Fillers

What are

In aesthetic medicine, the filler is an injectable substance into the dermis or subcutaneous tissue to correct skin imperfections, touch up facial imperfections such as wrinkles or scars, and restore lost volumes.

Literally, "filler" means "filling": these substances are in fact injected into the dermis to fill (in fact to fill) and smooth out facial wrinkles and other signs of aging.

Indications

Therefore, aimed at skin rejuvenation, filler injections represent innovative and effective alternatives - or a valid support - to plastic surgery.
Filler bites are indicated in the following circumstances:

Fill and level the wrinkles around the eyes (the so-called crow's feet) and the mouth;
Increase / reshape the volume of thin lips;
Correct the nasolabial folds;
Shaping the shape and volume of cheekbones, chin and forehead;
Fill in folds and depressions typical of aging;
Eliminate scars left by acne or surgery.

Ideal characteristics

What characteristics should ideal fillers possess?

Ideal fillers should:

Guarantee constant, predictable and natural results;
Be economical;
Being painless;
Be safe and hypoallergenic;
Be free of side effects;
Be suitable for all categories of patients;
Ensure a long-lasting filling and rejuvenating effect;
Cost little.

Unfortunately, the ideal fillers do not exist, however, given the high demand for these particular aesthetic treatments, research in this field is always in constant evolution.

Types of fillers

For more information: Types of Fillers

Fillers are not all the same: the boom in requests in the last decade has pushed scholars to seek ever more innovative, effective and safe fillers. The hyaluronic acid filler is certainly the most popular for combating wrinkles and moisturizing the skin. in depth, while ensuring a completely natural "soft-lifting" effect. Collagen fillers are also quite coveted and requested fillers in the aesthetic medicine sector; in particular, collagen punctures are indicated in increasing the volume of the lips and in the treatment of surgical or acne scars. Both collagen and hyaluronic acid fillers belong to the category of fillers defined as "resorbable", since the body is able to slowly reabsorb them over time.
There is also "another category of fillers: that of the so-called synthetic fillers. These fillers, in turn, are divided into:

Partially synthetic fillers, in other words, semi-permanent.
Completely synthetic or permanent fillers that are able to volumize cheekbones, chin and lips by inserting real non-absorbable prostheses under the skin.

Finally, some dermal fillers are used to support other procedures, such as botulinum injections or plastic surgery.

Curiosity

The entry of fillers into aesthetic medicine dates back to about 50 years ago, when the injectable substances to mask the signs of aging were still made up of dangerous silicone oils. The use of silicone oil fillers in this aesthetic sector was banned around the 1980s (and still is).

Before the treatment

The injection of a filler is a relatively simple aesthetic medicine treatment which, if well done, can lead to excellent results.
Before undergoing the filler injections, however, it is necessary to carry out a preliminary interview with the specialist doctor. During this interview, the doctor will evaluate the type and severity of the imperfection to be treated and - according to his needs - will indicate to the patient which type of filler is best to use.
At the same time, the doctor will have to investigate the general health of the patient, in order to identify the presence of any contraindications to the execution of the injections.
In the event that the specialist consents to the administration of the filler, he will provide the patient with all the necessary information and will indicate the behaviors to follow before undergoing the treatment.
Furthermore, for some types of fillers (such as, for example, collagen fillers), in order to avoid the onset of allergic reactions, the doctor may decide to carry out a preliminary intradermal test. We proceed by inoculating a small amount of substance in the "forearm, analyzing, in the following 24-48 hours, the way in which the skin responds.In the case of a negative reaction (the analyzed skin is neither red nor irritated), a second control test of the same filler is carried out on the other forearm. Only if the second test is also negative, it is possible to proceed with the injections. of fillers on the face.

Execution

How fillers injections are performed

Since it is not an invasive procedure, the filler injections are performed on an outpatient basis and generally do not require any type of anesthesia.
However, depending on the area to be treated and in the case of particularly sensitive patients, the doctor may decide to administer local anesthetic drugs before performing the injection.

The painful perception, in fact, varies according to the individual sensitivity and is closely linked to the site where the substance is inoculated. Just to give an example, the lips are particularly sensitive points; therefore, filler injections can be quite unpleasant and create soreness and slight numbness (tingling). To overcome this drawback, the area to be treated is, therefore, anesthetized half an hour before the injection, using anesthetic creams to be applied locally or anesthetizing substances to be injected via the trunk (the anesthetic substance is inoculated near the nerve trunk ).
In any case, the fillers are always injected with pre-filled syringes equipped with extremely thin needles, in order to cause the least possible pain and deposit the right dose of product. Furthermore, the needle is generally inserted just a few millimeters below the superficial layer of the dermis: by doing so, it is possible to obtain an excellent rejuvenating effect, ensuring at the same time an (almost) painless treatment.

After the treatment

In the 24-48 hours following the injections of fillers, the appearance of side effects such as redness, swelling and bruising in the treated area is a phenomenon to be considered normal. In any case, these symptoms should resolve spontaneously in a short time.
However, in principle, normal daily activities can be resumed immediately.

Side effects

As mentioned, the appearance of some minor undesirable effects in the first days following the injection of the fillers is to be considered an almost normal phenomenon. In detail, these side effects consist of:

Formation of small - even if evident - skin signs;
Redness;
Edema;
Hematomas and bruising;
Erythema.

Fortunately, in most cases, the aforementioned side effects are completely reversible within a few days.
However, there is also the possibility - albeit rare - that filler injections cause other unwanted effects, such as:

Hyperpigmentation of the treated area;
Formation of subcutaneous nodules;
Intensification of herpetic episodes (patients predisposed to infections by Herpes virus, in fact, following the injections of fillers, they are more exposed to the appearance of new herpetic manifestations).

Finally, we also remember the possible adverse reactions of serious entity that, generally, occur following injections of permanent fillers:

Abscesses;
Bacterial infections;
Granulomas from fillers;
Fibrosis from fillers;
Compression of nerve endings;
Localized tissue necrosis.

Not to forget, then, the possibility of onset of allergic reactions in sensitive individuals. In any case, as mentioned, to remedy this problem, the doctor generally performs the above described preliminary intradermal test.
In severe cases, however rare, filler injections can cause unpredictable and very serious adverse reactions, such as abscesses, local necrosis (tissue death), hives and vasculitis (inflammation of the blood vessels).

Results and Benefits

The extraordinary advantage of fillers is the predictability of the result: in fact, the "soft-lifting" effect of "stretching" wrinkles or filling volumes (surprisingly effective) is rather predictable and immediate, and ensures a completely natural facial expression. Unlike plastic surgery, this aspect is very positive and appreciated, since it gives the patient a certain peace of mind about the final result.
The natural results that can be obtained with filler injections, combined with the non-invasiveness of the treatment and the possibility of immediately resuming all normal activities, certainly represent the main advantages of this aesthetic treatment.

Disadvantages

If on the one hand, the natural results that do not give artificiality to the face or body represent the main advantages of fillers, on the other hand, their duration can represent a real disadvantage.
First of all, it should be noted that the duration of the rejuvenating effect guaranteed by the fillers is heavily influenced by the patient's lifestyle (smoking, stress, degree of physical activity, exposure to UV rays or atmospheric pollutants, etc.), by type of filler chosen and the area where the substance is injected. In fact, except for the injections of permanent fillers (non-absorbable), the imperfection that has been corrected by the filler tends to reappear after 3-10 months from the injection.
The much sought-after return to youth of women "no longer adolescents" soon turns out to be too short a dream, so much so that the patient asks for a "further injection of filler as soon as the effect of the first session wears off."
Another not negligible aspect - which in some ways can be considered as a real disadvantage - is represented by the cost of each treatment with the filler. Like any self-respecting medicine, the quality-price ratio of a particular type of filler is a very important parameter that weighs heavily on the choice of treatment. However, it must be emphasized that patients, terrified by the "inexorable advancement of the biological clock, tend to spare no expense in order to obtain a" more rejuvenated self-image of 5 or 10 years. Precisely for this reason, the large manufacturing companies , cunning and calculating - like the Doctors of Beauty - tend to keep the costs of products at quite high levels, as they are aware of the "addiction" effect (so to speak) on fillers. The cost of the treatment is influenced both by the area to be treated and by the chosen filler. As we will see in the course of the article, in fact, there are several types of fillers, with different characteristics and different costs. In general, the price ranges from 300 to 600 euros for each session. Be careful, however, to always rely on surgeons or doctors expert, specialized and competent aestheticians, able to best guide the patient in choosing the filler that best suits their needs.

Contraindications

Before proceeding with the filler injections, it is necessary to ascertain the state of health of the patient. In fact, fillers cannot be inoculated under the skin in the following circumstances:

Known or presumed allergy to the filler;
Coagulopathies (impaired blood clotting);
Collagenopathies (autoimmune diseases of collagen and connective tissue, involving the joints. For example: systemic lupus erythematosus, Sjögren's syndrome, ankylosing spondylitis);
Pregnancy in progress;
While breastfeeding;
Herpetic (Herpes) infection in progress;
Autoimmune dermatological diseases.