FILLING MATERIALS (DERMAL FILLER)
infill Where are u Substances Used?
●Lines descending from the edge of the nose (Nasolabial Lines)
●Lines between the nose and mouth (Philtral Lines)
●Radial lines around the lips
●Wrinkles around the eyes
●Lines on the forehead
●Deformities caused by accident or trauma
●Plumping the cheeks and cheekbones
They are used to correct some asymmetries in the body.
Fillers (dermal fillers) are examined in three groups among themselves.
A- Non-Permanent Fillers
B- Semi-Permanent Fillers
C- Permanent Fillers
– Hyaluronic Acid Based Fillers;
Hyaluronic acid; it is actually a sugar chain (NASHA) in polysaccharide structure. It is found naturally in the human body, living things. The function of hyaluronic acid, which is naturally present in the tissues, is to carry water to the skin and fix it. Acid, which is synthetic or of animal origin, can be easily accepted by the body. This substance has functions such as cell division, providing lubrication of the joints and giving tension to the skin. Hyaluronic acid can hold a thousand times more water than its own volume and retain its shape for a long time where it is injected. It was produced under special laboratory conditions and presented to cosmetic applications. It is metabolized and excreted by the body in an average of 6-12 months.
Since there is no allergic reaction in these fillings, no allergic testing is required. In this group, Restylane, Perlane, Puragen, Teosyal, Varioderm, Surgiderm, JuvadermThere are many different brands such as
Containing stabilized hyaluronic acid, Restylane is a modern filler used to remove lines and wrinkles, plump lips, and keep the skin looking younger. Restylane combines with the existing hyaluronic acid in the body to retain water, gain volume and provide fullness.
● Restylane: for moderate wrinkles
● Restylane Perlane (1 ml): For deeper wrinkles
● Restylane Touch (0.5 ml): For fine wrinkles, crow’s feet and perioral wrinkles
● Restylane Vital (1 ml): For hands, décolleté, neck and face
● Restylane Feb Q (2 ml): For chin and under eye
● Restylane Lipp (1 ml): Used for full lips.
Puragen is another filler containing hyaluronic acid. Puragen, which is not permanent, produced by the Mentor company, is effective for 8 – 12 months.
While other hyaluronic acid-based fillers such as Perlane, Juvaderm, Restylane contain single cross-linked hyaluronic acid; Puragen contains double cross-linked hyaluronic acid. This extends the effect time of the structure. Puragen is injected into the dermis layer of the skin. Since it retains some water after the injection, it should not be given more than necessary. If retouching is to be done, it should be applied at least 2 weeks later. Does not require allergy testing.
Teosyal is not of animal origin, it is a non-permanent filler containing hyaluronic acid..
● Teosyal First Lines: It is used to fill fine skin wrinkles and crow’s feet lines around the eyes.
● Teosyal Touch-up: It is used for moderate wrinkles on cheek – nose or between two eyebrows. It is applied to the middle dermis layer.
● Teosyal 30 G Global Action: It is used for moderate wrinkles on forehead, cheek, nose or between two eyebrows. It is applied to the middle dermis layer.
● Teosyal 27 G Deep Lines: It is used to fill the deep wrinkles between the cheek – nose and down the lip edges. It is applied to the middle dermis layer.
● Teosyal Kiss: It is used for lip thickening.
● Teosyal Ultra Deep: It is used for people with thick skin with deep wrinkles, to provide fullness on the cheekbones or to fill the collapsed areas that are difficult to fill, such as highlighting the chin contour. It is applied to the deep dermis.
Divinyl sulfone and hydroxypropylmethylcellulose were used to form a strong crosslink in hyaluronic acid. In this way, its permanence is extended. The average duration of effect is 8 months. Usage areas; glabellar (frown) wrinkles, nasolabial folds, contour lines, lip contouring, crow’s feet
Containing hyaluronic acid
It is an effective preparation for 6 to 12 months.
Surgiderm are non-permanent dermal fillers from Corneal company that contain hyaluronic acid. Local anesthesia or nerve blocking is required during the injection.
● Surgiderm 18: It is used to remove fine wrinkles on forehead, crow’s feet and frown lines. Effective for 6 months . It is an ideal hyluronic acid preparation that can be used with botulinum toxin applications. . It is injected only into the superficial dermis, which is the most superficial layer of the skin.
● Surgiderm 30: It is used in cheek wrinkles, nasolabial grooves, lip rim wrinkles and deeper wrinkles to define the lip contour in order to provide volume on the cheeks and lips. It is effective for 9 months. It is applied to the deep dermis.
● Surgiderm 24 XP: It is used in forehead and frown lines, nasolabial grooves, lip wrinkles, deep wrinkles to define the lip and lip contour. It is effective for 9 months. It is applied to the deep dermis.
● Surgiderm 30 XP: It is used in deep wrinkles in the nasolabial groove, to provide volume on the cheeks, to thicken the lips and to define the lip contour. It is effective for 12 months. It can be applied to the skin in 2 – 3 layers, multi-level.
● Surgilips: It is used for lip wrinkles, adding volume to the lips and clarifying the lip contour. It is effective for 9 – 12 months. It can be destroyed more quickly in people with a fast metabolism.
● Surgilift plus: It is produced especially for application on the face, neck, décolleté and back of the hands.
It is an FDA-approved filling material containing calcium hydroxyl apatite crystals, effective for an average of 5 years. There are preparations containing 1.3 ml. This material, which does not require allergy testing and needs to be injected into the mid-deep dermis, is successfully used in the removal of nasolabial lines (lines between the lips and cheeks), marionette lines (lines extending from the corner of the mouth to the chin), soft tissue augmentation and lip contouring.
Its long-lasting effect is due to the combination of cross-linked Hyaluronic acid and cephadex microspheres. The replenishment of hyaluronic acid stores is enhanced by the production of collagen fibrils stimulated by microspheres. This is called a double-acting mechanism of action.
Small microspheres with electrostatic charge stimulate collagen fibril synthesis. In this way, Reviderm Forte is considered a semi-permanent wrinkle-filler product.
An additional or second application may be required 3-6 weeks after the application. For this, some Reviderm Forte is increased during the first application, and the remaining amount is given at the next application, which makes the application perfect. After the first application, the results of the treatment are immediately visible, as collagen begins to be produced around the microspheres. The second application after that stimulates an extra layer of collagen. As a result, the lack of hyaluronic acid on the collagen infrastructure is eliminated.
Usage areas; glabellar (frown) wrinkles, nasolabial folds, contour lines, lip contouring, forehead lines, acne scarsis . It is not preferred to be used for fine wrinkles around the eyes.
Beautical 2/5 is a new generation polyacrylamide skin filler. The product contains a polyacrylamide cohesive hydrogel. It has a biodegradable analog structure, whose performance and half-life in vivo can be changed as needed. During the degradation of these analogs, a continuous release occurs from short, soluble PA chains. The gradual excretion of the PA chains gradually reduces the gel volume, giving Beautical a unique property. Beautical 2 is used to correct superficial lines, wrinkles and folds. The duration of effect is 2 years. Beautical 5 is used to correct deep lines, wrinkles and folds, shape the face and increase volume. Effect duration is 5 years.
Contains 60% stabilized hyaluronic acid, 40% acrylic hydrogel. While hyaluronic acid disappears over time, acrylic gel continues its filling effect by protecting itself. Therefore, it is considered to be permanent.
While Dermalive is used for medium wrinkles; dermadeep is used for deep wrinkles, post-operative deformities, collapses, soft tissue augmentation, chin tip and cheekbones. Does not require allergy testing.
Sculptra, also known as New Fill, is one of the fillers containing Poly L Lactic acid. This substance is included in the structure of some suture materials. It not only functions as a filler, but also shows an extra feature by increasing the synthesis of new collagen in the area where it is located. Since it is easily accepted by the body and does not cause an allergic reaction, there is no need to test before application.
The effect starts to become evident after 1 month. New fill can be applied in thick lines, deep pits and in cases where the volume of the face is reduced. Since it is absorbed late by the body, its effect lasts up to 2 years by creating fibrosis.
C- Permanent Fillers
Bioalcamid is a permanent filler in gel form containing 4% alkylimide and 96% water. After injection, bioalcamid is surrounded by the collagen in our body, so this filler is also called ‘endo-prosthesis’. This reaction is not an allergic reaction or a foreign body reaction, it is the wrapping and isolation of bioalcamid with a very thin collagen layer by the body. Usually, this period is 45 days and up to this period, there may be a 10% reduction in material volume with edema, but it is completely permanent after that.
Bioalcamid has some differences from other fillers:
● It can be injected in very large quantities (such as 500 – 1500 cc) compared to other fillers and then the injected endo-prosthesis can be removed if desired. It is recommended to apply several sessions with an interval of 2 months instead of injecting large amounts of bioalcamid in one go, only in areas where the skin is thin, such as the face area.
● Since there is no enzyme that breaks down bioalcamid in the body, and the material is resistant to oxidation and hydrolysis, the result is permanent.
● Injection does not require an allergy test.
● It can be stored at room temperature.
● Since the surrounding thin collagen layer is fixed at the injection site of the implant material, it does not move from the injection site to the surrounding tissue.
There are 3 different forms of bioalcamid. Lip (lip), face (face) and body (body). The contents of these forms are the same, but their elasticity is different. Since Bioalcamid is not injected into the mucosa, it is not used to thicken the lip, but to define the lip contour.
Bioalcamid can be used for aesthetic purposes or it can be used in high amounts, so it is successfully applied in correcting deformations, gaining the volume of depressed hollow areas, chest deformities, and volume problems in the extremities.
Artecoll is an injectable substance that acts on facial wrinkles and other skin disorders for a long time. Artecoll 2/3 denatured bovine collagen is the form of a substance known as polymethylmethacrylate at a ratio of 1/3 into spheroids with a diameter of 30 microns. Since these globules are stored in the tissue, their absorption and rejection are not possible.
Collagen in Artecoll is absorbed after 3 months, but PMMA globules become permanent and new tissue formation around it ensures the permanence of Artecoll. Artecoll shows the process of settling in the applied area within the first 20 days. The real desired effect starts after that and fully emerges within 3 months.
After Artecoll is applied, it settles in the skin and is covered with fibrin fibers made by fibroblast cells, at the earliest 3 months. Efficiency and success can be increased, especially with an additional application after 3-4 months. Requires forearm allergy test 14 – 28 days before applicationAlthough often negative, 1-2% allergic reactions can be seen.
Artecoll is an extremely effective method especially in the lines extending between the forehead, between the eyebrows, the lines above the lips, and the corner of the nose and mouth. It is used for filling in the collapses that occur under the eyes. It is also used to fill the collapses that may occur after plastic surgery operations.
It is successfully used in filling acne scars. It is also used successfully to enlarge and shape the lips.
Frequently Asked Questions About Fillers
How long does the effect last when fillers are applied?
It lasts 6-12 months in hyaluronic acid-containing preparations, 1-2 years in Poly L Lactic acid-containing applications, 3-5 years in hydroxyapatite-containing preparations, and a lifetime in permanent fillings, depending on the properties of the substance used.
How long do filler applications take?
An application takes around 15-30 minutes on average.
Is there any pain during the application?
If there is no pain that will disturb the person, numbing cream can be applied 30-60 minutes before the application, if desired, local anesthesia can be applied in some applications. Sometimes sedation anesthesia is used.
Is there any discomfort on the face?
Since the application is made with an injection method, there may be a very slight swelling, then it will be useful to apply ice. Especially in lip injections, swelling will be a little more.
Is there any obstacle to going to work?
The application can be done at any time, after which you can easily return to your work and daily life.
Dr. Suhan SUNGUR