Filler… Is one of the lesser known non-surgical cosmetic procedures when compared to other better known agents such as Botox. Remember from a previous post that Botox is a brand name neuromodulator that paralyzes muscles. For a refresher see [post title].
As always let’s start at the beginning…
What is facial filler?
As the name implies, fillers are a large category of substances used to provide added volume to the face and lips. However, not all fillers are made of the same thing. Hyaluronic acid injections and fat grafting are probably two of the most common fillers currently in use, though others are available.
Why would I want it?
Reasons can be that as we age, we lose volume in areas of the face. Adding volume to the face can bring a more youthful appearance. Filler can also be used to fill in some deep and superficial wrinkles and acne scars in the face but also can be used to enhance parts of the face itself such as lips, nose, chin etc. The effects of fillers can remain for 6 months to forever, depending on the filler used, location injected, and provider’s technique.
What is Hyaluronic acid?
Hyaluronic acid this something called a glycosaminoglycan also called a GAG for short (Not just because the name is crazy long) but basically it is sugar molecules connected in chains holding hands with a bit of protein every other sugar molecule. Hyaluronic acid is a naturally occurring gel in the body and is used for joint lubrication, cartilage, connective tissue including skin, and many other more boring processes that are not important for this talk.
Hyaluronic acid is constantly being turned over is the body by natural processes and this is what makes it temporary. On its own hyaluronic acid do not last long in the body but these properties can be changed by changing the structure slightly by making crosslinking between different chains. Basically the chains hold each other so close the machinery the body uses to break them down can only work on the edges slowing the break down process. The quick and dirty is the longer the chains with more cross linking are a more solid gel used for deeper structure like deep wrinkles where as less cross-linked gel are more liquidly and used for more superficial fine lines but also for things like lip plumping.
Hyaluronic acid product lasts typically 6 months – 2 years, making it temporaty-ish. This is a good choice for those that want a change but do not want something permanent but also do not want to come to the office frequently for touch ups. A bonus is it has an antidote that can help dissolve it if the results are not desired.
*Of note injection of any kind causes inflammation and a small amount of scar tissue. The amount of scar tissue will differ from person to person. For example after lip filler even after it dissolves your lips will never go 100% to pre injection state though usually pretty darn close.
What is the process of filler injection?
As always, it is best to get filler from a trained professional with a good understanding of facial anatomy and aesthetics. Your provider will go over areas of concern and will talk about which formulation is needed and what can be achieved. Always ask about if they provide touch ups and if these come at a cost or are included in the price. Some will charge by volume and some by location. Make sure you understand this as well.
The process is pretty easy as it is done in the office setting. Compared to getting Botox, filler is considerably more painful, but is still tolerated by most. You cannot get something for nothing. Most providers I know typically will do numbing jelly and/or ice packs before the procedure but I am not convinced these provide that much benefit. Many formulations have some lidocaine (similar to the numbing medication at the dentist office) that is supposed to help with pain but really does not help with the initial injection itself, and it feels weird having a numb lip/face for an hour.
Expected side effects are usually mild and include soreness, bruising, and swelling. Typically people are presentable in public the next day but I have known people that had extra bruising or swelling that needed a day or two before they felt comfortable to go out. Remember that swelling sets in shortly after injection and can take many days to a week to fully resolve. This may make you feel overfilled and that is OK. Give it time for the swelling to go away to see what your final results are.
Possible issues can be over filling and asymmetry. Use of filler is an art. Many providers will provide touch ups after a few weeks if there are small changes that need to be made. Other less than desired outcomes can be irregularity of filler. You will be able to feel the filler so sometimes you will feel differences that people may not be able to see. If the filler is too superficial in the skin (close to the surface), it can sometimes have a blue hue which can be seen. There are treatments to fix all of these issues, and a good provider will work with you should these happen.
Other very rare but still possible side effects can be infection, granuloma formation (think of this like your body rejecting the product), changes in pigmentation, cold sore reactivation, vascular compromise of skin with possible tissue loss (filler blocks blood flow to the skin and the skin dies), numbness, and blindness (only for injection in forehead between eyes when injection gets into one of the arteries of the face). With that said these are very rare side effects and I have not personally ever seen them.
Overall facial filler is very safe and, in a skilled hand, very subtle differences make a big difference and look very natural. If you are the kind of person looking for more dramatic changes those are also possible. I mean, I do love a good duck lip.
Recap
- Fillers come in many formulations with different benefits that a little while or up to forever
- Filler hurts but can make subtle or dramatic changes in the face and lips
- Filler is over all very safe but as with all procedures has side effects you should be aware of
Additional Reading:
Cosmetic Injectable Fillers, An Issue of Facial Plastic Surgery Clinics of North America
Fillers: Contraindications, Side Effects and Precautions
Use of hyaluronic acid fillers for the treatment of the aging face
Dermal fillers in aesthetics: an overview of adverse events and treatment approaches