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Facial Rejuvenation with Cosmetic Fillers E-mail
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Rejuvenating newly identified fat compartments in the facial cheeks can help reduce the hollowed look of the face as it ages. Restoring these compartments also improves volume loss under the eyes, helps eliminate lines around the nose and mouth and gives more curve to the upper lip, all of which restore a more youthful appearance to the face.

About Injectable Fillers 

While fillers will not replace the need for a face lift here are numerous applications of cosmetic fillers that create a subtle, beautiful and natural appearance.

Fillers can be used for anything from smoothing out a little wrinkle to evening out a deep furrow to correct hollowness around the eyes, add fullness to thin lips, or balance a disproportionate face and to restore fat which is naturally lost from the face with aging.

Most of these cosmetic fillers can be classified as temporary (lasting a few weeks or months), semi-permanent (6-12 months) to permanent.

The material for these fillers is derived from various sources-- animal sources, donated human sources (yours or someone else's), or are they can be completely synthetic. Some of these cosmetic fillers are injected, while some are surgically implanted. The range in cost for one treatment can vary between a few hundred to a few thousand dollars. The information given below can help you in making your decision during your consultation with the plastic surgeon for an affordable plastic surgery.

Temporary injectable fillers

CosmoDerm or CosmoPlast

CosmoDerm or CosmoPlast is FDA-approved for cosmetic corrective use. It is a human-derived collagen.  Cosmoderm is used for minor skin defects; CosmoPlast is used for defects that are more serious. Overcorrection (injecting more of the dermal filler substance than what is typically needed to produce a positive outcome) is needed to achieve ideal results. Lasts: 3 to 9 months.

Restylane and Perlane
Restylane and it’s thicker counterpart, Perlane are newer fillers made from hyaluronic acid, a natural substance that creates volume in the skin. Its advantage over  collagen
is that they do not pose an allergy risk.

Restylane is derived from bacteria and is used for more superficial wrinkling. Perlane is meant for use on deeper wrinkles. Overcorrection (injecting more of the dermal filler substance than what is typically needed to produce a positive outcome) is generally not needed with these substances, as it is for collagen or fat injections which degrade quicker.

Restylane and Perlane can last from six months to one year.  Application is done in the office.  A allergy skin test is not needed. The time required for the procedure is 5 to 15 minutes. A anesthetic is not neededm however a nerve block, topical cream anesthetic or a freon spray can be used to numb the injected area. Cost: $500 to $1000 /treatment

Permanent Fillers

As an alternative to injecting a substance that your body will eventually absorb, another class of fillers involves injection of a permanent substance. When this foreign substance is injected, the body naturally forms scar tissue around it to protect it from entering other areas of the body. This scar is made of collagen, which is a filler all by itself. However, since the foreign substance is not biodegradable, it will stay in your body presumably forever. It can be an ideal permanent solution to your facial contouring. However, it can also cause a immune reaction resulting in potential rejection by the body which may cause excessive scars, creating firmness, lumpiness, inflammation, and migration of the substance.

There are nearly 20 types of permanent injectable fillers, but the most commonly used are Silicone and Artecoll (made from the same chemical as plexiglas), though neither one of these is approved for use in the United States.

Natural Fillers

natural  fillers comes directly from your own body, so there is no chance of rejection. Once the material is harvested, it is tested and processed to remove any substance that could cause an allergic or infectious response. Longevity of these human-derived products varies widely, as does the cost. The more popular ones are Alloderm (implanted), Fascian (injected), and Cymetra (an injectable form of Alloderm

Fat transfer

Fat transfer is a method whereby your own fat is removed from one area and then injected into the area where fullness is desired. It is an excellent alternative to fillers from outside sources, and is one of the more permanent wrinkle treatments. Also known as fat grafting, fat transplantation, autologous fat transplantation, fat injection, or microlipoinjection, the procedure involves suctioning small amounts of fat, usually from the abdomen or flanks, processing it in a centrifuge to separate the fat from other substances, and then injecting the fat into the face for the desired effect.

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.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 overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen. This procedure can also be done in 15 minutes in the office.  Local Anesthesia is often used. Side effects may include some swelling, bruising or redness in both the donor and recipient sites lasting frm 24 to 48 hours.  Repeated injections may be necessary. Cost $2000 to $4500 /treatment

Permanent Filler Implants

Instead of injecting a filler through a needle, a minor surgical procedure can be performed in the office operating room to place a permanent implant. (These filler implants are not to be confused with facial implants used for cheek, chin, jaw, or midface augmentation). Filler implants are most commonly used for lip augmentation, but can sometimes be used to fill in the naso-labial grooves around the mouth. They can be shaped like tiny threads or strands, hollow tubes, or flat sheets of material that are trimmed to fit. The more commonly used filler implants are Gore-Tex and Softform.

The procedure to place the implant is performed with local anesthesia, and swelling may be evident for several days. These implants can usually be removed if you decide you don't like the look, but otherwise they are permanent.

Comparison of Injectable Fillers

  Collagen Hylaform® Restylane® Sculptra™ Radiesse™
What is it made of? Bovine Collagen Hyaluronic Acid Hyaluronic Acid Poly-Lactic Acid Calcium Hydoxyl-apatite
What is it used for? Wrinkles/Lip Augmentation Wrinkles/Lip Augmentation

Wrinkles/Lip Augmentation

Adding Volume to Cheeks and other Facial Areas Wrinkles and Lip Augmentation
How many treatments are needed? 1 1 1 3 or More 1
Is skin testing required? Yes No No No No
How long does it last? 3 to 6 Months Up to 1 Year Up to 1 Year Up to 2 Years 2 or More Years
Is there a risk of hypersensitivity? +++ ++ + + +
Where does it come from? Cow Hide Rooster Combs Bacteria Synthetic Synthetic
Is it animal based? Yes Yes No No No
How much does it cost? $ $$ $$/$$$ $$$$ $$$$


The Statistics

Plastic surgeons performed nearly 8,000 cheek implants in 2007, according to the American Society of Plastic Surgeons. In addition, nearly 47,000 fat injections and 1.1 million injections with hyaluronic acid fillers were performed last year.



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