Filler – wrinkle smoothing with hyaluronic acid

Facial wrinkles are caused by the contraction of facial muscles and age-related by the loss of the inherent elasticity of the skin and the decrease of subcutaneous fat. Wrinkles caused by muscle activity can occur at a young age and can be treated effectively with Botox (crows feet, frown lines, etc.). Wrinkles caused by the loss of intrinsic elasticity of the skin, are best corrected by streamlining operations (face lift, etc.). The loss of subcutaneous fat may be offset only by the introduction of body fat or artificial fillers (“filler”).

The first artificial filler was most likely paraffin, which was already used in 1900 to correct material defects. Due to serious complications, it was discontinued. About 1950, they used animal collagen and silicone oil. In collagen, there were frequent allergic reactions (animal protein), intolerance occurred in silicone oil. Around 1990 the first Hyaluronic acid preparations were put on the market. Hyaluronic acid is a sugar molecule, found in the human body and has some important features. Hyaluronic acid binds water in the skin (1,000 times the amount of the net weight), based on a mechanically resilient, three-dimensional network between cells and collagen fibers and stimulates the formation of fibroblasts (connective tissue). The ability to retain water gives the hyaluronic acid viscoelasticity and therefore it is well suited for injection.

A functional classification of a filler is possible in the following categories:

  • “Totally degradable” (resorbable), degradation takes place within 4-6 months
  • “Delayed degradable” (delayed absorbable), degradation takes place within one year
  • “Non-degradable” (not absorbable) is not degraded by the body
  • Mixed preparations

Hyaluronic acid is one of the resorbable fillers currently available under the following product names: Hylaform, AcHyal, Belotero, Hyal2000, HylanSeS, Jolidermis, Juvéderm, Perlane, Puragen, Restylane, Revanesse, Rofilan Hylan gel and Teosyal. The absorbable collagen fillers include Resoplast, Zyderm, Zyplast, Fibrel, Permacol, Evolence, Cymetra, CosmoDerm, Cosmoplast, autologous or isologous.
The delayed absorbable fillers include Radiesse and New Fill. Among the non-absorbable fillers are Amazinggel, Aquamid, Argiform, Evolution, Outline, Bio-Alcamid, Adato Sil-ol 5000, Bioplastique, Dermage, Silicex or silicone 1000th. Mixed preparations of absorbable and nonabsorbable are Artecoll/ArteFill, Dermalive or Dermadeep.

Permanent fillers or delayed absorbable substances pose a certain risk with regard to incompatibility reactions or nodules. For this reason I only use Hyaluronic acid as an artificial filler or transplant the body’s own fat.
Fillers can be used in all areas of the face, most often they are used to plump the lips, correct nasolabial folds, correct eye rings or add padding to the zygomatic region.

If used properly, fillers are safe and side effects are uncommon, after the treatment there is neither pain nor down time. In addition, the procedure leads to significant visible improvements with minimal time and financial burden. With consistent application over the years it might be worth considering using one’s own body fat as a filler. Although using your own body fat is initially more expensive, it is cheaper in the long run because autologous fat does not need to be repeated once the desired volume has been reached.

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Dr. Turkof

FAQ
1. What are fillers?

Filling materials or “fillers” refers to gel-like substances that are injected under the skin to offset defects of the skin, the subcutaneous tissue or the fatty tissue.

2. What preparations are there and how long does the effect last?

A distinction is made between a “totally degradable” filler (absorbable, degradation takes place within 4-6 months), delayed degradable filler (delayed absorbable, degradation takes place within one year), non-degradable filler (not absorbable by the body, not degraded), and mixed preparations.

3. What advantages and disadvantages are there with the different preparations?

Absorbable preparations have the advantage of being very well tolerated and almost without complications. The disadvantage is the need to repeat the treatment every 4-6 months. Delayed absorbable, resorbable or mixing drugs, have a much longer lasting effect, but carry a certain risk with regard to incompatibility reactions or nodules. For this reason I only use hyaluronic acid as an artificial filler or transplant the body’s own fat.

4. What is hyaluronic acid?

Hyaluronic acid (HS) is found in all vertebrates in the same form. Chemically, HS is a sugar molecule. In the human body itself HS is used as a ground substance in the so-called extracellular matrix of the skin, in joints and in the eyes. The adult body contains about 15g HS, half of which is located in the skin.

5. What medications containing the active ingredient Hyaluronic acid are allowed on the market?

Hyaluronic acid is currently available under the following product names: Hylaform, AcHyal, Belotero, Hyal2000, HylanSeS, Jolidermis, Juvéderm, Perlane, Puragen, Restylane, Revanesse, Rofilan Hylan gel and Teosyal.

6. What are fillers used for?

Fillers can be used in all areas of the face. Most often they are used to enlarge the lips, correct the nasolabial folds, correct eye rings or to pad the zygomatic region.

7. Is a filler treatment painful?

The needle is very thin and the procedure is therefore relatively painless.

8. What complications can occur?

If used properly by an experienced practitioner, the use of fillers is a safe and low side effects procedure. Nevertheless, as with any medical treatment, side effects and complications cannot be ruled out. Among the non-specific side effects are swelling and bruising and tiny little scabs at injection points.

9. Can a treatment be carried out during a lunch break?

Yes, absolutely. A filler treatment takes an average of 5-10 minutes. After the treatment, the injection sites can be covered up with Make-Up.

10. When is the autologous fat transplantation preferred to artificial fillers?

If consistent application over the years is planned, it might be worth considering using one’s own body fat as a filler. Although using your own body fat is initially more expensive, it is cheaper in the long run because autologous fat does not need to be repeated once the desired volume has been reached.

Terms & Costs
First Consultation

If only one filler treatment is desired, the first consultation is free.

Treatment

I carry out a filler treatment in my private clinic. Depending on the number of areas to be corrected, treatment lasts between 5-10min. and incurs no cost apart from the fee.

Surgical fee

Depending on how many areas are treated, the fee is between EUR 350-1.200. An average filler treatment (nasolabial folds or lip augmentation) costs about EUR 350-550.

Check-ups

Check-ups are included in the surgical fee.