What is Filling?
As age progresses, there is collagen loss in the subcutaneous tissue. As a result, wrinkles, nasolabial, nasojugal grooves and tissue loss occur. Mimic movements also contribute to the formation of these wrinkles. The substances used to fill these gaps and provide volume are called fillers.
What are Fillers?
A good filler should be biologically compatible, long-acting, with known results, able to provide a natural appearance, and its effects can be removed when necessary. In addition, it should not require allergy testing, side effects should be minimal, easy to apply, and cost-effective. Although there is not yet a filler that fits this definition perfectly, the filler that responds best to these criteria is hyaluronic acid.
Today, hyaluronic acid (HA) constitutes 85% of the fillers used in the filling process. It is superior to many substances in terms of efficacy, cosmetic result and reliability. Complication rate is lower than other fillers. Its effects can be eliminated with hyaluronidase. Allergy test is not required and its permanence is moderate. Since its production requires advanced technology and there are few producers in the world, its price is generally high. It has been safely administered to more than 2 million people worldwide since 1996.
Collagen derived from bovine, porcine or human collagen has been used, but most have been abandoned due to allergies and other side effects. There are synthetic fillers such as calcium hydroxyapatite, silicone, polymethylmethacrylate, they are more permanent, but their complication risks are higher.
Filling Material Mechanism of Action?
HA is a polysaccharide normally found naturally in subcutaneous tissues. It adapts perfectly to biological tissues and is identical to the skin with its structural and mechanical properties. However, it loses its effect very quickly when used in its natural form. Therefore, its effect is prolonged by using cross-links. HA can be of animal origin, but today, products produced from streptococ bacteria with recombinant technology are mostly used.
HA is a strong water retainer; 1 gram HA holds 6 litres of water. Thus, it creates more volume than its own mass. Since they are in normal skin structure and due to their water retaining properties, they are very suitable for use as fillers. Collagen synthesis increases with injection into deep tissues and even if HA is lost in the tissue, collagen replaces it. Thus, the duration of effect increases.
Cross-linking rate and HA concentration are the most important factors affecting their permanence. The most important thing that gives HA its properties in filling is the presence and degree of cross-linking and HA concentration. There is no cross-linking in HA used in mesolift. The degree of cross-linking is related to permanence. As the cross-linking rate increases, the gel becomes harder and more permanent, but its application becomes more difficult and the risk of side effects increases.
The grooves between the eyebrows, forehead and crow’s feet wrinkles (but preferably botox should be applied first and the movement of that area should be eliminated to prevent any play in the filling and misplacement), the eyebrow area for eyebrow lift, the grooves extending from the wings of the nose to the corner of the mouth called nasolabial sulcus, the grooves starting from the junction of the eye and nose called nasojugal sulcus (tear trough) and extending to the cheek under the eye, They are used in areas such as temples and cheeks with loss of facial volume, nose tip to lift the nose, nose back, grooves under the corners of the lips called marionette lines, lips to clarify lip contour and volume, jaw line to improve the deteriorated jaw line due to sagging cheek or sometimes to fill the pits caused by atrophic scars caused by acne.
Filling should be done at an appropriate depth according to the particle size. If fillings with large particles are applied to superficial wrinkles, they cause lumps. If small particle fillers are applied to deep wrinkles, an ineffective application is made. Fine fillers are applied to thinner lines and dense fillers are applied to deeper wrinkles.
The procedure is performed after waiting for 20-30 minutes with anaesthetic creams applied before the application. The procedure varies according to the area to be treated, it takes an average of 20-30 minutes. You can return to your normal activities immediately after the procedure. You do not need to have any pre-test.
Anaesthetic creams, ice application or regional anaesthesia can be applied before the application. Some fillers contain lidocaine and minimise the side effects that may occur due to injection.
Things to Consider Before and After Filling?
Painkillers other than paracetamol that increase the risk of bleeding during the procedure (especially bruising and haematoma formation), blood thinners such as aspirin, vitamin E, herbal products (such as ginger, gingko biloba) should be discontinued 7-10 days in advance. If there is a history of frequent herpes, prophylaxis with antivirals should be performed.
For 24 hours, intense physical activity should be avoided, hot or cold environments should be avoided until the redness and swelling disappear, and hot showers should not be taken immediately afterwards. If there is pain, acetaminophen derivative drugs (such as parol, minoset, vermidon) are used. After the application, it is recommended not to use the facial muscles too much, not to drink alcohol, not to smoke, not to use blood thinners. Skin care or cosmetic products can be used from the next day.
After 2-4 weeks, it should be checked due to the need for correction.
How Long is the Permanence?
Temporary fillers generally last 4-6 months for superficial wrinkles and 6-12 months for deep wrinkles. Repeated sessions are needed. As the repetitions increase, the duration of permanence increases even more.
What are the Side Effects and Complications After Filling Application?
Approved filler should be used. Otherwise, the risk of complications and side effects of filling application is higher. JUVEDERM or TEOSYAL brand fillers are mostly used in our clinic.
Bruising, redness, swelling (oedema), pain, burning, itching, allergy, blue protrusion, infection, displacement, lumping, excessive or inadequate correction, scarring, pigment changes (darker or lighter colour change than the skin), hypertrophic scarring, tissue death called necrosis as a result of compression of the vessels may occur.
Who is not allowed to use fillers?
Those who are allergic to the applied substance
- Allergy to lidocaine in some lidocaine fillers
- Those with anaphylactic or severe recurrent allergic reactions
- Pregnant and breastfeeding women
- Skin diseases at the injection site (acne, infection, dermatitis, etc.)
- Those with a predisposition to keloid or hypertrophic scarring (swelling at the wound site as a result of excessive wound healing)
- Those with autoimmune collagen diseases
- Those with bleeding disorders
Cultured Human Fibroblast (Fibrocell)
A skin biopsy is taken from behind the ear with a 3 mm punch and sent to special laboratories with a cold chain, millions of collagen-forming cells called fibroblasts are produced. After an average of 6 weeks, 20 million cultured fibroblasts are sent back to the physician and this product is returned under the skin in the desired area. 3 sessions are performed with 2 week intervals. The effect is seen in 1-3 months.