Today, there is a large variety of filling materials for treating wrinkles and skin folds on the face, augmenting the size and shape of the lips, enhancing and emphasizing the cheeks, and filling areas on the face that lack bulk. Filling material is most commonly used for the lower half of the face. Wrinkles in this area are usually due to drooping of facial contours and folds that are caused, in turn, by general “wear and tear” of the skin and its underlying structures.

In general, the treatment itself is simple, and is performed by injecting the filler material via a thin syringe. Recovery is immediate, and any side-effects are short lived. The complication rate is nearly non-existent. The effect of the material on superficial wrinkles is enormous. This “filling out” of wrinkles is performed in the clinic setting. It can be done without any anesthesia but, if desired, superficial anesthetizing cream (such as EMLA) can be applied to the area before treatment. This treatment is suitable for men and women alike.

It is recommended one refrain from taking any blood thinners for at least a week before the treatment. This is in order to avoid any unnecessary bleeding or bruising. In patients with a history of herpes outbreaks, prophylactic treatment with oral Zovirax is recommended.
“Filling” wrinkles is suitable for those who have facial wrinkles that are bothersome. Any weight increase of 5kg or more may change the shape and severity of the wrinkles that were filled.

Injectable Fillers

During the pre-treatment consultation, examination of the face, including assessment of existing wrinkles and overall symmetry, is performed.

The common wrinkles observed are:
1. Wrinkles that start on the side of the nose and end towards the outer edge of the mouth (nasolabial lines).
2. Wrinkles that start at the outer edge of the mouth and end towards the side of the chin (marionette lines).
3. Wrinkles around the lips exacerbated by smoking, age, and genetics.

Furthermore, it is possible to fill any other line or wrinkle on the face, so long as it is superficial in nature.

The filling materials are divided into two: absorbable and non-absorbable.
With regards to all wrinkles, absorbable material has a structural advantage over the non-absorbable material. The duration of effectiveness of the non-absorbable material is approximately one year, depending on the area injected and the type of material introduced.

The most popular non-absorbable material is medical silicone. This material is in the liquid form, and has gone through an adaptation process that has rendered it suitable for injection into human tissue with minimal side effects. Injection should be done in small amounts and over several appointments in order to avoid formation of lumps.
The material is mainly used to thicken and/or enhance the shape of the lips (more of this later).

The absorbable material is based on natural ingredients that exist in the human body, albeit manufactured synthetically. The human body recognizes this material as “self” and slowly breaks it down by natural biological processes. The chance of infection with injection is nearly non-existent. The most popular absorbable material in this category is hyaluronic acid (the ingredients in products such as Restylane, Perlane, Theosyal, Juviderm). Other filler materials that are used include processed collagen found in all body tissues and hydroxy-apetite that is found in bones (Radiesse). Filling with natural adipose tissue (fat) is also possible (more of this later).

It is recommended that any physical activity be avoided for at least the remainder of the day after treatment. It is fine to return to normal daily activity the following day.

For the first few days after injection, one may notice bruising, redness, local irritation, and some swelling. These signs go away after a few days.

At times, it is necessary to repeat the injection and perform another “filling”.

The complications of this treatment are very rare, and may include: Bleeding or bruising, infection, and skin herpes outbreak. A very rare complication is the appearance of lumps.

Additional information about this treatment will be made available during the pre-surgical consultation.