If you want to restore youthful fullness to your face, plump your lips, improve superficial contours or smooth out facial creases and wrinkles, dermal fillers may be the answer. Dermal fillers are called “ liquid facelifts ” because they offer many of the benefits of a surgical facelift without the downtime. Although they can help with excess sagging skin, these facial fillers add volume and provide immediate results at a lower cost than surgery. These treatments are not permanent, however they can be repeated.

Some dermal fillers are used together with other rejuvenation treatments such as botulinum toxin injection. Your plastic surgeon will assess your needs and recommend treatment suited to your needs and expectations.

Dermal fillers are excellent for rejuvenating the appearance of the face, but they do not stop the aging process. If you want a permanent solution, talk to your doctor about facelifts and brow lifts.
Some people opt for a liquid facelift until a surgical facelift is more appropriate. It's a great way to see some changes and improvements in your appearance such as forehead wrinkle reduction, until you are ready for a permanent surgical option. Remember: you must undergo retreatment with dermal fillers, such as anti-wrinkle treatment, to maintain a rejuvenated appearance.

Wrinkle fillers can be divided into two categories: temporary and semi-permanent.

Temporary

Human fat, also known as autologous fat, is harvested from your own body. Using your own fat requires a more extensive procedure than other injectable filler procedures because you must first undergo liposuction to extract fat before the injection. The risk of an allergic reaction or rejection by the body is eliminated when using its own fat. It is known that not all living fat cells survive when transplanted to a new location. A fairly high rate of resorption can be expected. Therefore, your doctor will likely overwork the area to be treated. It may appear abnormal at first, but it soon regains its normal appearance and you will enjoy a new look. When the doctor extracts this fat through liposuction, it is possible that there will be more fat than necessary for one application. Fat can be stored for touch-ups.

Collagen is a natural protein substance, being the main component of cartilage, bones and teeth. It is derived from human or bovine skin (known as bovine collagen). Brands include: CosmoDerm, Cosmoplast, Zyderm, Zyplast.

Human cadaver dermis is skin grown from a cadaver and injected into your face. This substance results in impressive filling of facial depressions. Brands include: Cymetra, Dermalogen, Fascian.

Hyaluronic acid is also a natural substance found in your body.

High concentrations are found in soft connective tissue and in the fluid surrounding the eyes. It is also found in some cartilage and joint fluids, as well as in skin tissue. If the name sounds familiar, it's because the same substance is often injected into the joints of people with arthritis to relieve pain. Hyaluronic acid is not derived from animal origin. Brands include: Captique, Esthélis, Elevess, Hylaform, Juvederm, Perlane, Prevelle, Puragen and Restylane.

Calcium hydroxyapatite, the densest among facial fillers, is found naturally in human bone. This mineral compound is used to fill deeper creases such as the nasolabial fold, marionette lines and expression lines. It is also used to improve the fullness of the cheeks and other facial contours. Calcium microspheres are suspended in a water-based gel. Brands include: Radiesse, Radiance.

Polylactic acid is a synthetic material. When injected, it stimulates the body's own collagen production. This substance gives good results when applied to the lower half of the face to fill in lines caused by laughter, plump lips and fill deep nasolabial folds. This substance is different from other dermal fillers as it does not produce immediate results. Differently, it stimulates collagen production, so the results appear gradually over the months. Brands include: Sculptra, New-Fill.

Semi-Permanent

PMMA (polymethylmethacrylate) fillers contain about 20% tiny PMMA microspheres suspended in 80% purified collagen gel. This substance, considered semi-permanent, can be removed. PMMA is most often used to treat medium to deep wrinkles and folds, particularly nasolabial folds. It can also be used to fill in scars and plump up thin lips. PMMA has been used for many years in permanent surgical implants. Therefore, the surgeon will probably do minimal filler in the first treatment, adding more if necessary. Brands include: Articol, Artefill, Metacrill.

First, the surgeon will listen to you considering the results you want and will then evaluate your facial appearance and skin tone, noting the areas of your face to be augmented with dermal fillers.

Next, the surgeon will mark strategic points on your face that will serve as a guide to locate the appropriate points to apply the filler injection. 

The injection sites will be cleaned with an antibacterial agent. Then, a topical anesthetic will be used to numb the area, especially if you are sensitive to injections. In some cases the filling material includes anesthetic in the mix. 

The injections will only take a few minutes in total and just a few seconds per site. 

The marks will be washed and you will be given an ice pack to reduce any temporary discomfort. You may wear makeup at this time, however be careful not to put pressure on the treated areas as this may result in movement of the dermal filler. 

These areas often require multiple injections to obtain the desired result. If a deeper injection is necessary, local anesthetic will be used. The most common locations requiring deeper tissue filling are the nasolabial folds and marionette lines, as well as to improve cheek volume. 

There is no downtime when performing dermal filler procedures. You can resume most activities immediately. Remember not to rub the treated area so that the filling material remains intact. There will likely be some swelling or bruising, however this will disappear within a few days. If you opt for human fat as a filler, you will initially notice a “fuller” appearance. However within a few hours or, in some cases, a few days, this appearance disappears. For some people this “fuller” appearance can last for a few weeks. Fillers that are derived from non-human sources require pre-treatment allergy testing.

• Acne;
• Antibodies or rejection of the filler material may reduce the effectiveness of future injections;
• Asymmetry;
• Bleeding;
• Bruises;
• Filler containing microscopic granular substances, in particular calcium hydroxyapatite, may clump as a result of movement of the face or its natural aging process. Over time, these clumps can turn into lumps or nodules. Surgery removes the lumps;
• Infection at the injection site;
• Itch;
• Migration of filling material away from the original location;
• Necrosis (death of the skin);
• Redness;
• Rash;
• Skin sensitivity;
• Swelling;
• Temporary numbness;
• Temporary paralysis of facial muscles;
• Under or over correction of wrinkles.

It is important to know that dermal fillers are not permanent. Even the semi-permanent category eventually requires retreatment. The way your face ages and absorbs filler will determine how long it takes to undergo a new procedure. If you decide not to undergo further treatment, your appearance will return to its original condition. Wrinkles and scars will return and lips will lose volume. 

Injectable dermal fillers can increase the volume of thin lips, improve superficial contours, smooth facial wrinkles, eliminate wrinkles, and improve the appearance of scars. 

Cost is always a consideration in elective procedures. Prices can vary greatly depending on the procedure to be performed and the professional's experience. 

• Surgeon's fees;
• Anesthetist's fees;
• Medicine recipes.

Be sure to ask your doctor about all costs involved in the procedure.

When choosing a plastic surgeon to perform this procedure, remember that the surgeon's experience and your good relationship with him or her are as important as the final cost of the surgery. 

• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• Is the installation of the procedure room in your office authorized by the Health Surveillance?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure or treatment be carried out?
• What are the risks and possible complications associated with my procedure?
• What results are expected for me?