Injectable Fillers

Static wrinkles and volume depletion associated with progressive ageing, loss of collagen and elastin, bone remodeling and fat atrophy can be treated with injectable fillers. There are many such treatments available, and the highly competitive and dynamic market is expected to provide many more. Depending on desired outcome and longevity, depth of injection, elasticity of skin, different fillers can be used. Here are the more common ones:

Temporary injectables, which remain in place for variable amount of time, are used for a variety of indications, from more superficial wrinkles to recontouring and deep volume restoration.

The hyaluronic acid-based fillers (Restylane®, Juvederm®, Teosyal®, Esthelis®, etc.), which last from 3 to 12 months and more depending on their degree of reticulation, are some of the better known and are widely used:

• Poly-L-Lactic Acid (Sculptra®), which lasts for 2 years, is a collagen stimulator and is ideal for progressive volume restoration and facial contouring.
• Calcium Hydroxylapatite (Radiesse®), which lasts for 1 year, is also a collagen stimulator and good for contouring and deep lines.
• Semi permanent injectables last for 5-10 years and are used for deeper wrinkles.
• PMMA or Polymethyl methacrylate (Artesense®) is made of microscopic beads that are slowly enveloped by endogen collagen.

Most of these treatments take only a few minutes and cause little and generally short-term inconveniences. Any redness, swelling or local discomfort that may occur disappears completely after a few days.

Complications exist and could be potentially severe:

• Infections and biofilms
• Allergies
• Arterial accidents (by compression or intravascular injection)
• Granulomas

A good understanding of the anatomy and of the danger zones of the face is a prerequisite to all injections. Complication management requires skills and experience and no doctor should attempt to use injectable fillers without having had the appropriate training, both on the products, and the possible complications and their treatments.