Filler injection is a popular ambulatory procedure and is often used for restoring soft tissue volume or augmenting bony deficiencies. They are often performed in combination with botulinum toxin injection for synergistic results. Since the 1990s, a plethora of filling materials have been developed which are now used for a variety of aesthetic and reconstructive indications. There is now a wide range of fillers with various different characteristics to suit each individual’s unique anatomy and help them meet their aesthetic goals.
The use of fillers for reversal of age-related changes has been historically recorded since the late 1800s, shortly after the invention of the syringe. In the past, use of liquid paraffin and liquid silicone resulted in widespread complications and these were banned from clinical usage. Collagen was the first filler approved for aesthetic use and introduced in 1981. Collagen quickly fell out of favour due to its short duration of action, concerns of hypersensitivity to animal proteins and the need for skin patch testing before the use of the filler.
Hyaluronic acid (HA) fillers were developed in the 1990 and the first HA filler was approved by FDA for clinical use in 2003. Other notable filler materials that are approved for clinical use include calcium hydroxylapatite (CaHA, 2007), and poly-L-lactic acid (PLLA, 2009). Permanent fillers appeared in the market in the early 2000s but have fallen out of favour due to long-term complications.
Hyaluronic acid (HA) fillers have become popular in the recent years. HA is a naturally occurring polysaccharide and is abundant in the epidermis and dermis. With advancing age, HA is depleted causing loss of skin hydration and formation of skin wrinkles. HA fillers are highly biocompatible and allergic reactions are rare. It is hydrophilic (water-attracting) and therefore rehydrates the skin when deposited superficially in addition to revolumizing tissue. HA that is highly cross-linked is stiffer, degrades more slowly and lasts longer in tissues. These fillers are useful for structural support and are often used in the nose, cheeks and chin. In contrast, HA that is less cross-linked tends to be softer and are suitable for superficial revolumization and are often used in the under-eye area and cheeks.
Calcium hydroxylapatite (CaHA) fillers consist of a mixture of a synthetic calcium hydroxylapatite spheres blended into a gel carrier. CaHA fillers provide high structural strength for support. It also has excellent biocompatibility. It functions well as a bone replacement and is useful in the nose, cheeks and chin. CaHA fillers may be modified and used as a soft tissue stimulant for collagen production and volume filling in the superficial areas in the face.
Poly-L-lactic acid (PLLA) fillers comprise of microparticles of PLLA suspended in saline. PLLA is a resorbable synthetic polymer and is also commonly used in sutures and surgical implants. It is naturally degraded into carbon dioxide and water. These particles stimulate collagen production around the particles and deliver long-lasting revolumization.
The fundamental question really is, “What are my aesthetic goals?”. Each individual has different aesthetic goals and unique anatomy that makes every case different. There is a wide range of fillers with various different characteristics to help every individual meet their aesthetic goals. The choice of filler is therefore based on the most appropriate product suited to achieve the desired result.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using revolumization techniques alone, resulting in an overfilled “pillow face”. Filler injection does not reverse skin and muscle laxity or ligament lengthening. Choice of the incorrect filler type will also result in irregularities that become more prominent when an individual animates the face.
Attaining bespoke and natural-looking results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate product choice, precise administration by an experienced practitioner.
Delivering effective and safe treatments are the cornerstones of our philosophy at Picasso Plastic Surgery. Safe filler injection requires an experienced practitioner with intimate knowledge of the anatomy, precise technical execution, appropriate product choice and adopting relevant preventive measures to prevent complications. Picasso Plastic Surgery uses only products obtained from licensed distributors.
Ideal individuals who may consider filler injection include those with good quality skin and mild to moderate degrees of facial deflation and/or minor degrees of bony deficiency.
The effects of filler injection may be observed immediately following the procedure. Depending on the anatomical region injected, most fillers will be resorbed in 6 – 9 months and repeat treatment is required to maintain the result.
Individuals are advised to avoid vigorous massage or rubbing to the treatment area for 2 hours following the filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.
Dr Yeo is an experienced botulinum toxin and filler injector and is a trainer for several botulinum toxin and filler product lines. He frequently delivers lectures and conducts workshops on effective and safe filler administration in the Asia Pacific region. Picasso Plastic Surgery carries a large range of fillers that will help individual achieve their varied aesthetic goals. Near-painless injections are possible at Picasso Plastic Surgery with the use of a proprietary pain distraction device at the time of injection.