Filling Applications

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

In the facial area, botulinum toxin (BoNT-A) is not effective in very deep wrinkles and areas with volume loss. For this reason, corrections in such areas should be made with substances that will create more volume. For this purpose, many filling materials of temporary and permanent types are used. There are many fillers on the market, the most common of which are connective tissue protein containing hyaluronic acid. Hyaluronic acid, which is of animal origin, generally has a low probability of causing allergy. However, allergies can range from simple skin rashes to severe shortness of breath and even advanced allergies that require heart/lung resuscitation. Therefore, get information from your doctor regarding 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. The most commonly used commercial hyaluronic acid preparations include Restylane, Hyaloform, Juvederm, Teosyal, Puragen, Prevelle. The duration of action of these fillers, the reactions and problems they cause in the body after the injection may vary.

In my patients, I generally prefer hyaluronic acid (HA) fillers, which contain a local anesthetic called lidocaine, as they last 6-8 months and cause less pain during injection than others.

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

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

Apart from hyaluronic acid, there are also full synthetic, that is, obtained from other than natural sources, silicone, polydioxanone, polyacrylamide, calcium hydroxyapatite fillers with an effect lasting longer than one year and even permanent ones, but there are question marks regarding their reliability. Especially in injectable silicone-based injectable fillers, widespread granulomas, Situations such as silicone being expelled as a clot (silicon embolism) into vital organs such as the lungs, heart, and eye arteries have been reported (1,2). Various complications have also been reported with other non-HA fillers.

Essentially, what the patient needs to decide is whether to fill the wrinkles, that is, the recesses in the skin, or to increase the volume and restore the beautiful bump of a collapsed area. Most of the time, both needs are observed together in varying proportions in patients. There are also intermediate filling forms that may be suitable for such situations.

Filler injections may cause side effects such as temporary swelling and bruising, in addition to the allergies mentioned before. In order to minimize the occurrence of these side effects, the use of aspirin, non-steroidal anti-inflammatory drugs, and high-dose vitamins that may increase blood fluidity (blood thinners) should be stopped at least one week before the injection. Synthetic fillers have the ability to absorb water at certain rates and may cause unpredictable swelling and asymmetries in the injected areas, especially in non-specialist practitioners who have not completed the learning curve.

I recommend our patients who will have a filler injection to look for the following in the center they apply to;

At least the injection should be performed 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 in your presence for the first time. Verify which brand your filler is from.
If you have previously consulted a doctor due to any medication or food allergy, highlight it even if you are not asked.
Do not inject products that are not allowed to be imported by the Turkish Ministry of Health. Fillers have compliance statements with the US Food and Drug Administration (FDA) or European Union Standards. If neither of these are available, do not trust the suitability of the material to be used.
Check whether there is at least a work permit on the walls of the institution where you received the injection.

Frequently asked Questions

Can filler injection be done in every part of the body?

Although this is theoretically possible, serious problems have been observed in international scientific articles in the form of case reports. These can occur regardless of the filling type. For example; Blindness due to a filling clot escaping into the artery feeding the eye (optic artery) (3), nasal tip gangrene due to injections for non-surgical correction of the nose and resulting nasal tip losses (4), widespread granuloma formation on the hip (1). In addition, it has been reported that polyacrylamide gel injection, which is currently injected in underground centers for breast enlargement and lift purposes and marketed under the name "water filler", has serious side effects (7). This material, which is used especially in China, also causes various problems in our country.

Filling clot can also occur in the fatty tissue taken from the person and given to him/her following certain procedures, as in synthetic fillings [see. fat injection]. Therefore, in order to prevent such side effects that synthetic fillers may cause, avoid injecting synthetic fillers, especially at deep levels, around the eyeball and in the nose and breast area. Since these problems can also be seen in fat injections, the same applies to fat injections.

Can filling and botulinum toxin type-A or laser, skin scraping (dermabrasion) be performed at the same time?

Although it is possible to perform these applications together, it is not recommended to perform these applications together with filler injection in order to minimize possible problems. I recommend that my patients wait at least a week for it to pass. Especially for patients who are considering botulinum toxin (BoNT-A) application along with the filler, it would be logical to apply BoNT-A first and after a week, its effect has settled and the filler injection is planned according to the final state of the wrinkles on the skin. The damaging effect of lasers on the skin and subcutaneous tissue raises questions regarding the effectiveness and reliability of filler injection. Therefore, it will be safer to perform laser, chemical peel and mechanical scraping type applications days before filler injection.

I had filler injections; asymmetry appeared? What should I do?

First of all, I recommend that you learn the type of filler applied and even the brand name from the doctor who applied it. Thus, it may be possible to have information about the behavior of the filler after injection. If the filler material used is hyaluronic acid, the complaints will regress at the end of the effect period. Massage applications to the area with asymmetry in the early period can partially affect the distribution and reduce complaints. Hyaluronidase , the enzyme that dissolves this filler in the clinic , can be injected into the relevant area, but the strength of its effectiveness is variable. Hyaluronidase is mostly used for the treatment of blindness due to filling clot8. In my personal experience, I have observed that the effect of the enzyme develops very quickly. Contrary to popular belief, it is not expected to damage the soft tissue in the area where it is injected.

In this section, non-injectable, solid fillers are not mentioned. These are mentioned in more detail in the implants section.

I enlarged my breast with a hydrogel filler called Aq…. However, I feel hardness in my breast. Are these normal changes?

Among the fillers, hydrogel fillers, which are especially popular in Far Eastern countries such as China, Korea and Japan, mostly contain polyacrylamide. PA hydrogel appears to provide good volume due to its high water retention. However, as with all fillers that have high permanence in the body, almost all of these substances are exposed to the war waged by the immune system and are surrounded by a connective tissue sheath called capsule. They gradually harden and cause hardness. As the filling hardens, it tries to absorb the surrounding breast tissue, causing pain and deformities. On the other hand, the filling material trapped in the capsule may become infected and abscess. There are two types of polyamide hydrogels: faceline and bodyline. The bodyline type is produced especially for the body and is very long-acting. Many side effect articles have been reported in academic publications, mostly related to injections in the breast and hip area (7-12). In fact, in one of these studies, there was a case of breast cancer that occurred after a certain period of time after the injection of the gel (11).

Therefore, be sure to avoid the injection of such synthetic polymers, which are touted as a miracle product. Practically, I can say this; The majority of patients who apply to me with filler-related problems experience problems related to fillers that last 10 months or longer. Therefore, I do not recommend fillers that are effective for longer than 10-12 months to my patients. To my patients who want longer-lasting results, I recommend solid implants that are not likely to disperse into soft tissue.

I recommend that patients who have hydrogel injection into their breasts have the filler removed, if possible, before hardness occurs in their breasts, and that they choose healthier surgical treatment methods to eliminate the volume loss in the tissue. In patients with problems, I recommend surgical planning and removal of the filler after examination and breast MRI examination.

I have a bump on my nose. I learned that this can be hidden with filler. Will it cause any problems in the future?

Although nose surgery may seem like a traumatic procedure, as in every surgery, these surgeries may be necessary for both aesthetic and functional improvement in patients. In our country, the rate of septum deviation (deviations in the middle section of the nose), which causes functional impairment in the nose, was reported as 40% in one study (13). Statistical studies on this subject are unfortunately insufficient. Therefore, the number of problems that can be solved with minor touch-ups remains low.

In recent years, filler injections have been frequently used for retouching purposes due to problems in the nose, both existing and developing after nose surgeries. However, with this increase, the undesirable effects (complications) related to the filler have also increased (14-15). Although it is less common in the non-operated nose, even the most innocent filler can cause problems in the nose area. I rarely apply hyaluronic acid-based fillers to patients who do not want to undergo surgery but want to correct their deformity. However, in this case, I explain in detail that he took the risks himself. Skin loss has been reported on the nose, especially at the tip (14-15). Therefore, patients should go to their physicians for a check-up if they detect any redness, swelling, or increased regional temperature after receiving such injections.

Resources:

Singh M, Solomon IH, Calderwood MS, Talbot SG. Silicone-induced Granuloma After Buttock Augmentation. Plast Reconstr Surg Glob Open. 2016 Feb 19;4(2):e624. doi: 10.1097/GOX.0000000000000618. eCollection 2016.
Purdy-Payne EK, Green J, Zenoni S, Evans AN, Bilski TR. A Serious Complication of Illicit Silicone Injections: Latent Silicone Embolization Syndrome after Incision and Drainage of Local Injection Site. Surg Infect (Larchmt). 2015 Aug;16(4):473-7. doi: 10.1089/sur.2014.225. Epub 2015 Jun 12.
Beleznay K, Carruthers JD, Humphrey S, Jones D. Avoiding and Treating Blindness From Fillers: A Review of the World Literature. Dermatol Surg. 2015 Oct;41(10):1097-117.
Honart JF, Duron JB, Mazouz Dorval S, Rausky J, Revol M. A case of nasal tip necrosis after hyaluronic acid injection. Ann Chir Plast Esthet. 2013 Dec;58(6):676-9.
Tracy L, Ridgway J, Nelson JS, Lowe N, Wong B. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline. J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):564-8.
Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE. Complications following injection of soft-tissue fillers. Aesthet Surg J. 2013 Aug 1;33(6):862-77.
Luo SK, Chen GP, Sun ZS, Cheng NX. Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients. J Plast Reconstr Aesthet Surg. 2011 Jun;64(6):731-7.
Carruthers J, Fagien S, Dolman P. Retro or PeriBulbar Injection Techniques to Reverse Visual Loss After Filler Injections. Dermatol Surg. 2015 Dec;41 Suppl 1:S354-7. doi: 10.1097/DSS.0000000000000558.
Ono S, Ogawa R, Hyakusoku H.Complications after polyacrylamide hydrogel injection for soft-tissue augmentation. Plast Reconstr Surg. 2010 Oct;126(4):1349-57.
Manafi A, Emami AH, Pooli AH, Habibi M, Saidian L.Unacceptable results with an accepted soft tissue filler: polyacrylamide hydrogel.Aesthetic Plast Surg. 2010 Aug;34(4):413-22.
Cheng NX, Liu LG, Hui L, Chen YL, Xu SL. Breast cancer following augmentation mammaplasty with polyacrylamidehydrogel (PAAG) injection. Aesthetic Plast Surg. 2009 Jul;33(4):563-9.
Amin SP, Marmur ES, Goldberg DJ. Complications from injectable polyacrylamide gel, a new nonbiodegradable soft tissue filler. Dermatol Surg. 2004 Dec;30(12 Pt 2):1507-9.
Uygur K, Tüz M, Do¤ru H. The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg 2003;129:33-6.
Honart JF, Duron JB, Mazouz Dorval S, Rausky J, Revol M. [A case of nasal tip necrosis after hyaluronic acid injection]. Ann Chir Plast Esthet. 2013 Dec;58(6):676-9. doi: 10.1016/j.anplas.2013.08.005.
Kim SK, Kim JH, Hwang K.Skin Necrosis of the Nose After Injection of Ribose Cross-Linked Porcine Atelocollagen. J Craniofacial Surg. 2015 Oct;26(7):2211-2.

Filling Applications

Filling Applications