Due to the high demand for “light” non-surgical cosmetic treatments, the number and quality of anti-ageing injectable materials has evolved significantly in the last few years and their application has become increasingly frequent.
Hyaluronic acid was discovered in 1934. The exceptional properties of this molecule have completely revolutionized the ageing skin treatment. The evolution of products, their multiplication and technical progress in terms of injection method have made hyaluronic acid a pivotal point in the cosmetic therapy of filling, volume restoration and rejuvenation.
Hyaluronic acid is considered to be an object of reference used in the volume restoration and rejuvenation medicine due to:
- its long period of use – since 1994
- its durable presence in situ, varying from 8 to 24 months, injections having a sufficiently long time to be efficient and their temporary character allowing to
- monitor the ageing process
- The absence of tissue specificity being bio-compatible. Tolerance tests carried out before injection are thus not necessary (only for certain specialized fields)
- its 100% biodegradable composition
- its method of use, it does not require any prior preparation
- its extensive range of use: the same product can be used in various forms adapted to the various types of ageing
Side-effects are minimal and rare. The possibility to inject it in different forms allows for a better use of its properties:
- hydrating and revitalizing in mesotherapy
- correction of superficial wrinkles
- correction of deep wrinkles
An injection session can be performed in specific areas, but can also be complimentary to other more invasive medico-surgical rejuvenation techniques like peelings, laser, dermabrasion, upper or lower blepharoplasty, lifting, etc. They can also be applied simultaneously with the Botox injections, targeting tonus reduction in certain muscles responsible for wrinkle development.
The hyaluronic acid injection is a simple and quick method to reduce certain ageing or cosmetically disadvantaging signs on the face, filling or restoring volume where necessary.
The most popular corrections performed with hyaluronic acid can be divided into 4 categories: Folds: nasolabial fold (from the nostril to the corner of the mouth), labiomental groove (chin); Wrinkles: frontal/glabellar (between the eyebrows), corner of the eyes (crow’s feet), cheeks, chin, around the mouth; Lips: redesigning countour or lip filling if they are too thin, or simply to give them more volume.
Grooves or areas lacking volume: cheekbones, jaw line contour, cheeks, nose, temples, scarring (acne scars, spider veins, injury scars). Normally, these imperfections do not disappear on their own, but will be significantly reduced with the help of these filler injections. The perenniality of the correction varies according to the type of hyaluronic acid and patient, and has a temporary effect, the treatment having to be repeated to maintain and improve the cosmetic results.
Hyaluronic acid injection can be performed on both men and women, starting with the age of 30-35. In spite of this, injections are sometimes applied much sooner when localized issues are not age related (lips, cheekbones).
The basic principle consists in injecting the product at the skin level or deeper, in order to reduce certain types of wrinkles or groves in the face, or to restore volume where desired.
Nowadays, the market holds several types of hyaluronic acid products. These products differ in viscosity, which determines their more or less volumizing character. Among the most popular and used by us are: Juvederm, Voluma, Volift, Volbela, Teosyal, etc.
In situations in which the volume correction is greater or when patients are allergic, it is of utmost importance to discuss the possibility of autologous fat injection (lipofilling) with your doctor.
An accurate medical history is mandatory before injection to avoid potential side-effects:
- known hypersensitivity to hyaluronic acid
- pregnant or breastfeeding women
- the medical history assessment also needs to detect certain elements that imply a specific degree of caution (e.g. herpes for labial or peribuccal mouth injections) or to specify the nature of previous injections to avoid certain harmful associations of products in the same spot.
Medicine based on aspirin or anti-inflammatory drugs must be avoided three days before injection. It is preferable to also avoid alcohol consumption and sun exposure one day before injection day. A thorough examination, while sitting, will be compared with the desires and expectations of the patient, after which you will discuss what is possible and what is not.
Injections can be performed without anesthesia, and furthermore, numerous products already contain a local anesthetic inside the syringe.
In cases of more painful products or more sensitive patients or areas (lips or around the mouth), we can use one of the following methods:
- EMLA cream applied in a thick layer on the targeted areas, approximately half an hour before injection, reducing pain sensations on the surface
- local anesthesia: performed by injecting an anesthetic product at the beginning of the session, being the only method that ensures complete insensitivity
- the treatment area is disinfected before injection
- injections are made using needles or microcannulas
Most of the plastic and cosmetic surgery practices are professionally done by Dr. Claudiu Filip.
Depending on the number of treated areas, the spread of improvements brought and the need for potential anesthesia, an injection session can last from 10 minutes to one hour.
Cosmetic practice mentions several injection techniques adaptable to each individual case to achieve the best results.
The treatment is often applied in several overlapping layers to achieve an optimal results. The necessary quantity of product varies very much depending on numerous parametres. After injection, the doctor will massage the treated areas very well to optimize the evenness of the correction.
In certain cases it is preferred to consider from the very beginning that a retouch session may be required a few days or weeks before discussing the final result.
When there are several areas being treated in the same session, results are:
- more visible (global rejuvenation)
- more harmonious
- the face will be more balanced throughout the injected products assimilation
The most popular and requested hyaluronic acid areas of application are:
- wrinkles, folds on the face and neck
- lips which can be redesigned, widened or augmented
- facial hollow areas lacking volumes caused by ageing
- certain moderate morphological anomalies (weak chin, insufficient projection of the cheekbones or forehead, nasal irregularities, etc.
- skin defects (post-traumatic scars, uneven and irregular subcutaneous scars)
- deformities or low volume insufficiency of the body
In the first six hours you should stay calm, rest and refrain from any intense effort. It is also preferable to avoid facial movements as much as possible (no mimicry, no large smiles, minimal talking).
For the next few days you should also avoid alcohol, aspirin, anti-inflammatory drugs and high-temperature exposure of the treated areas (sun, tanning beds, sauna). Immediately after injection, you may experience edema (swelling) and skin redness which varies depending on the product used and the individual, which usually remain moderate in intensity (you can resume your social and professional life) and will disappear in one-three days.
On the lips, the edema will be more pronounced and can last for up to one week. In a few rare situations, patients can also experience a certain degree of sensibility, puss, hypo- or hyperpigmentation of the skin or small bruises at the sites of injection.
We must mention that during the first days, there may be a few temporary, uneven distribution of the edema, hence an appearance of hypercorrection, which will progressively subside.
Final results are visible only after a few days. In this period, it is necessary for the product to be well integrated and for the edema side-effect to disappear completely, so tissues can regain their suppleness. The immediate result following the treatment is definitely not the final one.
You should know that, unlike Botox, hyaluronic acid injections do not affect the mobility of facial muscles in any way, thus do not reduce facial expressions.
Normally, treated imperfections are significantly improved through injections, but will not disappear completely. Certain areas are difficult to treat and some old and deep wrinkles cannot be removed through injection, yet they can be reduced considerably.
The purpose of these injections is to improve, not to create perfection. If your desires are realistic, the result obtained should be greatly satisfactory.
The correction is temporary, so s long as you wish to maintain these cosmetic results, follow-ups of the treatment will be necessary at variable intervals of time, depending on the area, injected product and features related to each patient.
As any other medical act, hyaluronic acid injections imply a certain number of risks and complications.
By choosing an experienced and qualified surgeon who has the injection technical knowledge, the risks of undergoing the hyaluronic acid filler injections (which are remarkably tolerable anyways) are limited.
Nevertheless, there is a certain number of side-effects that can be noticed:
- post-injection local side-effects: edema, redness, hypo-pigmentation, irregularities, sensitivity, bruises. These side-effects are temporary.
- Herpes to individuals who are prone to this virus.
- Acute or chronic inflammatory response: possible after secondary injections in an area that was previously injected with other products, especially the non-absorbable ones.
Granulomas: rare in general. This is the most common complication. These are small, hard, more or less sensitive nodules, which can be felt when touched and are sometimes visible and unaesthetic. These granulomas correspond to a local inflammatory reaction that can evolve into bursts. They can appear a few day or weeks after injection. Most of them will subside spontaneously after a few weeks.
Rare complications: redness persisting for a few weeks, abscess or skin necrosis on the site of injection.
Due to its physio-chemical qualities and incomparable tolerance, hyaluronic acid mainly a momentarily incontestable place, not only as a filler, but also as a solution for volume and hydration.
Choosing an experienced and qualified specialist will help avoid these problems, guaranteeing that in case they still appear, he/she will be able to treat them.
More information about the treatment can be found during the consultation with Dr. Filip Claudiu.