Soft tissue fillers are instant volume replacement solutions for the aging face or serve as enhancement for areas such as the lips or eyes. Historically, the concept of volume replacement originated with the injection of collagen and silicone to replace lost volume. As skin sags, volume replacement in the area where the skin has fallen can mask the effects of gravity. Fillers can be used to rebuild a full cheek mound, soften deep folds, fill out the hollowness below the eyes and even plump the lips. At S.P.A., we want patients to understand that there are risks involved with the injection of fillers. Dr. Patel has published landmark research into the subject and takes the utmost care in ensuring each of his patients are well informed and safe prior to injection. It is of the utmost importance that these injections be performed by a practitioner with knowledge of the anatomy under the skin and ability to manage complications. Dr. Patel offers a variety of a la carte treatments that may be combined depending upon your needs. We utilize a technical approach to fillers selection and the amount and type varies depending on location, previous injection, skin type and nature of volume enhancement needed.

Restylane®/Juvederm® Injectable Gels

U.S. Food and Drug Administration (FDA)-approved Restylane® and Juvederm injectable gel are cosmetic “fillers” that contains hyaluronic acid (HA), a natural substance that is found in the body. HA gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane gel is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable.

The most common areas for treatment are the glabellar lines (which run between the eyebrows) and the nasolabial folds (which run from the sides of the nose to the corners of the mouth). Both injectable gels are also FDA-approved, for those 21 and older, for enhancing the lips. Different formulations of each gel have varying thickness and properties that allow placement at different depths and for different purposes. The thicker the get, the longer it stays in the body; however hyaluronic acid based fillers will be absorbed eventually.

Finally, a medication called hyaluronidase can be injected after an injection to “erase” any injected material. Older generation fillers did not carry any reversibility and though we rarely require the use of hyaluronidase, it always provides the ability to undo any treatment.

Side Effects Of Hyaluronic Acid Injectable Gels

The most common side effects of Restylane injectable gel are swelling, redness, pain, bruising and tenderness in and around the injection sites. They typically go away within a week. Although considered safe for most patients, both injections carry a risk of infection, bleeding or allergic reaction. The most serious consequence can be accidental direct injection of the gel into an artery or injection into an area that compresses an artery. This will lead to the rapid death of the skin surrounding the area; a process called necrosis. When this is suspected, a reversing agent called hyaluronidase can be injected to salvage the blood supply. In addition your doctor should give you immediate aspirin and apply nitroglycerin paste and ice to help improve the outcome. This outcome is rare but most common when injecting the cheeks or tip of the nose. In rare instances the gel can be injected and travel through a vein to occlude the blood supply to the eye causing blindness. It is for this reason that Dr. Patel is very cautious whenever he injects. He is vigilant in selection, technique and amount of filler used.

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