On a young face, there are 7 separate fat pad compartments that support the subcutaneous tissue. While these fat pads support the skin from below, it also protects the tissues from trauma.
As the age progresses, both loss of these fat pads and abrasions occur in bone structures, so sagging of the skin is observed due to the effect of gravity. These saggings appear especially in the form of folds in the middle face towards the line at the edge of the nose (nasolabial area) and on the sides (jaw line) in the chin area.
These saggings are also called bulging. As a result, it causes dimpling in the nasolabial area and cheeks, and a decrease in the prominence of the malar protrusion (midface bone).
On the other hand, it causes elongation in the lower eyelid and the orbicular muscle (eye muscle) being more prominent here, tear trough deformity and V-shaped deformation (disorder) on the cheekbone (zygoma).
As a result, the balance between concave and convexity in the middle of the face is disturbed.
As the name suggests, fillers are used to add volume to the applied tissue. Cheek and chin plumping, correction of tear trough, removal of fine lines and deep wrinkles, rhinoplasty, reshaping of the middle part of the face, lip plumping, rejuvenation of the upper hand and décolleté area, giving volume to the chest and hip areas, skin collapse It is used in the correction of scars and facial asymmetries.
Fillers show only a volume effect or a biostimulant effect to stimulate the production of new collagen in the skin in the tissue they are applied to, or both.
An ideal filling; It should be reliable, effective and easily applicable. It should be preserved for a long time under suitable storage conditions and should be able to stay safely in the tissue to which it is applied for a long time. Being effective means that it should be able to give the desired volume in the tissue to which it is applied. What is meant by safe filler is that the filler should not be allergic, carcinogenic or teratogenic and should not displace in the tissue to which it is applied. The filler should be compatible with the tissue and should not cause a systemic and permanent reaction in the body after the application. Undesirable side effects should be minimal and short-lived.
The filling products used must be FDA, TÜV, CE and approved products of the Ministry of Health.
Fillers should be applied by a specialist doctor who is experienced in applications.
After the application, the patient should be given an epicrisis including the application areas, the filler used, the LOT and barcode of the filler, and the early and late side effects after the application. This is extremely important before filling in the same area or before laser, aesthetic, surgery and similar applications to be made later.
Fillers used today can stay in the application area for a long time. It is natural for these fillers to appear in imaging methods such as MR, PET, US or CT to be performed in the application area due to other health problems of the patient. It is extremely important for the radiologist to know this during the evaluation. Filling application epicrisis is extremely important in order to prevent diagnostic or incorrect evaluations.
If the filling containing calcium hydroxyapatite is visible on the PET scan, it may cause misdiagnosis.
As the applicability of fillers increases, complications and side effects increase.
Today, many fillers with approved applicability are used. When fillers are applied to tissue, they may remain in the tissue or be broken down by the tissue. This is called the biodegradability of the filler. Fillers according to their biodegradable abilities;
Biodegradable fillers; Like Collagen and Hyaluronic Acid (HA),
Non-biodegradable fillers; such as Polyacrylamide, Polymethylmethacrylate (PMMA) and silicone,
Among the biodegradable fillers, the most widely used in the world today is hyaluronic acid fillers.
Hyaluronic acids, no matter how much acid is in the name, are actually a polymer derived from sugar, naturally found in human skin and consisting of repeating carbohydrate units. By acting as the same mortar in the skin tissue, it balances the moisture content of the skin and also plays a role in communication between neighboring structures. Its ability to balance humidity is due to its chemical structure, which is largely soluble in water. With this feature, this molecule, which has a water holding capacity up to 1000 times its molecular weight, supports the tissues by forming a clear liquid with a gel-like consistency between the tissues.
The rate of cross-linking in their molecular structures decreases depending on the concentration and particle size.
When hyaluronic acids are applied to tissues, they form both cohesive (adhesive) and elastic tissue with their homogeneous network structure. These abilities are indicated by the elastic modulus G’ and the cohesiveness index Ns. The cohesiveness shows the filling ability of the filling, and the elastic modulus shows the effect of stretching the ‘lift’ tissues.
In addition, concentration and particle size of hyaluronic acid; It shows the ability to give volume, the cross-link between hyaluronic acid molecules, viscosity, elasticity and hyaluronidase resistance, which ensures its destruction in the tissue (this determines the residence time in the tissue.) It is important whether the filler contains lidocaine. In addition, its molecular 3D structure shows its ability to shape when applied to tissue.
While hyaluronic acids are being developed today, it is aimed to increase their ability to stay in the tissues for a longer time and to give more fullness to the tissues with their more cross-linked molecular structures. However, with these properties, it can cause more unwanted complications and side effects in the applied tissue.
With the fillings containing hyaluronic acid, which are the most widely used today, procedures can be easily applied in areas such as the face, neck, décolleté, and upper hand, both to increase the quality of the skin and to give volume.
Will I feel pain during filling?
Depending on the area to be applied, local anesthetic creams or anesthesia with a needle are used beforehand. therefore, the feeling of pain is very, very low.
Can the same product be used in every region?
No. Hyaluronic acid-containing fillers increase their hardness from thin to thick according to the cross-link they contain. Thin fillings hold more water, while thicker ones create a greater volume effect. Different thicknesses of fillings are used for each region and application. As the fillings thicken, that is, as their hardness increases, they are placed deeper, while thinner fillings are applied to the surface.
Is the application called youth vaccination also a filling application?
No. There is also hyaluronic acid in the application called youth vaccine, but it is not in gel form but in liquid form. This application is actually a mesotherapy application. Instead of the fullness effect, the water retention and skin regeneration properties of hyaluronic acid are used. It is a procedure that is applied as a total of 3 sessions with 2-3 week intervals.