SOFT TISSUE
FILLERS

Soft tissue fillers help to diminish facial lines and restore volume and fullness in the face. As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity and lifestyle.

Soft tissue fillers can be used to:

• Plump thin lips
• Enhance shallow contours
• Soften facial creases and wrinkles
• Improve the appearance of recessed scars

Soft tissue fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach. Non-surgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate.

Soft tissue fillers are a good option for you if you:

• Are physically healthy
• Don’t smoke
• Have a positive outlook and realistic goals for the improvement of your appearance

There are several different kinds of fillers. They differ in chemical makeup, longevity and softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones. Your surgeon will determine with you the best type and volume of filler needed for your particular areas of concern.

For many people, the use of “off-the-shelf” fillers can be a simple office-based procedure that can nicely enhance their appearance. These fillers are very predictable, and have relatively minimal risks and side effects. These fillers are often injected in the surgeon’s office or medspa.

During your consultation, be prepared to discuss:

• Your goals
• Medical conditions, drug allergies and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other non-surgical facial procedures as well as any prior facial surgery

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Discuss your available options
• Examine and measure your face
• Take photographs
• Recommend a course of treatment
• Discuss likely outcomes of using soft tissue fillers and any risks or potential complications

Your plastic surgeon will carefully explain:

• Your course of treatment
• The type of filler recommended in your case and why
• Expected results
• The longevity of the result

If you choose to utilize packaged soft tissue fillers, the plastic surgeon, or his specially-trained nurse, will evaluate your facial appearance, skin tone and areas of your face to be treated. Strategic points on your face may be marked as the appropriate injection sites for the filler. Photographs may be taken of the areas to be treated.

The injection sites will be cleansed with an antibacterial agent. Pain at the injection site may be ameliorated by use of a very cold instrument to chill the skin, anesthetic ointment to numb the skin or injection of local anesthesia. While not painless, the injections are usually easily tolerated.

Injection usually takes only a few moments per site. The process of injecting, massaging, and evaluating the result is performed and additional filler added as needed. Depending on the number of areas to be treated, the whole process may be as short as 15 minutes, or as long as an hour.

Once the results are deemed satisfactory, any markings will be cleansed off. You may be offered an ice pack to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.

Other Options
Some patients may want to consider using fat harvested from their own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

Fat injection requires a more extensive procedure than “off-the-shelf” soft tissue fillers. A “donor area” must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face as a graft.

The grafted fat then has to redevelop a blood supply in order to survive. In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon’s treatment room or in an operating room.

The decision to use soft tissue fillers is extremely personal. You will have to decide if the benefits will help you achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/ or staff will explain, in detail, any risks. You will be asked to sign consent forms to ensure that you fully understand the procedure, as well as the risks and potential complications.

Complications from fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

• Acne-like skin eruptions
• Asymmetry
• Bruising, bleeding from the injection site, swelling
• Damage to the skin that results in a wound and possible scarring
• Infection at the injection site
• Lumps
• Palpability of the filler under the surface of the skin
• Skin rash with itching
• Skin redness
• Under- or over-correction of wrinkles

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon. Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers dissipate over time. To maintain your correction, you will need to consider repeating the injection process at intervals.