Cosmetic Medicine | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao

Fillers

Cosmetic Medicine - Fillers - Fillers

Fillers

  • Print
  • Send email
  • Download PDF

Injectable fillers constitute one of the most popular rejuvenation techniques. As we age, the underlying tissues which maintain the youthfulness and firmness of our skin begin to rupture due to the effects of gravity, exposure to the sun, diet, genetic factors and years of moving the facial muscles. With the passage of time, these factors contribute to the development of lines, wrinkles and creases on the face.

Where do Wrinkles form?

The skin is made up of two layers: epidermis and dermis. The epidermis, or external layer of the skin, serves as primary defence of the skin against the environment. The dermis, or innermost layer of the skin, is made up principally of connective tissue and provides the skin with a support structure. The majority of the deeper wrinkles and creases appear within the dermal layer of the skin.

What causes Wrinkles?

Within the connective tissue of the dermis, the collagen and fibres of elastin form a network, providing the skin with structure, support and elasticity. In addition, fat cells and other molecules, such as hyaluronic acid, contribute to the creation of volume under the skin of the face. With the passage of time, this network of collagen and elastin ruptures, and the molecules of hyaluronic acid and fat cells which create volume diminish. The fact that these molecules break up and diminish simultaneously causes the appearance of wrinkles and other changes on the skin of the face. When used as individual treatments or in combination with other procedures, injectable fillers can reduce or eliminate wrinkles and scars, create fuller lips and treat lipoatrophy, or the loss of fat under the skin.

The Fundamentals – Hyaluronic Acid

Hyaluronic acid is a complex glucose molecule of natural origin which forms large matrices in the corporal connective tissue, such as the skin and the cartilage. Just like a sponge, its principal function is to bind and absorb water molecules, which creates volume in the face. Hyaluronic fillers are generally used to treat facial wrinkles and creases and to improve the appearance of the lips. Hyaluronic acid fillers are one of the most widely accepted dermal filler treatments available, and work by replacing the body’s hyaluronic acid which has diminished over time, thereby restoring volume under the skin.

Types of Hyaluronic Acid Fillers

Despite the variety of existing hyaluronic acid fillers, some of the most common ones are Juvederm®, Restylane®, y Emervel®, Esthelis®. Juvederm is commercialised by Laboratorios Allergan, while Juvederm is commercialised by Laboratorios Galderma (formerly Q-Med). Hyaluronic acid fillers are generally biocompatible, which means that no allergy skin test is required prior to the treatment.

Preparation for the Procedure

Depending on the scope of the treatment, hyaluronic acid injection procedures generally take between fifteen and seventy minutes. Prior to beginning the procedure, the treatment areas are cleaned, generally using an alcohol-based cleaner. Unlike collagen injections, hyaluronic acid injections do not include an anaesthetic agent. Therefore, topical or local anaesthesia may be used to numb the treatment area during the procedure.

Injection Procedure

With an ultra-fine needle, the hyaluronic acid is injected into the dermis at different points around the edges of the treatment area. After approximately two to three injections, the doctor will massage the treatment area. He will continue injecting filler along the length of the wrinkle or crease until maximum correction has been achieved. If local anaesthetic has not been used, it is possible you will barely even feel the injections. Given that the injected hyaluronic molecules attract and bond the water molecules, the volume under the skin will increase, restoring a smoother and more youthful appearance.

Recovery

Immediately after the injections, you may experience some reddening, a slightly sharp sensation, slight swelling or bruising in the treatment area. It is also possible that minute scabs will form at the injection sites. Generally, these symptoms disappear within two to three days. It is not necessary to apply a bandage, and the majority of patients can immediately resume their everyday activities. Over time, the body will eventually metabolise and absorb the hyaluronic acid injected. Therefore, although the effects are immediate, hyaluronic acid injections do not provide the same long term results that can be obtained from cosmetic surgery. Although the results vary with each patient, the results of hyaluronic acid injections generally persist for six to twelve months.

FREQUENCY OF TREATMENTS

Three sessions are performed, separated by 21 days between each of them. This process is repeated every 3 or 6 months, depending on the medical criteria.

RESTYLANE AND AESTHETICS

In its natural form in the organism, hyaluronic acid only last a few days. This is why, the unique stabilisation process patented by Q-Med (now Galderma) used in the production of Restylane, results in a minimal modification of the hyaluronic acid, providing us with long-lasting aesthetic results.

WHAT RESTYLANE CAN DO FOR YOU

If what you want is to rejuvenate your skin, smooth out the wrinkles, reshape facial contours or add volume to your lips, Restylane has the product to ensure your image is perfect and you feel good about yourself, providing aesthetic effects which are both instantaneous and long-lasting.
The results of Restylane can be appreciated instantly and as the treatment is non-surgical, you can resume your everyday life immediately.
In the image below you can find out what Restylane can do for you.  For more details about the different treatment areas click on the following links:
•    Treatment of wrinkles
•    Lip augmentation
•    Facial reshaping
•    Skin rejuvenation

THE TREATMENT OF WRINKLES WITH NATURAL RESULTS

With the help of Restylane, your appearance will quickly improve, providing you with a natural and long-lasting result.
Whatever your requirements, from smoothing out crow’s feet and smoker’s lines to correcting deep creases and expression lines, there is a solution that will provide you with the best possible results.
The Restylane products can smooth the following wrinkles:
•    The lines between nose and mouth (nasolabial grooves)
•    Crow’s feet
•    Smile lines
•    Expression lines
•    Glabellar lines
•    Forehead lines
•    Marionette lines – make the corners of the mouth incline downwards

LIP AUGMENTATION

The lips are often the centre of attention.  Restylane can increase the volume of the lips, emphasize the profile of the lips or better define the Cupid ’s bow in a natural manner.
Restylane can improve your smile by:
•    Increasing the volume of the lips
•    Defining the labial profile
•    Correcting the marionette lines which pull your mouth downwards
•    Reducing the smoker’s lines around the mouth
A significant improvement in your lips can be achieved through the definition of the labial profile, reduction of smoker’s lines, correction of marionette lines or by an augmentation of the volume of the lips.  With Restylane, you have the freedom to choose, as you can adapt the treatment to you wishes and your requirements.
Small changes can make a big difference.

The results of a treatment with Restylane are long-lasting without being permanent, enabling you to choose whether to maintain the effect. All the treatments can be undergone on their own or in combination with others – for a natural and personalised result. Your doctor will at all times advise you about what suits you best.

RESHAPING OF THE FACIAL CONTOURS

Restylane® can provide you with natural augmentation of the cheekbones as well as a more defined chin.
Restylane can help you to restore lost facial volume in a natural manner.  By gently adding volume to the chin and the cheeks, Restylane reshapes and emphasizes these areas in order to provide a youthful and more defined appearance.
Restylane can for example define and accentuate the features of the face by creating:
•   a more pronounced definition of the cheeks
•   a well-defined chin

CUTANEOUS REJUVENATION TO IMPROVE THE ELASTICITY AND STRUCTURE OF THE SKIN

Restylane Vital™ is a range of products for cutaneous rejuvenation (recovery of hydrobalance), which works by improving the elasticity and structure of the skin.
As we age, skin quality changes, such as the loss of collagen and elastic fibres and the distribution and function of the hyaluronic acid of the organism itself changes.  This leads to rougher and drier skin with less elasticity.  The biological clock plays an important role in this process, but also the factors of the patient’s own lifestyle, such as exposure to the sun, smoking and drinking.
Increase skin elasticity and improve the structure of the skin.
Restylane Vital is a complete beauty treatment that can help you, as it is a safe and natural treatment for cutaneous rejuvenation, which restores hydrobalance to the skin and improves elasticity and tone to create a fresher and more natural appearance. It has been scientifically demonstrated that Restylane Vital improves the quality of the skin and can be used to rejuvenate the face, neck, cleavage and back of the hands.
Restylane Vital can improve skin quality in the following areas:
•    Face
•    Neck and cleavage
•    Back of the hands

CUTANEOUS REJUVENATION TO IMPROVE THE ELASTICITY AND STRUCTURE OF THE SKIN

Restylane Vital™ is a range of products for cutaneous rejuvenation (recovery of hydrobalance), which works by improving the elasticity and structure of the skin.
As we age, skin quality changes, such as the loss of collagen and elastic fibres and the distribution and function of the hyaluronic acid of the organism itself changes.  This leads to rougher and drier skin with less elasticity.  The biological clock plays an important role in this process, but also the factors of the patient’s own lifestyle, such as exposure to the sun, smoking and drinking.
Increase skin elasticity and improve the structure of the skin.
Restylane Vital is a complete beauty treatment that can help you, as it is a safe and natural treatment for cutaneous rejuvenation, which restores hydrobalance to the skin and improves elasticity and tone to create a fresher and more natural appearance. It has been scientifically demonstrated that Restylane Vital improves the quality of the skin and can be used to rejuvenate the face, neck, cleavage and back of the hands.
Restylane Vital can improve skin quality in the following areas:
•    Face
•    Neck and cleavage
•    Back of the hands

FREQUENTLY ASKED QUESTIONS

What is hyaluronic acid?
Hyaluronic acid is a molecule of sugar which the body generates naturally.  The hyaluronic acid attracts water, helps in hydration and provides volume and structure to the skin.
It has many functions, from providing elasticity to the skin through to lubricating the joints.
What areas can be treated?
The Restylane products can be used to smooth out facial lines and wrinkles, increase the volume of the lips and reshape facial contours, such as cheeks and chin, and generally rejuvenate the skin.
The most common treatment areas are:
•   the lines from the nose to the mouth (nasolabial lines)
•    between the eyebrows (lines in the glabellar area)
•    lips (add volume and profile)
•    cheeks and chin (reshape and emphasize)
•    the back of the hands, cleavage, face, neck (cutaneous rejuvenation)
Link to the image

How does RESTYLANE work?
Restylane rejuvenates and adds volume to the skin, instantly reducing the appearance of lines and wrinkles, and providing a natural appearance. Restylane is an injectable gel made up of stabilised hyaluronic acid of non-animal origin.  The gel does not damage the tissue and it is very similar to the hyaluronic acid that occurs naturally in the organism.  It is long-lasting but not permanent.

What does a RESTYLANE treatment involve?
Before
Begin by arranging an appointment with a qualified doctor.  To contact a clinic close to you, click on “Find a clinic”.  During the consultation be ready to discuss your individual requirements and listen to the recommendations in relation to which Restylane treatment is the most suitable for you. This will be based on what you want to achieve, your characteristics and factors relating to lifestyle.
After the consultation you will receive the appropriate treatment.
During
Restylane is injected into the skin in small quantities with a very fine needle. The gel provides natural volume to eliminate the appearance of lines and wrinkles, improve facial contours, or increase the volume of the lips.  Restylane Vital products improve the elasticity and texture of the skin, and restore and maintain the hydrobalance of the skin.
The treatment is quick, normally lasting some 30 minutes.  Treatment with Restylane does not affect facial expression and the benefits can be seen instantly.
After
Restylane products are biodegradable, which means that the gel starts to degrade and disappear in the body in a natural and progressive manner.  After 6 to 12 months a maintenance treatment tends to be necessary, depending on individual factors and the areas to be treated. Discuss with your doctor when the follow-up treatment would be required.
After treatment there may be some reaction.  The most common one is slight redness, swelling, stinging, bruising, discomfort and sensitivity. The reactions are generally from mild to moderate and normally disappear shortly after the injection.  They normally disappear spontaneously within one or two days after the injection, but in some treatments they may last longer.

How long does RESTYLANE treatment last?
One of the great advantages of Restylane is that the effects are long-lasting, but not permanent.  The duration depends on many factors, such as the person’s skin type, lifestyle and age.  After the initial treatment, follow-up sessions are recommended after 6 or 12 months depending on the person and the treatment.

Can everyone use RESTYLANE?
Most people can benefit from Restylane treatment. If you want to reduce lines and wrinkles or augment your lips, Restylane can help you.  Also, if you want to emphasize the contours of your face, such as the chin or cheeks, or rejuvenate the skin on your face, back of hands, neck or cleavage, Restylane is a good option for you.
Restylane should not be used in areas close to skin which is, or has been, damaged in any way, nor if there is any inflammation or related condition.  Restylane has not been tested in pregnant women or in women who are breastfeeding.  People with health conditions which reduce the immunological response of the body or who are undergoing a therapy which inhibits the immune system, may be liable to infection through the cutaneous injection process.
During the consultation prior to the treatment, you should discuss your medical history in some depth with your doctor.

Is the use of anaesthetic necessary prior to applying RESTYLANE?
Generally, when Restylane is injected into the skin to correct wrinkles, the use of anaesthetic is not required.  Some people may experience mild discomfort during the treatment.  In any event, an anaesthetic cream can be used on the area to provide a more comfortable treatment.
The lips are an extremely sensitive part of the body, therefore, the use of anaesthetic is recommended prior to a lip augmentation.  This is more effective using local anaesthetic or dental block.
Restylane® and Restylane Perlane™ are now available with lidocaine, ensuring greater comfort during the treatment.

Is there any risk with RESTYLANE?
More than 10 million treatments have been performed since the launch of Restylane in 1996. Reactions relating to the product are rare.  There are some reactions in relation to the injections which can occur after any injection; they normally disappear spontaneously a few days after an injection into the skin, a week after an injection into the lips and a week after injections with Restylane SubQ. These reactions include redness, swelling, discomfort, stinging, bruising or sensitivity in the area that has been injected.
After a lip augmentation procedure, the lips may be swollen for a week.
In cases of more acute reactions or if they were to last for longer than a week, consult your doctor.
As in all skin injection processes, there is a small risk of infection.  Local inflammatory reactions have been rarely reported, described as mild to moderate and normally with a 2 week limit.
If you would like more information, ask your doctor about the full side effects.

Over time, the body eventually metabolises and absorbs the hyaluronic acid injected.  Therefore, although the effects are immediate, the hyaluronic acid injections do not provide the same long-lasting results that can be obtained from cosmetic surgery. Although the duration of the results varies with each patient, the results of hyaluronic acid injections are generally maintained over six to twelve months.