisms so there can never be allergic reactions. For injection, a non-animal stabilized form is used to give a very high level of safety. Manufactured under the names Restylane and Perlane, the product is a crystal clear injectable gel formulated by purely chemical processes in the laboratory. Restylane is commonly used for fine lines and wrinkles. Perlane is more highly concentrated or thicker. Hylaform and Juvederm are similar alternatives.

Risks
Allergic reaction is not a problem with the most modern types of injectable hyaluronic acid. Because it is derived from a non-animal source no pre-treatment skin test is required. However there is a small risk of infection and other infrequent complications.

Anaesthesia
Because the anaesthetic lidocaine is mixed in with the hyaluronic acid, additional anaesthetic is not normally needed. However, if you are especially sensitive, your doctor may use a local cream anaesthetic or a freon spray to numb the injected area. Alternatively you may elect to have an injected local anaesthetic or sedative drugs.

The procedure
The procedure is the same as for collagen, except that no skin test is required before treatment, and no overfilling of the area is necessary. Your surgeon will do his best to achieve the final contour at the time of treatment.

After treatment and Result
These will be the same as for collagen. All these hyaluronic acid fillers are safe, effective, and temporary, lasting 3-4 months.

FAT

The fat-injection procedure (autologous fat transplantation or microlipoinjection) involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most frequently used to fill in sunken cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimise forehead wrinkles and to enhance the lips.

Risks
Again allergic reaction is not a problem since the fat is harvested from the patient's own body. There is still a small risk of infection and other infrequent complications.

Anaesthesia
Both the donor and recipient sites are numbed with a local anaesthestic. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a lift home after your treatment.

The procedure
The donor and recipient sites are cleansed and treated with a local anaesthestic. Fat is then withdrawn using a syringe with a large-bore needle or a cannula (the instrument used in liposuction) attached to a suction device. Once the fat has been prepared it is then injected with great care into the recipient site using a needle. Sometimes an adhesive bandage is applied. As with collagen, a degree of overfilling is necessary to allow for some 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. To survive and maintain the correction live fat cells require a new blood supply at the recipient site. Achieving this can be difficult which is why the success of fat injection is rather unpredictable.

After treatment
You can expect some swelling, bruising or redness in both the donor and recipient sites depending upon the size and location of the treated areas. The swelling and puffiness may last several weeks, especially if a large area was filled. In this case you may be advised to take things easy for a brief time. However, many patients resume normal activity immediately. You should stay out of the sun until the redness and bruising subsides - usually after about 48 hours. In the meantime, make up with sunblock protection will help to conceal your condition.

Results
The long lastingness of the fat injections varies significantly from patient to patient. Some patients have reported results lasting a year or more, but the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Repeat injections may, therefore, be necessary. Your doctor will advise you.

NEW-FILL

Polylactic acid (PLA) hydrogel or 'new-fill' is the same material used in absorbable surgical stitches. It is reported to induce the formation of new collagen at the site of injection even as the implant reabsorbs. Again the correction is temporary.

FURTHER OPTIONS

Cosmetic make up can be made permanent by using microinsertions of pigment into the skin of the lips, eyebrows and eyelashes. This helps people allergic to makeup and can also be used for camouflaging scars, vitiligo, stretchmarks and areola restoration.

HAPPY?

Most patients are very satisfied with the results of injectable treatments. You may be surprised how pleased you will be at the results that these procedures can deliver.