Fillers

How is a fillers procedure performed?

Dermal fillers are administered with a syringe to various areas on the face and head, including around the eyes, along the jaw, around the lips and in the forehead. The number, location and depth of the injections depend largely on the type of dermal fillers used and the desired results.Some fillers contain a local anesthetic like lidocaine to enhance comfort during injection. Numbing cream may also be used.

What are my options?

There are three types of dermal fillers commonly used: temporary, semi-permanent, and permanent. Hyaluronic acid-based fillers are temporary, while other types of fillers offer longer-lasting results.Temporary Fillers

• Collagen-Based Fillers: Collagen is a naturally occurring protein that adds strength and structure to the skin. Collagen was the first filler on the market, but the arrival of hyaluronic acid-based fillers has decreased its popularity.
• Hyaluronic Acid-Based Fillers Like collagen, hyaluronic acid is a naturally occurring substance and primarily used to promote fullness and volume.
• Calcium Hydroxylapatite: Heavier and denser than hyaluronic acid, this filler is injected deeper, underneath the skin, and does not usually cause immune or allergic responses because the material is usually found in bones.

Semi-Permanent Fillers Longer-lasting dermal fillers typically contain thicker substances, such as the biodegradable synthetic filler known as poly-L-lactic acid. These types of soft tissue fillers are used to treat deeper facial lines, and though they offer semi-permanent results, it’s possible that you’ll need an occasional “touch up” several weeks after your initial injections.Permanent Fillers Permanent fillers are made of polymethylmethacrylate (PMMA), which are microspheres that are not absorbed by the body. The filler also contains collagen and is only recommended for thick-skin areas such as the nasolabial folds. It is not recommended for any areas around the eyes or for the lips.Silicone Injections – Patient Safety Warning Silicone injections are an unsafe and unacceptable option to use as a filler. These injections are not FDA approved and often offered by unlicensed individuals and should be avoided. Always consult with a board-certified plastic surgeon, preferably an ASAPS member, if you have questions about a particular type or brand.What are the brand names for fillers?There are a number of soft tissue filler brand names, but some of the most common are:

• Hyaluronic Acid-Based Fillers: Restylane®, Restylane® Lyft, Restylane® Silk, Juvederm, Juvederm Volbella, Juvederm Voluma, PREVELLE Silk, Hydrelle, Belotero
• Collagen-Based Fillers: Cosmoplast, Cosmoderm, Evolence
• Semi-Permanent Fillers: Sculptra, Radiesse
• Permanent Fillers: Bellafill

 After finding a board-certified plastic surgeon in your area who is experienced in performing filler injections, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation with your plastic surgeon, he or she will ask you about the areas on your face that concern you the most and what outcomes you’d most like to see. He or she will also evaluate the lines on your face to make recommendations. Together, you’ll decide on a type of dermal filler that will be best suited for your needs as well as injection sites to target. Once your surgeon or injector understands your goals, alternative and additional treatments may be considered (see related procedures).

Your treatment plan

Fillers can be administered the same day as your consultation because of their minimally invasive nature, low downtime, and safety record. Based on your goals, physical characteristics and many years of training and experience, your dermatologic surgeon will share recommendations and information with you, including:

• Filler injection recommendations that will give you the best outcome
• The outcomes that you can anticipate
• Your financial investment in the procedure
• Associated risks and complications
• What is needed to prepare for filler injections
• What you can expect to experience after fillers
• Share before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

It is important for you to take an active role in your procedure, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for filler injections?
• Who will be performing my filler injections? (If not the surgeon, then ask about licensing and qualifications.)
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for this procedure?
• Do I need topical anesthetic?
• What will be the costs associated with my fillers treatment?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my filler injections does not meet the goals we agreed on?

How do I prepare for a fillers procedure?

Your surgeon will provide thorough pre-treatment instructions and answer any questions you may have. In the weeks before your injections, you’ll be asked to refrain from taking aspirin, ibuprofen, vitamin E, St. John’s Wort, and any other medications that could cause bruising. Be sure to inform your physician of any medicines you are taking. If you have a history of cold sores, your surgeon may recommend taking Valtrex as a precaution. Your doctor may ask you to stop smoking before the procedure. Regardless of the type of procedure to be performed, hydration is very important before and after treatment for safe recovery. 

Immediately after injection You will likely see the results of your injections immediately following the procedure, though it’s not uncommon for patients to experience swelling or minimal bruising in the area of the injection site. Your physician may give you an ice pack or cold compress to help stem swelling. The period of swelling will depend largely on the type of soft tissue filler you received, though most swelling, bruising, and redness should dissipate within one week to ten days.Recovery time frame One of the most enticing features of soft tissue fillers is their minimal recovery time. In the approximate week it takes for swelling and bruising to disappear, your doctor may advise you to avoid wearing hats or other headgear and only use small amounts of makeup.

The length of results from your dermal fillers is dependent on the type of injection you received:

• Collagen-Based Fillers: Results will last from two to four months.
• Hyaluronic Acid-Based Fillers: Results vary, though results of most common brands will last six to twelve months.
• Semi-Permanent Fillers: Results will last between twelve and eighteen months.
• Permanent Fillers: Results are typically still visible after five or more years.

The cost of filler injections varies from doctor to doctor and from one geographic area to another.These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to fillers.Filler injections are elective treatment, so insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable. 

As with any cosmetic procedure, patients must be in contact with their doctor during their recovery period. You should get in touch with your surgeon at the first sign of an abnormality or unexpected side effect. Prolonged pain and swelling could be a sign of infection or an allergic reaction.There are very few risks associated with fillers, but you should contact your doctor if:

• Swelling, bruising, or redness does not dissipate after one week
• You experience acute pain near the injection site coupled with asymmetry, lasting more than seven to ten days after the procedure
• You develop any nodules or bumps in or around injected areas or any uneven areas around the skin

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your filler injection procedure.