This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use an injection. The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.
• DEFINITION OBJECTIVES AND PRINCIPLES
Meet demand increasingly high for soft techniques of Aesthetic Medicine (non-surgical) to fight against the effects of aging, the number and quality of injectable materials has evolved considerably in recent years and their use has become extremely common . These are products which fluids may be injected either to reshape portions of the face or to obtain the wrinkle filling, grooves or other depressions in the surface.
A session of injections may be performed alone, but can also complete prelude or more radical medical-surgical rejuvenation techniques such as resurfacing (peeling, laser, dermabrasion), blepharoplasty (eyelid upper and / or lower), facelifts, etc. It can also ... proceed in parallel with injections of botulinum toxin to reduce the tone of muscles responsible for the appearance of wrinkles.
• OBJECTIVES
An injection of fillers proposes to correct a simple and fast way, some signs of aging or present misfortunes in the face, filling or bulking where necessary. The most frequently performed corrections can be divided into four categories:
• Furrows: nasolabial folds (the Ala at the corner of the mouth), marionette lines (the corner of the mouth on either side of the chin), furrow labiomentonnier ....
• Fine lines and wrinkles: forehead, "frown" (between the eyebrows), "crow's feet" (around the eyes), cheeks, chin, "pleated sun" around the mouth.
• Lips: redraw the hem (outline), thicken if they are too thin, or make fuller
• Depression (hollow) or lack of volume: cheekbones, chin, mandibular contour cheeks, nose, scars scarring (acne, chicken pox, trauma ...)
Usually these misfortunes will not completely disappear but will be considerably reduced by injections. Some alterations are also much better to treatment than other more difficult to manage. Similarly, the continuity of the correction is extremely variable depending on the product (see below) and the patient (s), but in most cases the correction is only temporary and the treatment should be repeated to maintain the result . It should be noted that many other changes can be
present, but their treatment is only possible using more complex than simple technical medico-surgical injections. This is particularly the sagging tissues (eg jowls) and the excess skin (eg lids) that can only be removed surgically. Similarly, certain skin abnormalities (bumps, small scars, blemishes, wrinkles micro "crumpled
skin ") will be marked by a resurfacing (peeling, laser, dermabrasion).
Injections, also performed well in women than in men, can be performed at 30-35. However, they are sometimes made much earlier, when misfortunes are constitutional or hereditary and not related to age (lips, cheeks ...).
• PRINCIPLES
The basic principle is the injection of a fluid in the thickness of the skin or in the subcutaneous space to create a volume increase or fillers. There are many products available on the market, benefiting from the CE mark (European Community) or MA (Authorisation Market) issued after numerous tests like the
drugs.
The offer is constantly changing, it is impossible to give an exhaustive list of existing products. However, we can distinguish two main categories of products:
Biodegradable products: they will resolve gradually and completely
Collagen (* Zyderm, Zyplast * Résoplast * ...) animal - allergy risks justifying two successive skin test prior to injection - life of a few months.
hyaluronic acid (Restylane * Perlane * Juvederm * Hyaluderm * Hylaform * Rofilan * Reviderm * ...): one of the products most-used synthetic origin / no pretest - life of a few months (deemed somewhat longer than collagen)
polylactic acid (New-Fill *): synthetic - no test - life of a few months.
Non-biodegradable products: persistent in situ for several years, or even indefinitely
Silicone: prohibited in injectable form since 1997 due to some disastrous side effects.
acrylic hydrogel (Dermalive *) and polymethyl methacrylate (Artecoll *): non-biodegradable synthetic particles "transported" either with hyaluronic acid or with collagen - granulomas deemed high risk (see below).
polyacrylamide - (Aquamid * BioAlcamid * Outline *): latest market - supposed to last several years and give little or no granuloma.
In case of large volume-corrected (cheekbones, chin, ..) or in the patient (s) allergic, should be discussed with your practitioner interest reinjection of autologous fat (see factsheet : reinfusion of autologous fat or fat-filling or lipostructure).
• BEFORE INJECTION
A precise examination is performed to check for any cons-indications to certain products (eg allergies), to detect elements involving special care (eg for labial herpes infections and perioral), or specify the nature of any previous injections to avoid some dangerous combinations of products on the same site. A careful examination is faced with the demands and expectations of (the) patient (e) to clarify what is feasible and what is illusory.
Based drugs aspirin or anti-inflammatory drug should be avoided in the 3 days before the injection. It is best not to drink alcohol or be exposed to strong sun the day before and the day of the session.
• TYPE OF ANESTHESIA AND CONDITIONS OF INTERVENTION
Usually injections are practiced without anesthesia. However, for some products a little more painful, in some (s) patient (s) more sensitive, or in some difficult areas (around lips and mouth), there may be one of the two existing methods:
• Emla Cream *: applied thickly on the areas to treat at least one hour before the injection, it reduces painful sensations in area.
• real local anesthesia: obtained by injecting an anesthetic at the beginning of the session alone ensures total insensitivity.
• INJECTION
Depending on the practitioner, the number of areas treated, the extent of improvement, and the possible need for anesthesia, the injection session can last from 10 minutes to 1 hour.
In practice, there are several techniques and injections every doctor adopt a method of its own, and it adapts to each case to obtain the best results. The amount of product required (number of needles) course is highly variable depending on many parameters. It will be evaluated as accurately as possible beforehand.
In some cases, it is best to immediately consider a follow up session after a few days or weeks in order to optimize the result.
• AFTER INJECTION: THE AFTERMATH
The first six hours it is best to stay calm, rest and refrain from any violent effort. It is also desirable to avoid as much as possible to mobilize his face (no mimicry, not talk or laugh too). For a few days it is better to avoid alcohol, aspirin, anti-inflammatory, sun and sauna. The immediate aftermath can optionally be marked by the appearance of edema (swelling) and skin redness whose magnitude and duration vary widely depending on the product and from one individual to another, but remain usually moderate (not prohibiting the return to a normal social and professional life very quickly) and disappear within one to three days. On the lips, however, edema, often marked can sometimes last a good week. More rarely, it can be observed during the first days at the injection point, a certain sensitivity of the skin, itching, pale skin, hyperpigmentation, or small dot bruises (blue).
Note that the first few days, there may be some temporary irregularities due to the inhomogeneous distribution of edema, or an overcorrection appearance (in relief) which will gradually disappear.
• THE RESULT
A delay of a few days is necessary to assess the final outcome. This is the time required for the product to be well integrated, the swelling had disappeared and that the tissues have regained their flexibility. The immediate result after treatment is therefore not reflect the final result. The injections have helped to correct the problems addressed, thereby rectifying discretely and naturally the old and tired facial appearance. Note that filler injections, unlike injections of botulinum toxin, do not alter the mobility of the muscles of the face and do not reduce facial expressions.
Usually, misfortunes are treated very much mitigated by injections, but do not always disappear completely. In fact, some locations are particularly difficult to treat and there are deep and ancient wrinkles that can never be completely erased.
We have seen that the duration of action is highly variable depending on the product (absorbable or not), but also in areas (less durable on the lips) processing, injection technique, and the patient (s) in Depending on the type of skin, lifestyle (stress, tobacco, alcohol, sun ...) and the degree of perfection desired. In most cases, however, the correction is only temporary and the treatment should be repeated after a few months or years to maintain the results.
• POSSIBLE COMPLICATIONS
While if it is small medical procedure, there are a number of uncertainties and risks. By choosing a qualified practitioner, formed specifically to these injection techniques and knowledge to choose the most suitable product for you, you limit these risks without removing them completely, especially since the majority of potential problems are inherent in the product itself and the reactions it may induce unpredictable:
• Allergic reactions: they are essentially the prerogative of collagen and should be avoided by pre-testing.
• Local reactions post-injections: we have seen that sometimes meet swelling, redness, pallor, irregularities, tenderness, itching, bruising. However, these reactions are only temporary.
• Pushing labial herpes in susceptible.
• Acute or chronic inflammatory reaction: possible after secondary injection in an area that has already been injected with other products, especially non-absorbable.
• Granulomas: Although rare, this complication is more "classic". It is small indurated nodules, more or less sensitive, perceptible to the touch, sometimes visible and unsightly, often with "in a string" along with an injection line. They correspond to a localized inflammatory reaction that can flare up. They may appear days to weeks after injection. With absorbable they are much rarer (exceptional with hyaluronic acid) and above, then they are the most regressive spontaneously in a few weeks time (a few months for collagen).
In contrast, the granulomas observed with non-absorbable products are unfortunately more common, can appear later (even years after injection) and are often larger and more durable (sometimes several years).
• rare complications: a few cases have been described in several weeks persistent redness, abscess or skin necrosis, located on a site of injection.
In the end, we should not dramatize things overstating the risks, but just be aware that injection of fillers, even seemingly simple as non-surgical, still a small share of hazards.
The use of a qualified practitioner ensures that it has the training and competence required to try to avoid these problems, or effectively treat as appropriate.
It is important that we make a note of the nature of the injected product in order to carefully advise another practitioner who would eventually be brought to you later take care.
These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.
FILLERS
AESTHETIC PLASTIC
& RECONSTRUCTIVE SURGERY
© Docteur Garson MAJ 2013