Filling

Botulinum toxin (BoNT-A) in the face area is not effective in very deep wrinkles and areas with volume loss. For this reason, corrections in such regions should be made with materials that will create more volume. For this purpose, many temporary and permanent filling materials are used. Among these, there are many fillers consisting of connective tissue protein containing hyaluronic acid, which are the most common in the market. Hyaluronic acid, which is of animal origin, has a low probability of causing allergies in general. However, allergies can range from simple skin rashes to severe shortness of breath and even advanced allergies that will require heart/lung resuscitation. Therefore, get information from your doctor about filling allergy. Hyaluronic acid is widely found in cartilage, joints, skin and various soft tissues in the body. Its production as a medicine is carried out by bacterial fermentation and purification processes. Among the most used commercial hyaluronic acid preparations, Restylane, Hyaloform, Juvederm, Teosyal, Puragen, Prevelle can be counted. The duration of action of these fillers, the reactions and problems caused by the body after the injection may differ.

In my own patients, I generally prefer hyaluronic acid (HA) fillers, which contain a local anesthetic called lidocaine, with an effective duration of 6-8 months and cause less pain in injection than others.

As the duration of the filling material stays in the body, the rate of development of an inflammatory response, called granulomatous reaction, against this material, which the body can perceive as a foreign body, may increase.

HA fillers are of the nature to absorb a certain amount of water due to their molecular structure. With this loss of water at variable times after injection, a certain decrease in the filled volume occurs.

Apart from hyaluronic acid, there are also full synthetic fillings obtained from natural sources, such as silicone, polydioxanone, polyacrylamide, calcium hydroxyapatite, with a duration of action longer than one year and even permanent fillings, but there are question marks in terms of their reliability. Especially in injectable silicone-based injectable fillings, common granulomas, Situations such as clotting of silicon to vital organs such as the lung, heart, and eye arteries (silicon embolism) have been reported (1,2). Various complications have also been reported with other non-HA fillings.

Filling materials have been prepared in different types for each part of the body in terms of molecular diameter. There are subtypes of the same brand that vary according to the injection site and the volume to be injected.

Basically, the patient should decide whether it is to fill the wrinkles, that is, to fill the recesses in the skin, or to restore a collapsed area to its former beautiful bump by increasing the volume. Mostly, both needs are observed together in varying proportions in patients. There are also intermediate filling forms that may be suitable for such situations.

Filling injections may cause side effects such as temporary swelling and bruising, apart from the allergy mentioned before. In order to minimize the occurrence of these side effects, it is necessary to discontinue the use of aspirin, non-steroidal anti-inflammatory drugs, high-dose vitamins that can increase blood flow (blood thinners) from injection at least one week in advance. Synthetic fillers are capable of absorbing water at certain rates and may cause unpredictable swelling and asymmetry in the injected areas, especially in non-specialist practitioners who have not completed the learning curve.

I recommend our patients who will have filler injections to call the following centers at the center they apply;

At least, injection by a plastic reconstructive and aesthetic surgeon or dermatologist. Remember; The only clinical discipline that can eliminate the problems (complications) that may occur after filler injections is plastic, reconstructive and aesthetic surgery.

Make sure that the filler package injected into you is opened for the first time with you. Verify which brand your filler belongs to.

If you have previously consulted a doctor for any drug or food allergy, highlight it even if you are not asked.

T.R. Do not inject products that are not allowed to be imported by the Ministry of Health. The fillings have the statements of conformity with the USA Pharmaceuticals and Food Administration (FDA) or European Union Standards. If both of these are not available, do not rely on the suitability of the material to be used.

Check that the institution where you are injecting has at least a work permit on its walls.