Volume Fillers

Wrinkles are best classified into Dynamic and Static lines. The dynamic lines which are due to muscle activity are best treated with Botox while the static lines more commonly due to environmental damage and aging are more frequently addressed with the use of dermal fillers. The variety of dermal fillers are numerous and will be reviewed individually. Soft tissue loss is most commonly addressed with the use of SCULPTRA, ALLODERM or fat injections. Skin Tightening, Skin Resurfacing and Skin Rejuvenation are additional skin concerns which are addressed utilizing Laser Technology and will be discussed in a subsequent section.

SCULPTRA which is distributed by Sanofi Aventis is considered more of a volume soft tissue augmentation filler product than a line or crease filler. The product is a poly-l-lactic acid. SCULPTRA, also called New Fill, is the first FDA-approved treatment of lipoatrophy. Lipoatrophy is the loss of that fat that is stored under the skin, particularly in the face and limbs. The aesthetic consequences of lipoatrophy include sunken cheeks, hollowed eyes, and indentations in the skin of the face and limbs. Lipoatrophy can be the result of repeated insulin injections into the same area of the skin or may be the result of Human Immunodeficiency Virus, or HIV. In August 2004 the FDA approved SCULPTRA for the safe and effective treatment of lipoatrophy.

During the SCULPTRA treatment, a material called polylactic acid hydrogel is injected under the skin. This material is biocompatible and immunologically alert, thereby eliminating the need for a pre-treatment allergy test and reducing the risk of complications. The compound used in SCULPTRA treatments has been safely and effectively used in a variety of medical applications for decades.

Prior to the approval of SCULPTRA, the FDA conducted four major studies to measure the safety and efficacy of SCULPTRA treatments in 225 HIV-positive patients with lipoatrophy. After tracking the results of SCULPTRA treatments for years, researchers concluded that SCULPTRA can increase the thickness of subcutaneous skin layers two to threefold. Clinical research has found that SCULPTRA can significantly improve the overall facial appearance by safely and effectively restoring volume and shape to those areas affected by lipoatrophy.

A patient in good physical and emotional health who understands the risks, benefits, and expected results of the procedure is ready to receive SCULPTRA treatments. SCULPTRA treatments do not require that a patient be placed under general anesthesia. Typically a local anesthetic is applied to the treatment area to mitigate any minor discomfort a patient may experience during a SCULPTRA procedure. The treatment itself takes about thirty minutes to complete and SCULPTRA treatments are typically repeated every few weeks for a few months in order to achieve the desired results. The frequency and length of SCULPTRA treatments will ultimately depend on a patient’s individual skin condition and response to treatment.

After a SCULPTRA treatment session is complete, a patient will be able to resume normal activities. It is very rare, but possible, for SCULPTRA patients to experience complications like minor bleeding, discomfort, bruising, inflammation, swelling, and tiny bumps at the injection site. These side effects are typically minor and resolve spontaneously without medical intervention. The benefits of SCULPTRA greatly outweigh the potential drawbacks associated with the procedure.

ALLODERM is an acellular dermal matrix derived from human skin and acts as a scaffolding for your own personal collagen to grow into the lattix of ALLODERM. Ultimately the ALLODERM is completely replaced by your own tissues. The most common area of use is for lip augmentation.

Fat injection
The terms fat injection and fat transfer refer to the process of taking fat from your stomach area (or other area) and injecting it into your facial area (or other area). The goal of the procedure is to add fullness to the face, lips, buttocks or hands. Facial fat injections, by virtue of the fullness, give some lifting to the general facial structure.

As you age, the dermis under your skin thins out. This can leave the face looking too thin and has the effect of making the skin look like it sags. This happens to women of all body types: small frame, medium frame, large frame. A fat injection adds fat to the area beneath the skin, and has the effect of ‘filling out the face’ to a more youthful state.

Patients may be familiar with the use of fat injections for lip augmentation, but there are many other uses in the face. For example, fat injections can also be used to lessen the lines around the mouth, fill out the cheeks and chin (areas which might have otherwise used facial implants), or as an all purpose filler in the face.

As we continue to understand the ageing process better, we have come to appreciate that in some patients, rather than stretching tissues, adding soft tissue volume (such as fat) will make the face look younger. We find ourselves using fat injections for “touch-ups” and as a part of face lift surgery.

Some patients think that fat injections “do not last”. However, this is not the case. When properly done, a large percentage of the injected fat cells do indeed survive. These are “permanent”. Since some fat cells are lost, the effect of the fat transfer is not as dramatic after a few weeks. For this reason, we tend to “overcorrect”, or inject more than we need to, knowing that after a few weeks the final result will be more to the patient’s liking.

If we inject less, the patient may be happy with the initial result, but be disappointed over time as the results “disappear”.

Fat transfers can be used for buttocks augmentation, also known as the brazilian butt lift. Fat is first liposuctioned from the stomach or flank area and then processed in a special decanting technique. The purified fat is then transferred or injected into the butt with special cannulas. Using fat transfers for butt augmentation gives a very flattering, sensual, and natural look. Another area which can benefit from a fat injection is the hands. Fat injections can give the hand a fuller and younger contour.

Compared to injectable facial fillers, fat transfers are more of an involved procedure because the fat has to be harvested from another part of the body. However, unlike injectable fillers, fat transfers can be used in larger volumes to fill larger defects.

Fat injections can be done under local or sedation anesthesia. Using small syringes, fat is harvested from the hip, inner or outer thigh, lower back, or lower abdomen. The fat is then processed in a special centrifuge, and is then injected into the desired area. When performed properly, a large percentage of the fat transfer will stay and the face will fill out to look more youthful. This is an office procedure under local anaesthesia which remains a simple and non painful technique.