Improving Skin Texture
As we age, our faces begin to show the effects of gravity, sun exposure
and years of facial muscle movement, such as smiling, chewing and squinting.
The underlying tissues that keep our skin looking youthful and plumped up
begin to break down, often leaving laugh lines, smile lines, crow's feet
or facial creases over the areas where this muscle movement occurs.
Soft-tissue fillers, most commonly injectable collagen or fat, can help
fill in these lines and creases, temporarily restoring a smoother, more
youthful-looking appearance. When injected beneath the skin, these fillers
plump up creased and sunken areas of the face. They can also add fullness
to the lips and cheeks. Injectable fillers may be used alone or in conjunction
with a resurfacing procedure, such as a laser treatment, or a recontouring
procedure, such as a facelift.
If you're considering a facial-rejuvenation treatment with collagen or fat,
this page will give you a basic understanding of the procedure - when
injectables can help, how the procedure is performed, and what results you
can expect. It may not answer all of your questions, since a lot depends
on your individual circumstances. Please ask your doctor if there is anything
about the procedure you don't understand.
Knowing your options
Injected collagen and fat are primarily used to improve the appearance of
the skin's texture. They can help fill out deep facial wrinkles, creases
and furrows, "sunken" cheeks, skin depressions and some types
of scars. They can also be used to add a fuller, more sensuous look to the
Injectables are usually not sufficient for severe surface wrinkles on the
face, such as multiple vertical "lipstick lines" that sometimes
form around the mouth. Instead, your plastic surgeon may suggest a resurfacing
technique, such as chemical peel, dermabrasion or laser treatments. Rather
than filling in facial lines, resurfacing methods strip away the outer layers
of the skin to produce a smoother appearance.
Deep folds in the face or brow caused by overactive muscles or by loose
skin may be more effectively treated with cosmetic surgery, such as a facelift
or browlift. Injectables are sometimes used in conjunction with facial surgery
procedures; however, injectables alone cannot change facial contour the
way surgery can.
Keep in mind that a plastic surgeon is a specialist that can offer you the most advanced treatments ranging from cosmetic surgery,
refinishing techniques, injectables and the use of other
fillers. You and your surgeon may determine that a single procedure or a
combination of procedures is the best choice for you.
Injectable collagen or fat can help
improve the skin's texture by filling
in the laugh lines and facial creases
that often occur with aging.
A word about other types of fillers
This page deals with the two most commonly used types of injectable
fillers, collagen and fat. However, to a lesser extent, a number of other
filler materials are also being used for facial-rejuvenation purposes. They
include: Fibril, a gelatin powder compound that's mixed with a patient's
own blood and is injected to plump up the skin (similar to injectable collagen);
and Gortex, a thread-like material that is implanted beneath the skin to
add soft-tissue support.
Each of these options has its own set of risks and benefits. If you're considering
any of these alternative filler treatments, tell your doctor.
What to expect from treatment
The most important fact to remember about injectable fillers is that the
results are not permanent. Injected material is eventually metabolized by
the body. You should not expect the same long-lasting results that may be
gained from cosmetic surgery.
In some individuals, the results may last only a few weeks; in others, the
results may be maintained indefinitely. Researchers believe that age, genetic
background, skin quality and lifestyle as well as the injected body site
may all play a role in the injected material's "staying power."
However, the precise reason for the variation of results among patients
has yet to be identified.
If you've had short-lived results from fat injections, you shouldn't necessarily
assume that collagen injections will work better for you. And, conversely,
if you've had disappointing results from collagen, don't assume that injected
fat is the answer. Although it's true that some individuals' bodies are
more receptive to one substance than the other, others may find that neither
substance produces long-lasting results. Sometimes one substance may work
better than the other for a specific problem.
Risks related to injectables
When injectables are administered by a qualified plastic surgeon, complications
are infrequent and usually minor in nature. Still, individuals vary greatly
in their anatomy, their physical reactions and their healing abilities.
The outcome of treatment with injectables is never completely predictable.
Risks not necessarily related to allergies include infection, abscesses,
open sores, skin peeling, scarring and lumpiness, which may persist over
the treated area. Reports of these problems are very rare.
Allergic reaction is not a factor for fat because it's harvested
from a patient's own body. However, there is still a small risk of infection
and other infrequent complications.
Planning for treatment
Facial rejuvenation is very individualized. That's why it's important to
discuss your hopes and expectations with a board-certified plastic surgeon
who has experience with many different types of surgical and non-surgical
In your initial consultation, your plastic surgeon will evaluate your face
- the skin, the muscles and the underlying bone - and discuss your goals
for the surgery. Your doctor will help you select a treatment option based
on your goals and concerns, your anatomy and your lifestyle.
Your surgeon will ask you about your medical history, drug allergies, and
check for conditions that could cause problems, such as active skin infections
or non-healed sores from injuries. Collagen injections are generally off
limits for pregnant women, individuals who are allergic to beef or bovine
products, patients who suffer from autoimmune diseases, and those who are
allergic to lidocaine (the anesthetic agent contained in the syringe with
the collagen material). For more specific information about the contraindications
and risks of collagen use, ask your doctor for the manufacturer's brochure
Insurance usually doesn't cover cosmetic procedures. However, if your injectable
treatment is being performed to treat a scar or indentation from an accident
or injury, you may be reimbursed for a portion of the cost. Check with your
insurance carrier to be sure.
Where your treatment will be performed
Injectables are usually administered in a surgeon's office-based facility.
If, however, you are being hospitalized for a facelift, necklift, browlift,
or any other procedure, your injections may be administered in the hospital
Types of anesthesia
Because the anesthetic agent lidocaine is mixed in
with collagen, additional anesthetic is usually not used. However, if you
are especially sensitive to pain, your doctor may use a topical cream anesthetic
or a freon spray to numb the injected area. Or, you may elect to have an
injected local anesthetic or sedative drugs.
Both the donor and recipient sites are numbed with local anesthesia.
Sedation can be used as well. If you elect to use sedation, be sure to arrange
for a ride home after your treatment.
Collagen is a naturally occurring protein that provides support to various
parts of the human body: the skin, the joints, the bones and the ligaments.
Injectable collagen, patented by the Collagen Corporation under the trade
names Zyderm and Zyplast, is derived from purified bovine collagen. The
purification process creates a product similar to human collagen. Injectable
collagen received approval from the Food and Drug Administration in1981.
It is produced in various thicknesses to meet individual patient needs.
Collagen is used primarily to fill wrinkles, lines and scars on the face
and sometimes the neck, back and chest.
Treatment with collagen can begin after a skin test
determines that you're not allergic to the subsstance. The collagen is injected
using a fine needle inserted at several points along the edge of the treatment
site. If a local anesthesia has not been used, you may feel some minor stinging
or burning as the injections are administered.
Years of squinting and other facial
muscle movements can take their toll
on the eye area, leaving crow's feet
and other noticeable lines
Since part of the substance is salt water that will be absorbed by the body
within a few days, your doctor will slightly overfill the area. You may
be asked to hold a hand mirror during the procedure to help your doctor
decide when you've had enough.
Immediately following treatment, you may notice
some minor discomfort, stinging or throbbing in the injected area. Occasionally
some bruising or swelling will occur, but it is usually minor. Any redness
that appears in the injected site usually disappears within 24 hours. However,
in some individuals, particularly fair-skinned patients, this redness may
persist for a week or more. Tiny scabs may also form over the needle-stick
areas; these generally heal quickly.
No bandaging is needed and you are free to eat, drink, and wear makeup with
sunblock protection shortly thereafter. There may be some temporary swelling
and redness in the treated area which should dissipate within a few days.
If these symptoms persist, contact your surgeon.
After treatment, the skin around the eye
area appears smoother and more taut.
As stated earlier, the duration of results from collagen
injections is variable. Collagen's longevity depends on the patient's lifestyle
and physical characteristics as well as the part of the body treated. In
general, the injected material is likely to disappear faster in areas that
are more affected by muscle movement.
Your doctor can help you determine how long you can go between treatments
to best maintain your results.
In the medical world, the fat-injection procedure is known as autologous
fat transplantation or microlipoinjection
. It involves extracting fat
cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting
them beneath the facial skin. Fat is most often used to fill in "sunken"
cheeks or laugh lines between the nose and mouth, to correct skin depressions
or indentations, to minimize forehead wrinkles and to enhance the lips.
After both the donor and recipient sites are cleansed
and treated with a local anesthesia, the fat is withdrawn using a syringe
with a large-bore needle or a cannula (the same instrument used in liposuction)
attached to a suction device. The fat is then prepared and injected into
the recipient site with a needle. Sometimes an adhesive bandage is applied
over the injection site.
Lines and creases that form around the
mouth are usually caused by gravity
and a breakdown of tissues beneath
As with collagen, "overfilling" is necessary to allow for fat
absorption in the weeks following treatment. When fat is used to fill sunken
cheeks or to correct areas on the face other than lines, this overcorrection
of newly injected fat may temporarily make the face appear abnormally puffed
out or swollen.
If a larger area was treated, you may be advised
to curtail your activity for a brief time. However, many patients are able
to resume normal activity immediately. You can expect some swelling, bruising
or redness in both the donor and recipient sites. The severity of these
symptoms depends upon the size and location of the treated area. You should
stay out of the sun until the redness and bruising subsides - usually about
48 hours. In the meantime, you may use makeup with sunblock protection to
help conceal your condition.
The swelling and puffiness in the recipient site may last several weeks,
especially if a large area was filled.
The lower face appears firmer and
smoother after treatment with injectables.
Lines around the mouth are filled in and
The duration of the fat injections varies significantly
from patient to patient. Though some patients have reported results lasting
a year or more, the majority of patients find that at least half of the
injected fullness disappears within 3-6 months. Therefore, repeated injections
may be necessary. Your doctor will advise you on how to maintain your results
with repeat treatments.
Your new look
If you're like most patients, you'll be very satisfied with the results
of your injectable treatments. You may be surprised at the pleasing results
that can be gained from this procedure.
With regular follow-up treatments,
your refreshed look can be easily