COSMETIC INJECTABLES

Cosmetic filler injections are a minimally invasive procedure that often uses naturally occurring chemicals to relax facial wrinkles and folds (i.e. smile lines), contour the body (i.e. reduce the appearance of a double chin), and improve the unpleasing signs of facial fat loss by adding structure, volume, and framework to the face and lips. There are many different types of filler injections that serve different cosmetic purposes.

Are Dermal Fillers the Same as Cosmetic Injections?

Dermal fillers are gel-like injectables injected beneath the skin to restore lost volume, smooth out fine lines and wrinkles, soften creases, or contour the face. Over 1 million men and women choose dermal fillers or other filler injections annually. It is a more cost-effective and safer way to take years off your face without any surgical treatments or downtime.

Dermal fillers are most often used as “wrinkle fillers,” or wrinkle treatment shots. However, they can do much more than just smooth out facial wrinkles. When it comes to cosmetic injectables, many new and exciting options exist to help reduce different cosmetic concerns, such as marionette frown lines, thin and wrinkled lips, depressed scars, and hollowed cheeks. A few of the more notable effects of using injectables include:

• Smooth out lines around the nose and mouth (a.k.a. marionette lines, smile lines, and parentheses).
• Enhance and restore volume to sunken cheeks or temples.
• Diminish vertical lip lines.
• Plump and enhance the lips.
• Smooth out a chin crease.
• Improve facial symmetry.

NEUROMODULATORS

The primary and most well-known category of cosmetic injectables includes those that use neuromodulators (aka neurotoxin) to soften and relax certain muscle groups in the face. Some of the more commonly recognized products include:

• Botox®
• Xeomin®
• Dysport®
• Jeuveau®

Botulinum toxin injectables remain some of the most popular and highly sought-after injections because of how effective and quick their results are.

DERMAL FILLERS

Dermal fillers sit underneath the skin to help provide support and volume to multiple areas in the face. Some of the most popular ones contain hyaluronic acid (often found in hydrating serums). Others are non-hyaluronic acid fillers, which often last longer. These can contain calcium hydroxylapatite, poly-l-lactic acid, bovine collagen (Bellafill®), or silicone.

Injectable Hyaluronic Acid (HA)

Injectable hyaluronic acid (HA) is a type of temporary dermal filler. Hyaluronic acid is found naturally throughout the body and often has the highest concentrations in the joints, eyes, and skin. HA in the skin often attracts water and allows for the skin to have a more hydrated appearance. Injectable HA is often used to reduce the appearance of fine lines and wrinkles, facial folds, or to create structure and give the face and lips more volume. The effects are usually seen immediately and typically last anywhere between six months to two years depending on the location of the injections.

Some of the more popular HA injections include:

• Restylane®
• Refyne
• Defyne
• Juvéderm®
• Vollure®
• Volbella®
• Voluma®
• Belotero®
• Teoxane RHA

Injectable Calcium Hydroxylapatite

Injectable calcium hydroxylapatite (CaHA) filler is an FDA-approved, biocompatible dermal filler typically used to improve moderate-to-severe facial wrinkles and folds, such as nasolabial folds. It may also be used as a treatment to improve increased skin laxity associated with the HIV virus. CaHA injections can be used alongside lidocaine anesthetic, or it can be used without it. The most commonly used CaHA injection is Radiesse®.

Injectable Poly-L-Lactic Acid (PLLA)

Commercially, injectable poly-l-lactic acid (PLLA) is most notably a Sculptra® Aesthetic product named Sculptra®. Since 2004, Sculptra® has been approved by the FDA to treat lipoatrophy (thinning of the fat pads on the face), as a side-effect of the HIV virus. Since 2009, Sculptra® has had FDA approval for improving the appearance of nasolabial folds, contouring the face, and treating facial wrinkles.

Injectable Polymethylmethacrylate (PMMA)

Bellafill®, an injection that uses injectable polymethylmethacrylate (PMMA) with bovine collagen has been approved by the FDA since 2006 to treat smile lines and other fine lines and wrinkles. More recently, the product has had FDA approval for improving moderate-to-severe atrophic, distensible, facial acne scars. Currently, Bellafill® is the only injectable filler approved to treat acne scars.

CYTOLYTIC MEDICATIONS

The final type of injectables is those that are considered cytolytic medications. These injectables utilize what is called deoxycholic acid to break down and dissolve small quantities of fat. It is typically injected beneath the chin.

Injectable Deoxycholic Acid

Deoxycholic acid is a bile acid that is naturally produced in the body. It breaks down and absorbs the fat we consume. Kybella® is one of the most commonly used, commercially available deoxycholic acid injectables used to non-surgically contour and improve the appearance of submental fullness.

The effects of your dermal fillers will most often depend on the product, the area being treated, and the individual. Generally, the denser the product and the deeper the injection, the longer it will last. However, that is not always the case. In order to maintain the desired results, your doctor will typically recommend multiple treatments – adjusting amounts and techniques as necessary to ensure desired results.

HA injectable fillers are often the most temporary option. These are often recommended to those receiving filler treatment for the first time. These treatments often last around 6 to 18 months. If injected into the lips, they will wear out a little faster than nasolabial treatments. Some HA products are engineered to last longer, but only service certain areas of the face (such as the cheeks).

Fillers that are not absorbed into the body often last the longest. Synthetic fillers may be a great option for some patients but often require the patient to commit to the results of the treatment for several years. It is important that if you are considering synthetic injections that you choose an experienced, qualified cosmetic surgeon to perform the treatment and whose aesthetic style you prefer.

Fat injections are meant to be indefinite. However, a small amount of fat may continue to resorb over the next six months, making this not generally noticeable over time. Depending on your aesthetic ideals, some patients require “touch-up” procedures to maintain optimal results. Often, your doctor may overfill the treated area with the expectation of fat being absorbed, dissolved, or settling over time. This may appear to give a fuller look than you initially expected.

Bruising
This may last 1-3 weeks and might show up several days after the treatment. Some areas are more vascular and are more likely to bruise, like areas around the tear troughs and lips. Bruising can be covered up with a full-coverage concealer, such as the Cosminology eye concealer collection.

For a week before your appointment, it is recommended you avoid eating nuts, seeds, fish, and fish oil, and discontinue the use of NSAIDs, supplements, and anything that prolongs bleeding. This will significantly help minimize bruising, bleeding, and swelling after your injections

Swelling
Initial swelling is common with some dermal filler and can take at least 2 weeks to settle. Sleeping propped up and icing the area will minimize the swelling. It’s best to avoid exercise for the first 48 hours to reduce the duration of the swelling.

Asymmetry
Asymmetry can be related to swelling and should subside 2 weeks after the treatment. Remember, we are all born with faces that are asymmetrical, though some are affected more than others.

Lumps and Bumps
The feeling of lumps and bumps can occur but improves within 2 weeks, as the swelling and/or bruising resolves. Avoid manipulating or massaging the area.

Dry Lips
During the first few days after filler placement, the lips can be dry as a result of the swelling post-treatment. Drinking plenty of water and applying a thick ointment, especially at night, will keep the lips hydrated during the first few days.