Top New York plastic surgeon Dr. Darrick Antell
is board certified in plastic surgery, emphasizing
aesthetic / cosmetic surgery. One of the plastic
surgery procedures he performs is collagen or
fat injections.
Soft-tissue fillers can help fill in lines and
creases, temporarily restoring a more youthful-looking
appearance. If you are considering soft-tissue fillers,
this section will give you a basic understanding
of the procedure.
To view more information about collagen and fat
injections, please click on one of the links below.
If you're
considering collagen or fat injections...
As we age, our faces begin to show the effects
of gravity, sun exposure and years of facial muscle
movement, such as smiling, chewing and squinting.
The underlying tissues that keep our skin looking
youthful and plumped up begin to break down, often
leaving laugh lines, smile lines, crow's feet or
facial creases over the areas where this muscle
movement occurs.
Soft-tissue fillers, most commonly injectable collagen
or fat, can help fill in these lines and creases,
temporarily restoring a smoother, more youthful
— looking appearance. When injected beneath
the skin, these fillers plump up creased and sunken
areas of the face. They can also add fullness to
the lips and cheeks. Injectable fillers may be used
alone or in conjunction with a resurfacing procedure,
such as a laser treatment, or a recontouring procedure,
such as a facelift.
If you're considering a facial-rejuvenation treatment
with collagen or fat, this brochure will give you
a basic understanding of the procedure — when
injectables can help, how the procedure is performed,
and what results you can expect. It may not answer
all of your questions, since a lot depends on your
individual circumstances. Please ask your doctor
if there is anything about the procedure you don't
understand.
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Knowing
your options with collagen or fat injections
Injected collagen and fat are primarily used to
improve the appearance of the skin's texture. They
can help fill out deep facial wrinkles, creases
and furrows, "sunken" cheeks, skin depressions and
some types of scars. They can also be used to add
a fuller, more sensuous look to the lips.
Injectables are usually not sufficient for severe
surface wrinkles on the face, such as multiple vertical
"lipstick lines" that sometimes form around the
mouth. Instead, your plastic surgeon may suggest
a resurfacing technique, such as chemical peel,
dermabrasion or laser treatments. Rather than filling
in facial lines, resurfacing methods strip away
the outer layers of the skin to produce a smoother
appearance.
Deep folds in the face or brow caused by overactive
muscles or by loose skin may be more effectively
treated with cosmetic surgery, such as a facelift
or browlift. Injectables are sometimes used in conjunction
with facial surgery procedures; however, injectables
alone cannot change facial contour the way surgery
can.
Keep in mind that a plastic surgeon is a specialist
that can offer you the full gamut of the most advanced
treatments ranging from cosmetic surgery, refinishing
techniques, laser therapy, injectables and the use
of other fillers. You and your surgeon may determine
that a single procedure or a combination of procedures
is the best choice for you.
ASPS brochures are available on chemical peel,
dermabrasion, laser treatments, facelift and browlift.
If you and your doctor think that one of these other
procedures might be more appropriate for you, ask
your plastic surgeon to provide you with a copy.
Injectable collagen or fat can help
improve the skin's texture by filling
in the laugh lines and facial creases
that often occur with aging.
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A word
about other types of fillers
This brochure deals with the two most commonly
used types of injectable fillers, collagen and fat.
However, to a lesser extent, a number of other filler
materials are also being used for facial-rejuvenation
purposes. They include: Fibril, a gelatin powder
compound that's mixed with a patient's own blood
and is injected to plump up the skin (similar to
injectable collagen); and Gortex, a thread-like
material that is implanted beneath the skin to add
soft-tissue support.
Each of these options has its own set of risks
and benefits. If you're considering any of these
alternative filler treatments, tell your doctor.
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What to
expect from treatment from collagen and fat injections
The most important fact to remember about injectable
fillers is that the results are not permanent. Injected
material is eventually metabolized by the body.
You should not expect the same long-lasting results
that may be gained from cosmetic surgery.
In some individuals, the results may last only
a few weeks; in others, the results may be maintained
indefinitely. Researchers believe that age, genetic
background, skin quality and lifestyle as well as
the injected body site may all play a role in the
injected material's "staying power." However, the
precise reason for the variation of results among
patients has yet to be identified.
If you've had short-lived results from fat injections,
you shouldn't necessarily assume that collagen injections
will work better for you. And, conversely, if you've
had disappointing results from collagen, don't assume
that injected fat is the answer. Although it's true
that some individuals' bodies are more receptive
to one substance than the other, others may find
that neither substance produces long-lasting results.
Sometimes one substance may work better than the
other for a specific problem.
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Risks related
to collagen and fat injections
When injectables are administered by a qualified
plastic surgeon, complications are infrequent and
usually minor in nature. Still, individuals vary
greatly in their anatomy, their physical reactions
and their healing abilities. The outcome of treatment
with injectables is never completely predictable.
Collagen: Allergic reaction is the
primary risk of collagen. To help determine if you
are allergic to the substance, your surgeon will
perform an allergy skin test about a month before
the procedure. After the test is performed, the
test site should be watched carefully for three
or four weeks, or as long as your surgeon advises.
Any sign of redness, itching, swelling or other
occurrences at the test site should be reported
to your surgeon.
Risks not necessarily related to allergies include
infection, abscesses, open sores, skin peeling,
scarring and lumpiness, which may persist over the
treated area. Reports of these problems are very
rare.
Fat: Allergic reaction is not a factor
for fat because it's harvested from a patient's
own body. However, there is still a small risk of
infection and other infrequent complications.
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Planning
for collagen or fat injections
Facial rejuvenation is very individualized. That's
why it's important to discuss your hopes and expectations
with a board-certified plastic surgeon who has experience
with many different types of surgical and non-surgical
facial procedures.
In your initial consultation, your plastic surgeon
will evaluate your face — the skin, the muscles
and the underlying bone — and discuss your
goals for the surgery. Your doctor will help you
select a treatment option based on your goals and
concerns, your anatomy and your lifestyle.
Your surgeon will ask you about your medical history,
drug allergies, and check for conditions that could
cause problems, such as active skin infections or
non-healed sores from injuries. Collagen injections
are generally off limits for pregnant women, individuals
who are allergic to beef or bovine products, patients
who suffer from autoimmune diseases, and those who
are allergic to lidocaine (the anesthetic agent
contained in the syringe with the collagen material).
For more specific information about the contraindications
and risks of collagen use, ask your doctor for the
manufacturer's brochure for patients.
Insurance usually doesn't cover cosmetic procedures.
However, if your injectable treatment is being performed
to treat a scar or indentation from an accident
or injury, you may be reimbursed for a portion of
the cost. Check with your insurance carrier to be
sure.
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Where
your collagen or fat injections will be performed
Injectables are usually administered in a surgeon's
office-based facility. If, however, you are being
hospitalized for a facelift, necklift, browlift,
or any other procedure, your injections may be administered
in the hospital as well.
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Types of
anesthesia for collagen and fat injections
Collagen: Because the anesthetic
agent lidocaine is mixed in with collagen, additional
anesthetic is usually not used. However, if you
are especially sensitive to pain, your doctor may
use a topical cream anesthetic or a freon spray
to numb the injected area. Or, you may elect to
have an injected local anesthetic or sedative drugs.
Fat: Both the donor and recipient
sites are numbed with local anesthesia. Sedation
can be used as well. If you elect to use sedation,
be sure to arrange for a ride home after your treatment.
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The collagen
and fat injection treatments
Collagen
Collagen is a naturally occurring protein that
provides support to various parts of the human body:
the skin, the joints, the bones and the ligaments.
Injectable collagen, patented by the Collagen Corporation
under the trade names Zyderm and Zyplast, is derived
from purified bovine collagen. The purification
process creates a product similar to human collagen.
Injectable collagen received approval from the Food
and Drug Administration in 1981. It is produced
in various thicknesses to meet individual patient
needs.
Collagen is used primarily to fill wrinkles, lines
and scars on the face and sometimes the neck, back
and chest.
The procedure: Treatment with collagen
can begin after a skin test determines that you're
not allergic to the subsstance. The collagen is
injected using a fine needle inserted at several
points along the edge of the treatment site. If
a local anesthesia has not been used, you may feel
some minor stinging or burning as the injections
are administered.
Years of squinting and other facial
muscle movements can take their toll
on the eye area, leaving crow's feet
and other noticeable lines.
Since part of the substance is salt water that
will be absorbed by the body within a few days,
your doctor will slightly overfill the area. You
may be asked to hold a hand mirror during the procedure
to help your doctor decide when you've had enough.
After treatment:Immediately following
treatment, you may notice some minor discomfort,
stinging or throbbing in the injected area. Occasionally
some bruising or swelling will occur, but it is
usually minor. Any redness that appears in the injected
site usually disappears within 24 hours. However,
in some individuals, particularly fair-skinned patients,
this redness may persist for a week or more. Tiny
scabs may also form over the needle-stick areas;
these generally heal quickly.
No bandaging is needed and you are free to eat,
drink, and wear makeup with sunblock protection
shortly thereafter. There may be some temporary
swelling and redness in the treated area which should
dissipate within a few days. If these symptoms persist,
contact your surgeon.
After treatment, the skin around the eye
area appears smoother and more taut.
Results: As stated earlier, the
duration of results from collagen injections is
variable. Collagen's longevity depends on the patient's
lifestyle and physical characteristics as well as
the part of the body treated. In general, the injected
material is likely to disappear faster in areas
that are more affected by muscle movement.
Your doctor can help you determine how long you
can go between treatments to best maintain your
results.
Fatcal world, the fat-injection procedure
is known as autologous fat transplantation or
microlipoinjection. It involves extracting fat
cells from the patient's abdomen, thighs, buttocks
or elsewhere and reinjecting them beneath the facial
skin. Fat is most often used to fill in "sunken"
cheeks or laugh lines between the nose and mouth,
to correct skin depressions or indentations, to
minimize forehead wrinkles and to enhance the lips.
The procedure:
After both the donor and recipient sites are cleansed
and treated with a local anesthesia, the fat is
withdrawn using a syringe with a large-bore needle
or a cannula (the same instrument used in liposuction)
attached to a suction device. The fat is then prepared
and injected into the recipient site with a needle.
Sometimes an adhesive bandage is applied over the
injection site.
Lines and creases that form around the
mouth are usually caused by gravity
and a breakdown of tissues beneath
the skin.
As with collagen, "overfilling" is necessary to
allow for fat absorption in the weeks following
treatment. When fat is used to fill sunken cheeks
or to correct areas on the face other than lines,
this overcorrection of newly injected fat may temporarily
make the face appear abnormally puffed out or swollen.
After treatment: If a larger area
was treated, you may be advised to curtail your
activity for a brief time. However, many patients
are able to resume normal activity immediately.
You can expect some swelling, bruising or redness
in both the donor and recipient sites. The severity
of these symptoms depends upon the size and location
of the treated area. You should stay out of the
sun until the redness and bruising subsides - usually
about 48 hours. In the meantime, you may use makeup
with sunblock protection to help conceal your condition.
The swelling and puffiness in the recipient site
may last several weeks, especially if a large area
was filled.
The lower face appears firmer and
smoother after treatment with injectables.
Lines around the mouth are filled in and
nearly imperceptible.
Results: The duration of the fat
injections varies significantly from patient to
patient. Though some patients have reported results
lasting a year or more, the majority of patients
find that at least half of the injected fullness
disappears within 3-6 months. Therefore, repeated
injections may be necessary. Your doctor will advise
you on how to maintain your results with repeat
treatments.
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Your new
look after collagen or fat injections
If you're like most patients, you'll be very satisfied
with the results of your injectable treatments.
You may be surprised at the pleasing results that
can be gained from this procedure.
With regular follow-up treatments,
your refreshed look can be easily
maintained.
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© Copyright American Society of Plastic Surgeons
If you would like to contact New York plastic surgeon
Darrick Antell, or if have any further questions
about collagen injections or any of our cosmetic
surgery procedures, please use our contact
form.
Phone: (212) 988-4040
