Fillers are injected into either fine wrinkles or deeper folds or other tissues. Collagen and Restylane are the most common agents for fine wrinkles; Radiesse, Sculptra, and fat, for the deeper folds.
A very fine needle is used to inject the filler directly into the wrinkles. Collagen numbs as it is injected, but Restylane and Radiesse do not contain anesthetic. For this reason, when I fill wrinkles in the center of the face or make lips larger I first numb the nerves to the cheek and chin. Through four injections, about 80 percent of the area around the mouth can be numbed. Sometimes, I numb the skin with EMLA anesthetic cream.
After filler injections there are little red pinpoints and bruising from the needles. These spots can be immediately covered with makeup. It may take up to two weeks for all of the bruising to resolve. Makeup can be applied the next day, but the swelling will last about two days.
When filler is injected into fine wrinkles, it is deposited in ribbons and blobs under the skin. The surgeon flattens the material with massage. If lumps are felt later, the patient can smush the gel with her finger. This step is important, because the blobs and ribbons will be camouflaged by swelling for a few days. Since hyaluronic acid absorbs water, wrinkles actually further improve in the days following injection. A typical hyaluronic-acid wrinkle-filling session takes thirty to forty-five minutes. The immediate result usually generates a ‘‘wow’’ from the patient.
While wildly popular, these injections are not without risk. Collagen injections have a high chance of causing allergic reactions. Skin tests are required prior to injection. Repeated collagen injections may lead to the development of diseases similar to rheumatoid arthritis. Allergan recommends that no more than an ounce be injected per year. Allergic reactions are much less likely with the newer fillers.
More important, the semisolid wrinkle fillers can be accidentally injected into blood vessels. When this happens, disaster looms. Around the eyes, nose, forehead, nasolabial folds, and even the lips, blood vessels link the skin with the eyeball and even the brain. If filler gets in these blood vessels, the result is immediate and permanent blindness. At least forty-three cases of blindness have been reported from injections around the eyes. If the material floats into the brain, a stroke can result.
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