Filler Injectable:

Dr. Sanjay Parashar is an expert in Filler injectables and has been practicing this art since 1998. He has conducted several workshops and training courses for Teosyal, Juvederm, Allergan and various other fillers. He has conducted courses for Kaya clinics, Association of Plastic Surgeons of India, ICAAM, DCAAM etc.

Injectables fillers are used to correct deep wrinkles, folds, furrows and enhance cheeks, lips and chin.

Fillers are gel like material and are of two tyoes-

  1. Permanent Fillers
  2. Semipermanent and Temporary fillers

Permanent fillers: such as Polyacrylamide gel, hydrogel are condemned in my opinion. They have a high risk of complications.  They can be used sparing only for deep and small defects such as scalp and forehead defects. Other areas such as face, breast and buttocks it should not be used. As I have seen many patients suffering from debilitating conditions like infection, abscess, sinuses, lumpy scars etc.

Temproray fillers: are based on Hyaluronic acid and are the safest fillers. Most popular brand of fillers include Restylane, perlane, Juvederm, Teosyal etc. Each brand has specific dosage of hyaluronic acid in cross linked and non crosslinked forms. Thinner gel containing 15-18 mg of Hyaluronic acid is used for superficial and fine lines. Thicker gel containing 24 mg of Hyaluronic acid is for deep lines and volume enhancement. Crosslinked Hyaluronic acid increases the longevity of the fillers.

Types of Dermal Fillers

  1. Restylane, Restylane Perlane,  restylane Vital, Restylane SubQ
    It is one of the most popular filler material that everybody is aware of. It was originated in 1996. Recently they have added Lidocaine to make it painless.
    It contains non animal stabilised hyaluronic acid (NASHA) gel.Where can it be used?
    It can be used for fine lines and wrinkles, lip enhancement, cheek enhancement.
    Vital is used as mesotherapy to hydrate the skin of face, décolleté and hands.

    How long does it last?
    It can last from 3-9 months. SubQ tends to stay longer and has been reported to last for a year.

    What are the side effects?
    Mild transient redness, swelling and lumpiness can occur but is very rare in expert hands.

  2. Juverderm fillers, Juvederm Ultra, Voluma
    Juvéderm® ULTRA is cohesive, 3D hyaluronic acid matrix dermal filler with local anaesthetic, manufactured by Allergan; the makers of Botox® .It was popularized in 2008.

    Where is Juvederm used?
    Juvederm like any other filler can be used for wrinkles, lines and folds

    Advanced use includes-

    • Eyebrow lift
    • Cheek and jaw enhancement
    • Perioral lines
    • Chin enhancement
    • Scar reduction
    • Neck, décolletage and hand rejuvenation

    How long does it last?
    Although it is a temporary filler and is broken down within 6-9 months, clinical experience shows the after few sessions of filler it can stimulate collagen formation and have a longer lasting result.

  3. Teosyal range of Fillers
    The Teosyal® range is manufactured in Switzerland by Teoxane Laboratories. It consists of monophasic hyaluronic acid products of non-animal origin.The main advantage is that it has high hydrating capacity and can absorb water and is visco-elastic that helps to maintain the skins elasticity.

    It was launched in 2005.

    Teosyal First Lines
    20mg/ml of hyaluronic acid.
    It is injected into the surperficial dermis and is recommended for the treatment of fine lines and superficial wrinkles (such as crow`s feet).

    Teosyal Deep Lines
    25mg/ml of HA,
    It is used to correct deep lines, nasolabial folds, lip augmentation etc

    Teosyal Ultra Deep
    25mg/ml of HA
    It is longer lasting and has more hydrophilic property.
    It is used for deep lines, cheek, chin enlargement.

    Teosyal (Puresense) Redensity II Eyes
    15mg/ml of HA with a “dermo-restructuring complex” of 8 amino acids, 3 antioxidants, vitamins and minerals with lidocaine,
    It is specifically used for under eye treatment.

    Semipermanent fillers

    Radiesse™ is made up of synthetic Calcium Hydroxylapatite (CaHA) microspheres suspended in a gel carrier, which contains sodiumcarboxymethylcellulose, glycerin and high purity water.

    It can last upto 2 years and works by forming a scaffold that helps in building neo collagen. It is approved by FDA for correction of deep lines and nasolabial folds.

    This is a new filler material that combines the benefits of both immediate correction of wrinkles and folds as well as stimulating the generation of the body’s own natural collagen for longer-lasting results.

    It is made up of polycaprolactone (PCL) which has a long and proven safety history.

    Procedure for Botox and Filler

    Patient assessment
    It is important to assess the patient, understand the concerns and clinically correlate the need for such treatment.
    Detail medical history is elucidated to rule out medical conditions, allergies and bleeding tendencies.
    Detail education is important so patient understands it thoroughly. This is important as it is an ongoing treatment.

    Patient preparation
    – Documentation and consent
    – Antiseptic preparation
    – Topical anaesthetic application
    – Ice packs if required
    – Local anaesthesia is given for some fillers in sensitive areas such as lips.

    Injection technique
    Patient is seated comfortably and with adequate light and magnification the procedure is diligently carried out.
    Botox is reconstituted and after proper dose estimation, it is injected with a tiny needle in strategic spots.
    Filler comes in prefilled syringes. It can be injected using needles or blunt cannula. Blunt cannula is less painful, less traumatic and has less risk of bruising.

    After Injection care
    – Ice packs
    – Patient is instructed to avoid massage to areas of botox treatment.
    – Filler areas can be gently massaged
    – Refrain from exercise for 24 hours

    Followup care
    Follow up care is very important. Patient returns back in 7-10 days time for evaluation of result and patient satisfaction. A top up dose may be required to improve the result.