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Collagen & Fat Fillers (Facial Injections)

Collagen and fat fillers, also called soft tissue augmentation, is a procedure that correct wrinkles, depressions in the skin, and/or scarring. Fillers can also create fullness to the lips and cheeks. The effects of gravity, sun exposure and years of facial muscle movement may be maintained using injectable fillers. The procedure involves injecting a substance (collagen and/or fat) into the skin area being treated creating a fuller, more attractive appearance to the face. The most important fact to remember about injectable fillers is that the results are not permanent. The desired results may last anywhere from a few weeks to indefinitely. Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. This procedure may be performed alone or in conjunction with a resurfacing procedure, such as a facial laser skin resurfacing, or a recontouring procedure, such as a facelift.

 

Collagen

Is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen, patented by the Collagen Corporation under the trade names Zyderm and Zyplast, is derived from purified bovine collagen. The purification process creates a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in1981. It is produced in various viscosities to meet individual patient needs.

Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest. Injected collagen and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Fat

In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

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How is a collagen or fat injection procedure performed?

Collagen

Treatment with collagen can begin after a skin test determines that you're not allergic to the substance. The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.

The FDA approved collagen injections in 1981. They have proven to be a very popular nonsurgical cosmetic procedure; see current American Society for Aesthetic Plastic Surgery (ASAPS) statistics. Injectable Zyderm and Zyplast collagen, natural substances derived from purified bovine (cow) collagen, essentially replace the natural collagen that the skin loses over time. Collagen injections are most useful in the treatment of frown lines, "crow's feet," and nasolabial folds (smile lines). To improve deeper creases or enhance lip fullness, there also are filler materials, such as soft ePTFE (expanded polytetrafluoro-ethylene) that can be surgically implanted.

Technique: Collagen, which contains local anesthesia, is injected with a tiny needle into the skin depressions being treated. Several injections may be needed, depending on the length and depth of the wrinkle. The procedure for both injections and implants takes less than an hour. Implantation procedures for the lips and nasolabial areas are done with a local anesthetic. A tiny incision is placed at either end of the site. Then the implant is inserted and positioned. Incisions are closed with a suture.

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Fat

After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this over correction of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

Body fat makes excellent soft tissue filler material. Fat injection (also called autologous fat transplantation) transfers fat from one part of the body to another to recontour the face; diminish frown lines, crow's feet and nasolabial folds (smile lines); and provide definition to areas like the cheeks and chin. It can also be used to fill out depressed scarred areas on any part of the body. Fat injection is not permanent, and may require an effective maintenance program.

Technique: The donor site (for example, abdomen, buttocks or thighs) and the treatment site are injected with local anesthetic. Intravenous (IV) fluids also are injected into the donor site to facilitate fat collection. Fat cells are extracted through a small needle attached to a syringe. The fat is then processed to remove excess fluids and reinjected with another needle in multiple thin strands in the desired area. "Overfilling" is a necessary corrective due to fat absorption in the weeks after treatment. Fat also can be harvested during a lipoplasty (liposuction) procedure in one area of the body, and then reinjected in another. For longest-lasting effect, patients generally receive 3 to 4 treatments over a six-month period.

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How long does a collagen or fat injection procedure take?

15 minutes to one hour per session.

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What type of anesthesia is used?

Collagen

Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a Freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat

Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

Where is the procedure performed?

Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.

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When can I return home and resume normal activities?

You should avoid exercise or other strenuous activities for 24 hours after your treatment. However, after that time you should be able to resume your normal activities. Speak with your physician about what he or she specifically recommends for you.

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How do I prepare for a collagen or fat injection procedure?

During your initial consultation, your surgeon will discuss the changes that you would like to make to your appearance. Since the appearance of your face is a matter of personal perception and preference, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives.

Prior to your procedure, the surgeon will perform a complete health history and evaluate your face including the skin, muscles and underlying bone. Knowledge of your allergies, medications and previous surgeries should be brought to your surgeon's attention at this time. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). Specific instructions to assist you in preparing for this procedure will be given to you after the health history and face evaluation is complete. Your experience will be much smoother if you remain compliant with your surgeon's instructions.

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What precautions are necessary during recovery?

Collagen

Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly. No bandaging is needed and you are free to eat, drink, and wear makeup with sun block protection shortly thereafter. There may be some temporary swelling and redness in the treated area, which should dissipate within a few days. If these symptoms persist, contact your surgeon.

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Fat

If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sun block protection to help conceal your condition.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

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What are the possible complications after a collagen or fat injection procedure?

Collagen

Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon. Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare. It is always important to be informed about the possible complications before any procedure. Be sure to discuss any concerns you may have with your surgeon.

Fat

Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications. Facial rejuvenation is very individualized. It is always important to be informed about the possible complications before any procedure. Be sure to discuss any concerns you may have with your surgeon.

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What results can I expect after a collagen or fat injection procedure?

The most important fact to remember about injectable fillers is that the results are not permanent. The body eventually metabolizes the injected material. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections would work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem. When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

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Collagen

As stated earlier, the duration of results from collagen injections is variable. Collagen's longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement. Your doctor can help you determine how long you can go between treatments to best maintain your results.

Fat

The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.

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