Non Surgical Fillers

Recently, the American Society for Aesthetic Plastic Surgery (ASAPS) released new and informative statistics; an increase of 21% in non surgical fillers from last year. Interestingly enough, most of these procedures were lip fillers. Adding volume to the lips seems to be an ongoing trend now, especially with the younger generation.  Furthermore, patients are able to benefit from a very natural looking result without having to undergo surgery.

Plastic surgeon Dr. Jaffer Khan answers some of the most frequently asked questions when it comes to the procedure.

FAQ’s: Fillers with Dr. Jaffer Khan

Q.1.  What can I look to achieve with fillers, and who is a good candidate?

A.1.  During the process of aging, both gravitational effects and deflation are evident.  Volumization with fillers will treat the deflation aspect, both due to the loss of fat as a process of aging and also the reduction in collagen and elastic fibers in the skin.  Aging parameters, however, are not alone in their requirement for volumization as fillers can also be used to replace volume, which was never there due to inadequate bony structure or inadequate fat composition in a certain part of the face.  Indeed, this is true in the lips themselves where the amount of dry vermillion is lacking, and volumization of the lips such as to roll out the wet vermillion into the dry vermillion area will create a semblance of a larger lip.  Therefore, both younger and older patients will benefit from volume.

Good candidates are those who have good quality skin and who are looking to achieve results, which are not necessarily as good as the surgical ones, but indeed could be.

Q.2.  Which fillers do you use?

A.2.  We use predominantly hyaluronic acid fillers, and there are many proprietary brands for this.  We also use calcium hydroxyapatite (Radiesse), but we never use anything permanent as these largely have not had a good track record and have caused a multitude of problems in the past, which are not reconcilable.

Q.3.  How long do they last?

A.3.  This depends on the particle size of the hyaluronic acid used as well as the location.  Normally, fillers in those areas which are moving such as the nasolabial folds, the marionette lines, and the chin, as well as the lips, would usually last anywhere from 4 to 8 months.  Other areas placed deep on the cheek or in the under eye or temporal areas may last for a couple of years.  It is always a good idea to speak to your doctor regarding this, as oftentimes the length of time the filler is supposed to last published by the manufacturers are not entirely accurate.

Q.4.  Are there any side effects?

A.4.  Anything that we do in life has potential effects, and some of these can be adverse.  For fillers, the obvious ones are occasional bruising, bleeding, and potentially, sometimes, infection (although I have never seen this with the use of fillers over 15 years).  Some patients are allergic to hyaluronic acid, but this is also very rare, and this can result in prolonged redness, swelling, or pain, but this is completely resolvable.

The most dangerous complication of fillers are vascular ones where inadvertent injection into an artery or a vein could result in congestion, prolonged swelling, redness, loss of skin, and even permanent loss of eyesight.   Mentioning these things are frightening for patients and quite understandably; however, it is important to consent patients for these potentially, extremely rare and adverse effects because the risk is certainly not zero.

Q.5.  I have had heard that fillers are a good alternative to a nose job.  Could you please explain how fillers can assist in this instance?

A.5.  Non-surgical rhinoplasty can only really be achieved with fillers if we are looking for those specific conditions, which are involving augmentation.  What I mean by this is addition of volume in certain areas, like increasing the projection of the tip and filling any defects, either proximal to distal to a hump, such that we produce a streamlined straight dorsum of the nose or increased projection of the tip would all be useful as an alternative to surgery.  In cases where noses are large and we are using a reduction method to achieve harmonious result, obviously fillers cannot be used.

Fillers are also very useful in correction of secondary post rhinoplasty deformities whereby small depressions can be corrected by use of fillers, which would last several months.  The interesting part is that by repeated usage, it seems the longevity in that particular area seems to be increasing, and this could be because of the fibrotic response of constant trauma when one is doing the fillers repeatedly over a period of years.

Q.6.  How can one avoid looking unnatural with fillers?

A.6.  The key for avoiding unnatural appearance is judicious use and conservative use.  One should never overfill, and should essentially do it in a step-wise fashion such that the patient obtains the confidence and also knows that they both tolerate the filler well and like its effects.  Undoubtedly, the most common cause of unnatural appearance is over-volumization.