What changes occur to our faces as we age?

What are fillers?

Fillers are materials used under the skin to fill in lines and deep wrinkles caused by sagging, age-related depressions (under the eyes, cheeks, etc.), and certain sunken areas of the skin (such as scars and acne marks); and sometimes to correct contours (such as making the lips look more vibrant, curved, and full). These are products made from a wide variety of chemical substances and offered on the market. However, since injecting foreign substances into the body can cause many problems, they are not preferred except for a few very reliable products (such as hyaluronic acid derivatives). Artefill (artecoll) is an FDA-approved filler containing a polymethylmethacrylate (PMMA) suspension in collagen; Sculptra is an FDA-approved, long-lasting filler containing poly-L-lactic acid; and Radiesse is an FDA-approved filler containing calcium hydroxylapatite as an active ingredient, and are among the reliable fillers used today.

In addition to these fillers, there are other biologically derived fillers such as Cosmoderm (a bio-engineered human collagen tissue containing anesthetic); Evolence (collagen filler derived from pig tendons); and Zyderm and Zyplast containing bovine collagen, but these products are not currently used in our country.

Are fillers only used for the face?

They are generally used to provide contouring on the face. Biological, temporary, semi-permanent, and permanent fillers can be used to define the curves of the lips and the tip of the chin, increase the convexity of the forehead, and plump the cheekbones. Although the areas of use for fillers are mostly around the face, their use for breast and buttock augmentation/shaping on the body has increased in recent years, but their safety is debatable. Fillers are also used to improve acne scars, eliminate depressions, reduce cellulite dimples, and minimize some marks on the body.

Is there an age limit for the use of fillers?

The use of fillers for cosmetic purposes is limited to a minimum age of 18. Aesthetic fillers should not be applied to individuals under this age.

How are fillers generally classified?

Fillers can generally be divided into two categories: those obtained from the body (such as fat, tissue cocktail, cartilage tissue) and foreign substances. Foreign substances can be further divided into permanent and temporary effects. Injectable and temporary fillers include suture materials (poly-L-lactic acid), gelatin powder, bovine collagen (Zyderm, Zyplast), polymethylmethacrylate (PMMA), and hyaluronic acid. Their duration of effect in the body varies greatly. There are also permanent implant fillers, which are silicone-based fillers, Gore-Tex, and solid silicone; these can be surgically placed in the nose or lips and provide a permanent effect. Because they are foreign substances, the risks of rejection and infection are much higher, and they should never be preferred.

Can all these substances be used safely?

No. Liquid silicone injections have been known to cause severe allergic reactions, tissue deformities, and death by entering blood vessels. It can cause skin damage and scarring. Therefore, silicone injections are no longer used. Injections containing silicone particles can create an artificial appearance and cause deformities under the skin. Other synthetic fillers can lead to permanent tissue damage, deformation, and skin discoloration due to infection or allergic reactions after application; therefore, we avoid solid silicone prostheses used for lips or Gore-Tex used for nose reshaping.

Is Aquafilling filler, used for breast and buttock augmentation, safe?

This injectable polyacrylamide hydrogel filler is hydrophilic, meaning it retains water. Depending on its form and concentration, it can draw in 3-400, or even 800, times its volume in fluid, according to some publications, providing volume/fill. Clinical trials of this substance are not yet fully completed, and it does not have FDA approval. For breast augmentation, if a significant amount of volume is not needed and only mild fullness is required, this substance can be used. For breasts requiring a volume increase of 250-300 cc, silicone implants should definitely be preferred. However, the use of these materials, which are not fully researched and may even trigger cancer, should be avoided or limited for now, as their potential reactions in breast tissue are unknown.

Which fillers can cause allergies?

Hyaluronic acid, polymethyl methacrylate, poly-L-lactic acid, and calcium hydroxyapatite are the main filler materials frequently and safely used today. Their risk of causing allergies is negligible. Generally, fillers derived from animal tissues are more likely to cause allergies. Bovine collagen causes an allergic response in the body and is rejected and excreted by the body within 3 weeks. As a result of these reactions, swelling occurs in the surrounding tissues, and this swelling provides both fullness and causes wrinkles to improve for 1-2 months. In other words, after collagen is injected into the body, it is rejected and completely excreted like a foreign tissue. A collagen allergy test must be performed before application. The most important disadvantage is that it can cause serious allergic reactions in some people and completely disappear 2-3 months after injection. In cases where allergy tests are not performed, the immune system's excessive reaction can lead to very important and potentially life-threatening reactions in the body. Therefore, the use of bovine collagen is currently restricted.

What is hyaluronic acid filler?

This filler material, which is in the form of a clear, transparent gel, is produced by microorganisms using biotechnological methods from hyaluronic acid, which is normally found in the body, and is administered to the body as a supplement when there is a deficiency. Hyaluronic acid is a polysaccharide-structured connective tissue element normally found in the connective tissues of all living things (plants, animals, and humans), between collagen fibers, and gives the skin fullness, radiance, and smoothness. The loss of hyaluronic acid in the skin structure over time is one of the most important factors in skin aging and causes the skin to fade, wrinkle, and develop fine lines. Injecting this filler material into the skin restores the skin's radiance, fullness, and elasticity.

In which areas is this filler material applied?

Dermal fillers are used to treat frown lines between the eyebrows, crow's feet deformities at the outer corners of the eyes, nasolabial folds extending from both nostrils to the corners of the mouth, fine wrinkles around the mouth and lines extending downwards from the corners of the mouth, lip contouring and lip augmentation, décolleté area, neck and back lines. They are injected into the skin in areas with fine wrinkles and folds to smooth and add volume.

Where are hyaluronic acid applications performed and how long do they take?

They must be performed in hygienic clinic conditions. It is absolutely wrong and dangerous for unqualified individuals to administer fillers in beauty salons, aesthetician offices, hairdressers, or at filler/botulinum toxin events and parties. Local anesthesia is rarely used in filler injections. After the skin is cleaned with alcohol or another antiseptic, the filler material is injected into the skin using very fine, specialized syringes to fill the wrinkles. The procedure takes approximately 15-20 minutes and has no side effects other than slight swelling and redness at the injection site.

Can I feel the injected substance under my skin after filler injections?

Fillers like hyaluronic acid, which are metabolized and dissolved naturally within the body, may cause a slight firmness in the skin after application, which may last for a few days. However, generally, we can say that "the filler should not be felt after application." After semi-permanent and permanent filler applications, lumps that can be felt like lentils or chickpeas, or granulomas, may form. This risk increases further in applications performed by inexperienced individuals.

What should be considered after the procedure?

Applying ice or cold gel within the first 24 hours after the procedure is appropriate and will reduce the risk of possible edema. Exercising or strenuous sports that may increase blood pressure in the first few hours after the procedure increases the risk of edema and bruising. After the procedure, discoloration (such as redness or bruising) can be camouflaged with high-quality, dust- and sweat-resistant, hypoallergenic, and non-irritating makeup. A drop or two of bleeding may occur at the needle insertion points, and a simple antibiotic ointment can be applied to these areas. Caution is necessary in patients who carry the herpes virus and occasionally experience cold sores; taking an antiviral medication before such procedures can prevent future cold sore outbreaks.

How often should hyaluronic acid fillers be used?

This filler is slowly eliminated from the body through absorption. This period is approximately 6-24 months, depending on the product used. Normally, a small amount of filler is slowly cleared from the body over time because the body's daily hyaluronic acid metabolism removes it. Therefore, it is a procedure that needs to be renewed every 6-18 months. However, in recent years, fillers that can maintain their effectiveness for up to 18-24 months have also started to be used. In general, collagen and hyaluronic acid can be considered shorter-lasting filler materials; while poly-L-lactic acid (Sculptura) and calcium hydroxyapatite (Radiesse) are long-lasting permanent fillers. Currently, the only FDA-approved permanent filler used worldwide is polymethyl methacrylate (artefill-artecoll). Which filler will be used in a patient may vary depending on the area being treated, the skin structure, anatomy, the patient's expectations and desires, and of course, their lifestyle.

What are the side effects and risks of the procedure?

Hyaluronic acid is a naturally occurring substance in the body, so it is unlikely to cause allergic reactions. It is FDA approved and widely used in America. Mild swelling and redness may occur after the procedure. This swelling will subside spontaneously within 48 hours. However, in cases performed by inexperienced individuals, or even unintentionally, injuries to blood vessels, temporary bruising, skin necrosis, and infection may occur. The best precaution is to find an experienced surgeon. Any irregularities or areas requiring reinforcement can be corrected with re-injection of filler material in the first few days after the procedure. Therefore, it may be more sensible to postpone filler applications for a few days before social gatherings and large events, knowing that touch-ups of the injected materials may be necessary.

How can I minimize the possibility of bruising after filler applications?

At least 2 weeks before the procedure, avoid anti-inflammatory treatments such as aspirin, vitamin E, and ibuprofen (Advil, Naproxen), and St. John's wort. The use of medications and herbal supplements that can prevent blood clotting, such as St. John's wort, ginkgo biloba, ginseng, saw palmetto, and garlic pills, should be discontinued.

In what situations should hyaluronic acid fillers not be applied?

During pregnancy and breastfeeding, application should be avoided due to insufficient information on the subject. Also, injections should be postponed in cases of herpes infections around the lips. It should not be applied to areas with inflammation or allergic reactions.

What is a liquid facelift and how is it performed?

A liquid facelift is an attempt to camouflage age-related changes and sagging in the face using fillers and neurotoxins, without performing anatomical surgical changes (i.e., without using a scalpel). The results will be short-lived, and the procedures need to be repeated to maintain the same effect. Advantages of a liquid facelift include quick results in reducing signs of aging and the absence of a recovery period. However, when evaluated over the long term, the financial cost to the patient may exceed that of a full facelift operation. Liquid facelift procedures generally aim to give the face a youthful look with a triangular and diagonal appearance by plumping up the cheekbones, which we call the malar region; to make the jawline contour seamless and smooth with fillers; to replace sagging and tissue loss in the lips and surrounding structures; and to eliminate fine wrinkles on the face and around the lips using various filler materials. Sagging, fat and bone tissue loss, lines, folds, and deep furrows in the face are thus repaired with fillers, providing a more youthful appearance. Wrinkles are treated with botulinum toxin injections.