Restylane - Fillers

Lips

Lips are usually injected in a naturally enhancing way, as opposed to the old technique of over-enlarging them. The modern fillers last longer than the advertised six months.

Very light filler is used in the lines above the lip. If a strong filler is used, the effect is too heavy with a duck lip developing. The rest of the area is treated with a gentle IPL to give a smooth finish

Lines from the nose to the mouth are very common and can be quite deep. They require strong fillers to give a good result. The results are very forgiving and it is a good place to start if you are nervous about trying a filler

Light filler is injected in a specific technique under the eyes to support collapsing tissue and reduce dark rings. If the tissue is too weak we will first laser it to give it some strength

Fillers

The lines that we get in the lower half of the face are generally caused by a collapse of tissue and not by over-expressive muscles. As a result it is usually better to use a filler (that fills up the defect) and not Botox® (that paralyses overactive muscles) to treat this problem. There is now a confusing array of fillers available commercially and you will be given different arguments as to why one is better than another. To simplify this we will present the history of fillers and then give a selection of the most common fillers available and what their strengths and weaknesses are:

Fillers are not a new concept and were used as far back as 1890 where doctors injected fat, paraffin and silicone into creases to try and reduce their appearance.

Collagen was seen as a useful product because it forms a part of our connective tissue which is partly what is lost when a crease is formed. By injecting it under the skin, the deficit should be replaced and as it slowly dissolves it should stimulate fibroblasts to create more connective tissue to replace it. Examples of collagen today are Zyderm (bovine extract) and Cymetra (human extract).

However, because this collagen was mostly extracted from cows there was always a risk that the body might reject it. When this happened there would be the formation of granular lumps under the skin and then scar formation. By 2000 after a few highly publicised disasters, collagen fillers became a lot less popular and were largely replaced by Hyaluronic acid fillers.

Examples of these are:

Hyaluronic acid is an extremely safe molecule that is synthetically made in the same structure as our own connective tissue Hyaluronic acid. It is inert and unlike collagen does not need allergy testing. It is an anti-oxidant and gently stimulates the fibroblasts to create more connective tissue in the area that it has been injected. It is the most studied filler in the world and has been successfully injected in over 30 million people globally. In our opinion Hyaluronic acid should currently be considered to be the filler of choice.

Newfill has been used fairly extensively for the last few years. It is made of polylactic acid which vigorously stimulates fibroblasts to make more supportive tissue. In some people this seems to over-stimulate the skin and scar tissue forms. In 2004 it was re-launched as Sculptra which we believe is useful particularly for the older skin that is not responding to other fillers.

Radiessse© is fairly new to the market and is made from calcium hydroxyapatite. This is a product that has been used for bone building of teeth, jaws and chins. It is being promoted for large areas of sculpting (building up sunken cheeks). Most of the above fillers work under the skin for about a year before being harmlessly absorbed by the body. Permanent fillers are fillers that are promoted to last for at least two to three years. The fear that people have of them is that by their very nature they may over stimulate the tissue and cause scar tissue formation.

Of these, if requested, we would prefer to use the last two.

Fat implants:

Thin slivers of your own fat are sucked up in a hollow needle and re-injected in the area that you want to fill. The limitation is that only a small area can be filled and the successful uptake is often limited. This tends to leave gaps in the crease that needs to be retreated.

Isologen:

This is an American company that grows your stem cells in the lab that have been aspirated from behind your ear. These universal cells are then re-injected into the crease that you want filled. The theory is that the stem cells will re-grow as connective tissue and the skin will rejuvenate as a wrinkle free area for about eight years. In our experience the practical problems are that the uptake is operator dependant and may be well below the 95% advertised by the company.

It is an expensive procedure and the recent improvement of the Hyaluronic fillers has left Isologen looking less competitive. The future of fillers will probably move towards skin rejuvenation. We will find more fillers that are healthy for you and additives like vitamins included into them. Amino acid therapy will grow and these will also be added. The permanent fillers will become less reactive against the skin. Stem cell therapy will change from using your own aging stem cells to foetal cord blood stem cells.

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