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W. Bushong, Ph.D., LMFT Richard A. Martin, Jr., M.D., FACEP Kimberly L. Westwood, CPE, CCE et al. |
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Specialists in the Medical & Psychological Aspects of Transgender Health Care |
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Injectable Fillers Soft-tissue augmentation or fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. Collagen/fat injectable fillers, also called soft tissue augmentation, is done in order to correct wrinkles, depressions in the skin, and/or scarring. Fillers can also add fullness to the lips and cheeks. The procedure involves injecting a substance (collagen and/or fat) into the skin in order to plump or fill-up the area being treated. The result of the procedure is usually not permanent and touch-up injections may be needed every 3 to 12 months. For some, however, the collagen injections can stimulate the body's own production of collagen, lengthening the time necessary between follow-up injections. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift. Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, a resurfacing technique, such as chemical peel, dermabrasion or laser treatment may be more appropriate. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance. The two most commonly used types of injectable fillers are collagen and fat, but a number of other filler materials are also being used. Each of these options has its own set of risks and benefits. They include:
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's staying power. However, the precise reason for the variation of results among patients has yet to be identified. And the outcome of treatment with injectables is never completely predictable. Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site is normally watched for three or four weeks. Any sign of redness, itching, swelling or other occurrences at the test site are reported back to the surgeon to make a determination. In addition to possible allergic reactions, other risks include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. With fat injections, allergic reaction is not a factor since it is harvested from a patient's own body. However, there is still a small risk of infection and other complications. Soft-tissue augmentation is often done in the physician's office. Collagen Injection Usually the anesthetic lidocaine is mixed in with collagen, so additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen is derived from purified bovine (from cows) collagen. The purification process creates a product similar to human collagen. Injectable collagen has been used for about the last 20 years. It is produced in various thicknesses to meet individual patient needs. Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest. Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly. No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. Fat Injection The fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips. After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site. As with collagen, overfilling is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. In the meantime, you may use makeup with sunblock protection to help conceal your condition. The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.
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