One of the most important factors in making our face look old is the loss of volume over the years. For this reason, filler injections have a very important place among the procedures applied for facial rejuvenation.
What are the effects of facial aging?
During the facial aging process, along with the volume loss observed in both facial bones and soft tissues, displacements occur in the direction of gravity, especially in the subcutaneous fat tissues.
Likewise, over the years, the lines on the facial skin resulting from the work of the mimic muscles gradually deepen and the damage caused by sunlight becomes especially evident. In the subcutaneous tissues, elasticity decreases due to the decrease in collagen and the deterioration of its structure, and the skin becomes thinner and looser. As a result, as we age, the total effect of the changes that occur in different layers of the face, such as the skin, subcutaneous tissues and facial bones, causes external signs of aging.
While the three-dimensional structure of the face, which is fuller in youth, reflects the light smoothly, with aging, changes in light reflections due to volume losses in different parts of the face and shadows that begin to stand out in some areas when looking at the face, cause the visual perception of old age.
These volume losses, which occur in the bones and mostly in the subcutaneous fat tissues, manifest themselves as a collapse in the temples, a gap around the eyes, a hollowing under the eyes, especially in the tear trough area, a drop in the eyebrows, a decrease in the prominence of the cheekbones, a collapse in the cheeks, a deepening of the lines on the sides of the nose, a drop in the corners of the lips, a drop in the lips. It manifests itself as thinning and fading, a collapse between the edges of the lips and the jawline, and a decrease in the prominence of the jawline.
All these changes, which are observed in different ways in different regions from person to person, also lead to a deterioration in the harmony between the upper middle and lower facial proportions that creates the perception of beauty.
In Which Areas Are Facial Filling Injections Applied?
While facial filler injections were mostly applied in previous years to plump the lips or to eliminate wrinkles that occur due to aging on the skin and deepening lines at the corners of the nose and mouth, in recent years, as the importance of volume losses in the aged face appearance and the anatomical dynamics of facial aging have become better understood, applications have been made to replace volume losses. has become more prominent.
Facial areas where filler injections are made to increase volume.
- Temple area
- Mid-face deep and superficial fat compartments
- Tear trough
- Orbitomalar groove extending from the outer lower part of the eye to the cheek
- Nasolabial lines on both sides of the nose
- These are marionette lines extending from the corner of the lips to the jaw line.
Nowadays, facial filler applications are used not only to replace volume losses but also to replace them.
- Shaping the forehead
- Elimination of vertical lines between eyebrows
- Lifting eyebrows
- Highlighting the cheekbones
- Shaping the nose
- Shaping of lips
- Lifting the corners of the lips
- Clarifying the jaw line
- Highlighting the corner of the chin
- Enlargement of small chin tips
- Elimination of superficial lines in different areas of the face
- It can be used to improve skin structure.
How is Nose Filling Done?
Rhinoplasty surgeries are among the most frequently performed aesthetic surgical interventions today. Although there is generally no option other than surgery to eliminate very obvious aesthetic problems in the nose, hyaluronic acid-containing filler injections can be an alternative to surgical interventions in eliminating not very noticeable nasal arches, concavities at the root of the nose, slight nose tip drooping and some irregularities that occur especially after previous nose aesthetic surgeries.
With nasal filling, which is a procedure that requires extreme care because the nasal anatomy contains many blood vessels, very good results can be achieved in a very short time, such as five to ten minutes, provided that appropriate techniques and filling materials are used.
Since the nose is generally an inactive area, the permanence of the fillers is longer than the applications in other parts of the face.
What to Pay Attention to in Facial Filler Injections?
In order to obtain successful results in facial filler applications, it is necessary to evaluate the current problems of the patients in a very good and detailed manner, and to understand their complaints and expectations accurately and to provide appropriate guidance when necessary.
Applications performed on some parts of the face may also affect neighboring anatomical areas. Increasing the volume of deep fat deposits in the mid-face area
It can reduce the problems in the adjacent tear trough area or the nasolabial folds next to the nose, and likewise, the volume increase in the cheekbones can reduce skin sagging in the lower jaw line. For this reason, it is better to evaluate the mid-face area before applying light filling to the tear trough and if there is a significant volume loss in this area, it is better to recommend that the problem in the mid-face area be corrected first or to evaluate the condition of the cheekbone before intervening in the lower jaw line and, if necessary, to apply it to this area first. approach.
Is There a Difference Between Filling Applications for Women and Men?
In women, the forehead is more curved, the cheekbones are more protruding, the facial features are rounder and the jawbone is generally weaker, whereas in men the forehead is flatter, the cheekbones are less protruding but wider, the facial features are generally more angular and the lower jaw is stronger.
During facial filler applications, it is necessary to pay attention to these differences in order not to give a feminine appearance to male patients and a masculine appearance to female patients, especially if not requested.
What Filling Materials Are Used on the Face?
Although there are different materials used for facial filler applications, the most preferred ones are Hyaluronic Acid, the patient's own fat tissue and Calcium Hydroxyapatite.
What is Hyaluronic Acid?
Hyaluronic Acid, which is also found in the structure of collagen in the skin, is today produced synthetically under laboratory conditions and in forms containing different cross-links between molecules. This diversity allows the use of different forms of Hyaluronic Acid according to the application purpose and the characteristics of the application areas.
For example, forms with a hard structure and strong bonds are preferred to increase volume in deep fat areas in the mid-face region, while forms that are soft and do not contain strong bonds are preferred in the tear trough, and forms that adapt to movement are preferred in superficial and mobile areas.
Hyaluronic acid forms, which have high water retention properties, are generally preferred to improve skin quality by moisturizing the skin in the areas where it is applied.
The most important advantages of Hyaluronic Acid fillers are that operating room conditions and anesthesia are not required for the applications, and the fillers are available at any time in the desired amount and content.
What should be taken into consideration before face filler application?
In healthy individuals who do not use blood thinners, no preliminary preparation or testing is required before Hyaluronic Acid injection.
Unlike neurotoxin applications, the effect of filler injections appears as soon as the application is made. For fillers with high water retention properties, the final result becomes apparent w How Long Does the Effect of Hyaluronic Acid Fillers Last?
Since the applied Hyaluronic Acid is absorbed by the body over time, the effect achieved varies between 8 and 12 months depending on the application area, the cross-link structure of the filler used and the tissue characteristics of the patient.
The permanence of fillers applied, especially in immobile areas such as the nose, can last up to 2-3 years.
Are Filling Applications Painful?
Although needle filler applications generally do not cause significant pain or discomfort, regional anesthesia can be applied before injections, especially in the lips, which are very sensitive.
In applications performed with a cannula, applying anesthesia to the cannula entry points increases the comfort of the procedure.
Some Hyaluronic Acid preparations contain local anesthetic medication. In fillings made with these preparations, no pain is felt in the application area after the first injection.
For patients with a low pain threshold, anesthesia can be applied with a cream on the skin before the procedure. Stimulating the skin with a vibrating device near the procedure area can also reduce the feeling of pain.
Are There Any Dangers in Filling Applications?
Some undesirable situations, which we call complications, may occur during and after Hyaluronic Acid filling applications.
The most important of these are infection, late-stage tissue reactions called granulomas, asymmetry or swelling due to incorrect or excessive application, and circulatory disorders due to intravenous filling application.
within a few weeks.
As long as appropriate skin disinfection is observed before the procedure, infection is an extremely rare condition and can usually be easily controlled with antibiotic treatments.
Likewise, as long as quality filling materials are used, granuloma formation is extremely rare. Granulomas, which are observed as hard sensitive masses under the skin in the application areas, form at a later stage than the infection. Antibiotics and corticosteroids are used in the treatment of granulomas, and in some cases they may need to be removed surgically.
While asymmetrical applications can generally be easily corrected with additional filler applications, in cases where more filler is injected than necessary, the problem can be corrected by injecting Hyaluronidase enzyme, which dissolves Hyaluronic Acid, into the application area.
Vascular occlusions and circulatory disorders resulting from the application of filler into the vein are the most serious and important complications of filler injections. Especially since the veins in the upper face area are connected to the veins feeding the eye, filler injections made under pressure into the veins in this area can reach the veins leading to the eye and even cause blindness.
Although the risk of intravenous penetration during facial filler injections is in many areas, the highest risk areas are the glabella region and the nose, where there are many veins in both superficial and deep planes.
In order to avoid this complication, it is necessary to know the locations of important vessels in the facial anatomy and their depth in the application areas, to perform the applications in risky areas with a cannula instead of a needle, to perform the applications very slowly and in small doses, and to always have the medicines and materials required for intervention on hand in case of a problem.
What is Fat Injection?
Another preferred material for facial filler applications is the patient's own fat tissue.
In this application, after fat is obtained from the lower part of the skin in areas such as the outer parts of the legs, hips and around the belly, it is processed through various processes and injected into areas with volume loss on the face.
The most important advantages of this method are that fat can be removed in large quantities, it is partially permanent in the areas where it is applied, and it increases the tissue quality in the application areas thanks to the stem cells it contains.
Considering the cost of using very high volumes of hyaluronic acid, especially in patients with severe and widespread facial volume loss, fat injection may be a more economical solution.
The fact that fat injection can be applied during different surgical procedures in the facial area provides an additional advantage in terms of cost.
The most important disadvantages of this technique are that since it requires a surgical procedure, it must be performed under operating room conditions, it may require general anesthesia, procedure-related tissue damage may occur in the areas where the fat is removed, and it is necessary to inject more than the amount needed at the first time, anticipating the volume loss that will occur in the applied fat over time.
What is Calcium Hydroxyapatite?
Calcium Hydroxyapatite, another frequently used filler, consists of microscopic spheres and is suspended in sodium carboxymethylcellulose gel.
Fillers containing Calcium Hydroxyapatite can be applied deeply on the bone to provide skeletal support or superficially under the skin to improve skin quality.
The most important advantages of this filling material, which is mixed with local anesthetics and injected due to its painful application, are that it stimulates collagen and elastin synthesis in the application area, its effect is reversible when necessary, and its long effect duration exceeds one year.
