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.
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.
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.
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.
is a collagen or fat injection procedure performed?
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
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.
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.
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.
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.
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
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.
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.
long does a collagen or fat injection procedure take?
minutes to one hour per session.
type of anesthesia is used?
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.
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.
is the procedure performed?
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.
can I return home and resume normal activities?
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.
do I prepare for a collagen or fat injection procedure?
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.
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.
precautions are necessary during recovery?
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.
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.
swelling and puffiness in the recipient site may last several
weeks, especially if a large area was filled.
are the possible complications after a collagen or fat injection
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.
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.
results can I expect after a collagen or fat injection procedure?
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.
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.
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.
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.
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.