Filler injections in cosmetic practice: How and Why

Filler injections are most commonly used in cosmetic medicine to treat wrinkles and plump up lips. They are very popular because of the minimal downtime and reliable results. 

Our skin becomes thinner as we age. This leads to wrinkles and creases. Loss of volume is also seen in the fatty layer under the skin. This causes sagging of the various youthful highlights of the face. Apparent lengthening of the lower eyelids, the descent of the malar (cheek) mounds and appearance of jowls and prominent folds between the nose and cheek are some of the changes as a result of volume depletion of these deeper layers.  Fillers can counteract these changes by providing volume to the skin and the fatty layer below it.

Various substances are employed as fillers. For example, hyaluronic acid, collagen, and hydroxyapatite based fillers. They differ in their indications, risks, and duration of action.
Hyaluronic acid fillers are perhaps the most commonly employed fillers. Hyaluronic acid is a naturally occurring substance found in the body.  Hence they are not associated with allergy following injections. Hyaluronic acid in addition to supporting the tissues also draws in water. This property also contributes to the volume enhancement. This, in turn, leads to a better appearance due to improvement in proportions of the treated areas.

Uses of filler injections 
They are most commonly used for: 

1. Treatment of fine wrinkles and lines
2. Treatment of marionette lines in lips
3. Off-label uses include lip augmentation and improvement of tear troughs and scars. Fillers are a convenient way to add volume to lips to give it a fuller appearance. 

Duration of action of hyaluronic acid fillers
Hyaluronic acid is metabolized in the body by hyaluronidase enzyme. The duration of action is approximately 8 to 12 months. It is possible to reverse the effect of a filler injection by injection hyaluronidase. 

Common side effects of hyaluronic acid fillers 
The most commonly include side effects include swelling, bruising and lumps. These are mostly temporary and last a few days. Cold compresses help in the resolution of these symptoms if they occur. Tyndall effect is a bluish discoloration as a result of superficial injection of the filler in areas with thin skin. Visual disturbances and vascular compromise are very rare complications seen with filler injections. 

Contraindications for filler injections
The following increases the risk of adverse events and constitute contraindications for filler injections: 

1. Unrealistic expectations
2. Bleeding disorders
3. Infection at the site 

How does one get a filler injection? 
A consultation helps the doctor to understand the expectations of the patient. A filler injection is an outpatient procedure. The area to be treated is numbed with a numbing cream or injections. The filler is injected into the area with syringes with very fine needles. There may be bruising at the treated area. Most of it is usually gone by one or two days. 

 The main benefits of filler injections are the minimal downtime and almost immediate results. Patients can get back to work or other activities soon after treatment.