Temporary Fillers

• Are safer to use.
• Most of them now are made of Hyaluronic Acid (HA). Hyaluronic acid (HA) is a glycosaminoglycan that is naturally found in the body and helps protect the skin from ultraviolet light and free radicals, which can damage the collagen and elastin. HA also helps hydrate your skin.
•  Can be removed usually – HLA fillers can be dissolved with the use of Hyaluronidase injections. The effect of the enzyme begins immediately, but it takes several days to reach full effect. Once dissolved, a second treatment may be performed very conservatively to remove the remaining filler. A repeat treatment of fillers can also be performed in a more appropriate manner.
• Are re-absorbed by the body over the course of 24 months.
• Your body can react to all types of fillers. When it reacts to permanent fillers you may encounter life long, progressive problems.
• Last from 6-18 months depending on the type of filler used, the amount of filler used and the location where the filler was placed.

Complications of HA Fillers

• Ischemia: due to intravascular injection. Injection near the eye carries an extremely low but devastating risk of blindness. After HA filler is dissolved following an occlusive vascular event, you may notice reactive redness or hyperemia from the irritation or revascularization event. You may also notice a vesicular eruption from the ischemic insult. Many practitioners mistake this for an allergy or infection. Steroid creams and nitric paste are often used to help resolve this and prevent any scarring. Long-term pain may be experienced for up to 3 years due to residual inflammation.
• Allergy: Patients may experience allergy to the HA or the lidocaine within the gel. More commonly, patients experience edema caused by systemic allergies, improper placement of filler, or simply bad luck. This can be treated with a short course of steroids, antihistamines or removal of the filler.
• Infection: infection should be treated with antibiotics immediately. Filler dissolving should be postponed until resolution of the infection.
• Unfavorable outcomes: these are the result of fillers placed in wrong locations or planes, or from using certain type of fillers in sensitive areas. For example, injecting juvederm under the eyes or in the lips will most likely result in discoloration and can migrate up to 1 cm. fillers usually last for 1 year; however, when they migrate, they can stay there up to 10 years.

Improper placement of fillers or overfilling can result in adverse outcomes such as:

• Under eye bags
• Incorrect filler under the eye which may last years
• Blue discoloration under the eyes
• Simian appearance, making the mouth appear round
• Low, fatty cheeks
• Lengthened upper lip
• Lack of facial definition
• Masculine look
• bumps
• Asymmetric appearance

All these adverse effects can be corrected. It is very important that these procedures be performed by an experienced and highly trained doctor, someone who is very familiar with the anatomy of the face to avoid uncertain outcomes and significant complications.

Permanent & Semi-Permanent Fillers

• Fat
• Silicone
• Polymethylmethacrylate (PMMA)
• Calcium Hydroxylapatite (CaHA)
• Poly-L-Lactic Acid

Fat

• Can be used as graft, regular fat or liquid fat.
• It is typically suctioned and harvested from the abdomen, flanks or inner thighs and injected into the face for volumization.
• Small amounts grafted to the face at the proper depth can give a very nice look.
• It can also be processed into nano-fat. This is used in tissue healing and it has a very low rate of complications when compared to regular fat transfer.
• The survival of transferred fat ranges from 0-100% from patient to patient.
• when injected deep, it appears to have less complications than when injected superficially.

Complications

• Severe complications are rare but include vascular events.
• Injecting fat in the face should be done carefully to avoid irregularities, discoloration and chronic inflammation which leads to swelling, asymmetries and are difficult to treat.
• You can use kybella or attempt surgery to remove excess fat. In general liposuction has a poor outcome treating misplaced fat.

Silicone

• Should never be used as injections.

Complications

• Irreversible
• It melts with surrounding tissues and cause fibrosis on the long run.
• You can only treat the complications of silicone injection (nodularities, granulomas ) once every while but you cannot remove the silicone itself.

Polymethylmethacrylate (PMMA)

• Equal or lesser complications than silicone itself.
• Do not use in the face.

Complications

• Same as silicone

Calcium Hydroxylapatite – Radiesse

• It is a bony type mineral.
• We suggest that it be used over the bone and more judiciously in the soft tissues.
• It stimulates collagen production in form of fibrosis just like absorbable threads.

Complications

• Radiesse is not immediately dissolvable. It should never be injected anywhere at risk of vascular compromise.
• Avoid injecting superficially into the skin. This will likely leave bumps that may take years to resolve.
• Avoid injecting under eyes with Radiesse. This can cause chronic swelling and it cannot be removed easily.
• Radiesse should not be injected into the lips or nose.

Poly-L-Lactic Acid (Sculptra)

• Sculptra is a stimulator composed of a suture-type material similar to what vicryl sutures are made of. When injected, it is intended to stimulate collagen production and slowly increase volume.
• Sculptra is a good option when adding diffuse volume such as when dealing with facial atrophy or weight loss.

Complications

• The most common complication is the formation of nodules. Similar to Radiesse, needling with saline may help speed up the resorption process.
• The most common issue encountered is mild redness, pain, bruising or swelling at the injection site.
• Sculptra cannot be surgically removed.

Dr. Abi Akl is an expert in injectables. During your consultation, he will guide you through all the available options of facial rejuvenation and together will decide on the best treatment for your case. There is no one size fits all procedure, each case is customized to meet your goal.

If you are interested in facial fillers, schedule a virtual or clinical appointment or call our office.