What You Should Know About Wrinkle Fillers

Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional face lift costs. Most will fill lines and wrinkles in less than 30 minutes with results that can last from four months to more than a year.

Injectable wrinkle fillers, unlike Botox injections that relax the muscle under a wrinkle, fill the line or crease with one of several different substances. As a result, the line or crease seems to have nearly disappeared.

http://www.webmd.com/beauty/facial-fillers/wrinkle-fillers-what-you-should-know

Wrinkle fillers can also be used as "volumizers," plumping and lifting cheeks, filling out thin lips, and plumping sagging hands.

The treatment is fast and easy. But all wrinkle fillers have a downside, including the risk of allergic reaction and the formation of tiny bumps under the skin. In some cases, those bumps may be permanent. A bluish skin discoloration known as the Tyndall effect is also possible. The color change can last for several months, but there are treatments available. In very rare cases, skin cells may die if the wrinkle fillers are not used properly. Typically, the wrinkle fillers with longer-lasting effects are the ones more likely to cause side effects.

Not every wrinkle is right for every type of wrinkle filler. The least risks and best results come from using the right wrinkle filler correctly. That's one reason why you should only have wrinkle fillers injected by a board-certified dermatologist or plastic surgeon.

To help you discuss your options with your doctor, here is a breakdown of the wrinkle fillers currently available. It includes their basic ingredients, how they work, their risks and benefits, and the best areas for treatment. Your doctor can help you choose the right one for you.

Hyaluronic Acid Wrinkle Fillers

The most popular category of wrinkle fillers is hyaluronic acid. Each type of hyaluronic acid wrinkle filler works in a slightly different way with varying results.

Side effects are rare, but they can include redness, swelling, and bruising at the injection site. The filler may also be seen beneath the skin as tiny bumps. This is a problem that often improves over time.

How long the results last varies from several months to over a year. Some research shows that repeated injections may help stimulate the body's own natural production of collagen. That will help reduce the number of lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.

Wrinkle Injections

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(Botulinum Toxin) & the Cosmetic Indications

The following four Botulinum toxins are available in EU and UK countries:

1. Botox  (Serotype A-Toxin)
2. Dysport (Serotype A-Toxin)
3. Xeomin  (Serotype A-Toxin)
4. Neurobloc (Serotype B-Toxin)

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Treatment with RADIESSE® is quick, comfortable and convenient, with immediately visible, long-lasting results. Experience what millions worldwide have and begin your journey towards a naturally, more refreshed you today.

Filler trouble? Hyaluronidase (and smarts) to the rescue

By Lisette Hilton

The filler crash cart that Ontario, Canada, plastic surgeon Claudio De Lorenzi, M.D., recommended years ago has narrowed significantly. Now, he says, physicians need only bovine testicular hyaluronidase (HYAL) and knowledge.

And the knowledge needed is less than in the past because providers don’t have to remember all the other stuff.

“[Knowledge about] hyperbaric oxygen, prostaglandins, eye of newt, toe of frog, wool of bat and tongue of dog. All unnecessary!” Dr. De Lorenzi jokes.

But seriously, physician injectors need to know how to stay out of trouble, as well as what to do when trouble happens, according to Dr. De Lorenzi, who presented “Injectables, anatomy and safety,” Tuesday at the Aesthetic Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Las Vegas.

“Avoidance is primary strategy, but if you get into trouble: HYAL and lots of it (about 450 IU per cubic inch of ischemic tissue). Rinse and repeat hourly until resolution,” Dr. De Lorenzi says. “Everything else is superfluous. We want HYAL flooding of the ischemic tissue."

According to Dr. De Lorenzi, dosing is 3 cc of 150iu/cc HYAL per cubic inch of ischemic tissue. The goal is to ensure that all the obstructed vessels are surrounded with a sufficient concentration of HYAL for a sufficient length of time to hydrolyze HA fillers inside the arteries. Flood the ischemic tissue and gently massage the area, he says.

“We want flooding because the HYAL has to pass through the vessel wall with enough local concentration to hydrolyze the HA filler inside the vessel — especially if the entire vessel is full, or if the initial HA bolus has broken up into smaller blobs that have subsequently passed into smaller vessels downstream,” he says.

And the bigger the area, the more HYAL. That’s because HYAL dosing is based on how much tissue one treats, according to Dr. De Lorenzi.

“Repeat treatment hourly until you have restored cutaneous perfusion,” he says. “It is the HYAL that dissolves the emboli…it is always intravascular embolus/emboli. It's never external compression….”

A couple of tips for staying out of trouble:

When doing filler treatments, cosmetic and plastic surgeons should use a small bolus technique (i.e. less than 0.1 mL per pass), according to Dr. De Lorenzi.

“High-volume intravascular events are far more difficult to treat and, more often, involve other systems (which can result in blindness, hearing loss, stroke, etc),” he says.

Finally, physician injectors should ensure they start with an adequate supply of HYAL. Having about 4500 IU immediately available is a reasonable start, according to Dr. De Lorenzi.

“How are you going to get more HYAL in an emergency?” he says. “Not a bad idea to think about that before it happens, especially in smaller, geographically isolated communities.”

Disclosure: Dr. Lorenzi is medical director for Allergan, Canada, and Merz, Canada. He is on the advisory board for Kythera Biopharmaceuticals, Suneva Medical and Valeant Pharmaceuticals.

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