Fillers
Soft tissue filler injections represent one of the most transformative advancements in aesthetic medicine. Designed to restore volume, smooth wrinkles, and enhance contours, these minimally invasive procedures offer a “liquid facelift” alternative to surgery. By replenishing lost facial volume—a hallmark of ageing—fillers can rejuvenate the face and neck, soften hands, and subtly reshape the body.
Modern fillers are sophisticated biocompatible materials that work in two key ways:
1. Immediate Volume Replacement (e.g., Hyaluronic Acid gels).
2. Collagen Stimulation (e.g., PLLA, PCL, CaHA), which gradually rebuilds skin structure.
Their appeal lies in minimal downtime, customizable results, and (for most types) reversibility. However, expertise in anatomy, product selection, and technique is critical to ensure safety and natural outcomes.
A. Fillers for Face and Neck vs. Body
Facial Applications target volume loss, wrinkles, and contour deficits:
– Midface: Cheek augmentation (HA, CaHA, PCL) to restore malar volume.
– Lower Face: Marionette lines, lip enhancement (soft HA like Restylane Silk), jawline definition (CaHA, PLLA).
– Periocular: Tear trough correction (low-viscosity HA), temple hollows.
– Neck: Platysmal band softening, horizontal rhytides (low-G’ HA); décolletage rejuvenation.
Body Applications address volume depletion and skin laxity:
– Hands: Dorsal volume loss (CaHA, PLLA) to reduce tendon visibility.
– Buttocks/Calves: Non-surgical augmentation (PLLA, PCL) via collagen stimulation.
> Key Consideration: Facial fillers prioritize precision and low viscosity, while body fillers use biostimulatory agents (PLLA, PCL) for broader volume restoration.
Body Applications address volume depletion and skin laxity:
– Hands: Dorsal volume loss (CaHA, PLLA) to reduce tendon visibility.
– Buttocks/Calves: Non-surgical augmentation (PLLA, PCL) via collagen stimulation.
> Key Consideration: Facial fillers prioritize precision and low viscosity, while body fillers use biostimulatory agents (PLLA, PCL) for broader volume restoration.
B. Indications
1. Cosmetic:
– Static/dynamic wrinkles (nasolabial folds, glabellar lines) .
– Lip augmentation, cheek contouring .
2. Volume Restoration:
– Age-related fat atrophy, HIV-associated lipoatrophy (CaHA, PLLA FDA-approved) .
3. Structural Correction:
– Scar revision (atrophic acne scars), facial asymmetry, earlobe rejuvenation .
C. Types of Fillers by Longevity
Type
Temporary
Semi-Permanent
.
Permanent
Duration
6–18 months
1–2 years
.
5+ years
Examples
Juvederm, Restylane
PLLA/PCL biostimulators
(2–4 sessions)
Bellafill
(PMMA)
Key Properties
Reversible, low complication risk
Collagen stimulation, thicker consistency .
Microspheres persist; granuloma risk .
Polycaprolactone (PCL – Ellansé): Hybrid category; immediate gel correction + 2–4 year collagen stimulation .
D. Filler Materials: Properties and Mechanisms
1. Hyaluronic Acid (HA)
• Mechanism: Binds water for immediate volumizing; reversible with hyaluronidase.
• Variants: Low G’ (lip filler), High G’ (cheek, e.g., Voluma) .
2. Calcium Hydroxylapatite (CaHA – Radiesse)
• Mechanism: Microspheres stimulate collagen; used for deep folds and hand rejuvenation .
3. Poly-L-Lactic Acid (PLLA – Sculptra)
• Mechanism: Gradual collagen synthesis; requires multiple sessions
4. Polycaprolactone (PCL – Ellansé)
• Mechanism: CMC gel (immediate effect) + PCL microspheres (collagen induction over 2–4 years) .
5. Polymethylmethacrylate (PMMA – Bellafill)
• Mechanism: Collagen gel (temporary) + PMMA microspheres (permanent scaffold) .
Note: Autologous fat grafting is permanent but requires liposuction and has variable resorption .
E. Injection Techniques
1. Anatomic Planning:
– Danger zones (e.g., glabella, nasal ala) require cannulas to avoid vessels . 2. Methods:
– Serial Puncture: For linear wrinkles.– Fanning/Cross-Hatching: Cheek volumizing.
– Bolus Deposition: Deep malar volume (supraperiosteal).
3. Instrumentation:
– Sharp needles (precision), blunt cannulas (safety in vascular areas)F. Downtime and Recovery
• Typical: Mild swelling/bruising (24–72 hours); resume work immediately .
• Activity Restrictions: Avoid exercise, heat exposure, and pressure on sites for 48 hours .
• Fat Grafting: Up to 2 weeks recovery due to liposuction
G. Side Effects vs. Complications
Category
Side Effects
Complications
Examples
Bruising, edema, asymmetry
Vascular occlusion, blindness
Onset
24–72 hours
Immediate
H. Major Complications
1. Vascular Occlusion:
– Signs: Blanching, pain, mottled skin; can lead to necrosis or blindness .
2. Granulomas:
– Late-onset (months/years) with permanent/semi-permanent fillers .
3. Infection/Necrosis:
– Staphylococcus biofilms in improperly injected fillers .
I. Treating Complications
1. Anatomic Planning:
– Danger zones (e.g., glabella, nasal ala) require cannulas to avoid vessels . 2. Methods:
– Serial Puncture: For linear wrinkles. – Fanning/Cross-Hatching: Cheek volumizing. – Bolus Deposition: Deep malar volume (supraperiosteal). 3. Instrumentation:
– Sharp needles (precision), blunt cannulas (safety in vascular areas)J. Longevity
• HA: 6–18 months (lip < cheek).
• CaHA/PLLA: 12–24 months.
• PCL: Up to 4 years (collagen replacement).
• PMMA: Permanent.
Factors Influencing Duration: Metabolism, injection depth, filler rheolog
K. Conclusion
1. Material Selection:
Match filler properties (viscosity, longevity) to anatomic needs . 2. Safety First:
Mastery of facial anatomy and avoidance of high-risk zones prevents vision loss or necrosis. 3. Complication Preparedness:
Hyaluronidase availability and emergency protocols are essential . 4. Innovation:
Biostimulatory agents (PCL, PLLA) offer durable results with fewer repeat procedures . nBody-Specific Fillers
1. Buttock Augmentation
– Purpose: Non-surgical “Brazilian Butt Lift” alternative for volume enhancement, contour correction, and mild lifting.
– Ideal Candidates: Patients with mild-moderate gluteal volume loss or asymmetry, seeking subtle enhancement without surgery.
– Products & Mechanisms:
– Biostimulators (PLLA – Sculptra / PCL – Ellansé):
– Stimulate collagen for gradual, natural-looking volume (2–4 years).
– Technique: Deep supra-muscular injection; requires 2–3 sessions.
– Permanent Fillers (Hyacorp MLF1):
– Composition: Polymethylmethacrylate (PMMA) microspheres in collagen gel.
– Longevity: Lasts 5+ years.
– Key Use: Targeted volume restoration in small-to-moderate areas.
– Safety Note:
– Avoid intravascular injection (risk of pulmonary embolism).
– Max 100 ml/session; use cannulas for dispersion.
2. Hand Rejuvenation:
– Radiesse (CaHA) or Sculptra (PLLA) to conceal tendons and veins.
3. Calf/Shoulder Sculpting:
– Ellansé (PCL) for symmetrical augmentation.
Body-Specific Fillers
Decade
30s–40s
50s+
Body Concerns
Early volume loss
(buttocks/hands)
Severe deflation
Treatments
Hyacorp/HA for buttocks; Radiesse for hands
PLLA/PCL biostimulators (2–4 sessions)
Safety & Complications
• Buttock Filler Risks:
– Vascular occlusion → potentially life-threatening PE.
– Granulomas (Hyacorp PMMA: 1–3% incidence).
• Prevention:
– Cannula-only for deep buttock injections.
– Ultrasound guidance for vessel mapping.
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