What are Injectable Fillers?

       Fillers include a variety of substances designed to be injected below the skin to decrease the appearance of wrinkles. Filling skin defects using different materials has been attempted for over 100 years. Initially, in 1893, the patient's own fat was used. In 1953 silicone was used, but caused severe complications in some patients. (Actually, with new techniques, silicone is safely and successfully used by some physicians). Since the 1950's collagen processed from cows has been used and Zyderm was approved as a collagen filler in 1981. Some of the older fillers like collagen lasted only a few months and required skin allergy testing before placement in the face.
       The newer fillers like Juvederm are composed of hyaluronic acid, which is the same molecule your body produces to plump up tissue and help hold in water. (It's also one of the main substances filling your eyeballs). It is designed to be slowly absorbed and, therefore, lasts 6 to 12 months. In fact, after 12 months a lucky 20% of patients are still doing well. Because it is the same molecule your body makes, the risk of an allergic reaction is so low that prior skin testing isn't necessary.


How are Fillers Given?

      The initial consult is to determine whether you're a good candidate for fillers and to really sit down and help decide if you want to undergo the procedure. The office staff will also tell you how much the injections cost. We almost always schedule the procedure for a later visit in order to allow enough time and to allow you to carefully decide, without any pressure, whether you really want the injections. Many offices incentivize the staff to encourage patients to purchase more and more treatments of one type or another. This is nuts. You should always feel comfortable saying you need time to consider something in this area or even to get a second opinion somewhere else. It's also important to stop taking aspirin, ibuprofen, and other meds that thin the blood several days before the injection to decrease the risk of bruising. Tylenol is fine however.
      The procedure itself is pretty straightforward. Depending on the area treated, a topical and possibly local anesthetic might be given. Ice is usually applied to the area and I show you exactly where I think the filler will do the most good. If you agree, the fillers are injected just below the skin with a tiny needle. Going very slowly here and being meticulous helps with patient comfort and helps ensure a good result. Ice and mild pressure can be applied for a few minutes afterward.

      Click here to see our before and after pictures.


What about Aftercare?

      There isn't much to do afterward except to look younger. Seriously, you can usually do anything except vigorous exercise that day. Also avoid boxing and rugby for a few days in case you get a bruise and then we wouldn't know if it's from the filler or the contact sport. (I like the name of a club rugby team my daughter once played in college: "Blood, Bath, and Beyond".) We usually do a quick follow-up visit in a couple of weeks to see how you're doing. If you do get a bruise, from the filler or from rugby, feel free to use makeup to reduce the appearance.


What are the Risks of Fillers?

      There are very few serious risks here. The risk of an actual scar is one in thousands. There is a slight possibility of a visible lumpiness in the treated area, but this can usually be massaged away. Also rare, is the appearance of a tiny bluish bleb just below the skin due to filler being too close to the surface. If this is bothersome it can usually be resolved by making a tiny needle puncture in the bleb and squeezing out the fraction of a drop of filler there. Or you can just wait for it to go away by itself.
      More common is a mild redness, swelling, and possibly itching in the treated area for part of a day. It's no big deal. There is a several percent risk of a bruise for a few days, so I wouldn't advise getting fillers within a week of an important social engagement. (This wouldn't be a problem for me since I avoid important social engagements unless my wife says I should go).
      For more information visit www.Juvederm.com


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