On a young face, there are 5 separate interrelated fat pad compartments that support the subcutaneous tissue. While these fat pads provide support from below to make the skin look tighter, they also protect the tissues from trauma.
As age progresses, both loss of these fat pads and wear on the bone structures occur, due to the effect of gravity. Sagging skin is observed. These saggings appear as folds that occur especially in the middle face towards the line on the side of the nose (nasolabial area) and on the sides of the chin area (jaw line).
These saggings are also called bulging. . As a result, it causes hollowing in the nasolabial area and cheeks, and a decrease in the prominence of the malar protrusion (mid-facial bone).
On the other hand, it causes elongation in the lower eyelid and the orbicularis muscle (eye muscle) becomes more prominent here. It causes tear trough deformity and V-shaped deformation on the cheekbone (zygoma).
As a result, the balance between concave and convexity in the middle of the face. It deteriorates.
FILLERS:
As the name suggests, fillers are used to add volume to the tissue to which they are applied. Cheek and chin plumping, correction of tear troughs, removal of fine lines and deep wrinkles, rhinoplasty, reshaping of the middle part of the face, lip plumping, rejuvenation of the back of the hands and décolleté area, volumizing the chest and hip areas, skin sagging. It is used in facial asymmetries by correcting scars.
Fillers, with their contents, have either a volume effect on the tissue they are applied to, a biostimulant effect that will stimulate the production of new collagen in the skin, or both.
An ideal filling; It must be reliable, effective and easy to apply. It should be preserved for a long time under appropriate storage conditions and remain safely in the tissue to which it is applied for a long time. What is meant by its effectiveness is that it should be able to provide the desired volume in the tissue to which it is applied. What is meant by safe filler is that the filler is not allergic or carcinogenic. It must not be teratogenic and must not migrate into the tissue to which it is applied. The filler must be compatible with the tissue and must not cause a systemic and permanent reaction in the body after application. Unwanted side effects should be minimal and short-term.
The filler products used must be FDA, TÜV, CE and Ministry of Health approved products.
Fillers should be applied by a specialist doctor who is experienced in their applications.
After the application, the patient is given a note containing the application areas, the filler used, the LOT and barcode of the filler, and early and late side effects after application. An epicrisis must be given. This is extremely important before repeating the filling in the same area or before laser, aesthetic, surgical and similar applications.
The fillers used today can remain in the application area for a long time. It is natural for these fillers to appear in imaging methods such as MRI, PET, US or CT performed in the application area due to other health problems of the patient. It is extremely important for the radiologist to know this during the evaluation. Filling application epicrisis is extremely important in order to prevent diagnostic or incorrect evaluations.
The visibility of the filler containing calcium hydroxyapatite on the PET scan may lead to incorrect diagnoses.
As the applicability of fillers increases, complications and side effects also increase.
Today, many fillers with approved applicability are used. When fillers are applied to the tissue, they may remain in the tissue or be broken down by the tissue. This is called the biodegradability of the filler. Fillers according to their biodegradable abilities;
Biodegradable fillers; Biodegradable fillers such as collagen and hyaluronic acid (HA);
Among the biodegradable fillers such as polyacrylamide, polymethylmethacrylate (PMMA) and silicone, hyaluronic acid fillers are the most widely used ones in the world today.
Hyaluronic acids, although acid is mentioned in the name, are actually derived from sugar, are found naturally in human skin and are reused. It is a polymer consisting of carbohydrate units. It acts as a mortar in the skin tissue, balancing the moisture content of the skin, and also plays a role in communication between neighboring structures. Its ability to balance moisture content is due to its chemical structure, which means it is largely soluble in water. With this feature, this molecule, which has the capacity to hold water up to 1000 times its molecular weight, supports the tissues by creating a clear liquid with a gel-like consistency between the tissues.
The cross-linking rate in its molecular structures depends on the concentration and particle size. Accordingly, biodegradability rates decrease, thus providing effectiveness in the tissue for up to 6-18 months.
When hyaluronic acids are applied to tissues, they create both a cohesive (adhesive) and elastic tissue with its homogeneous network structure. . These abilities are shown by the elastic modulus G' and cohesiveness index Ns. Cohesiveness shows the filling ability of the filler, and elastic modulus shows the 'lift' effect of stretching the tissues.
In addition, the concentration and particle size of hyaluronic acid; It shows its volumizing ability, the cross-link between hyaluronic acid molecules viscosity, elasticity and hyaluronidase resistance that provides its destruction in the tissue (this determines the residence time in the tissue). It is important whether the filler contains lidocaine or not. In addition, its molecular 3D structure shows its shaping ability when applied to the tissue.
While hyaluronic acids are being developed today, their ability to stay in the tissues longer and give more fullness to the tissues is increased with their more cross-linked molecular structures. is targeted. However, with these properties, it may cause more undesirable complications and side effects in the applied tissue.
With the Hyaluronic acid-containing fillers, which are the most used today, both in areas such as face, neck, décolleté and back of the hands. Procedures to increase skin quality and increase volume can be easily applied.
Will I feel pain during the filling?
Local treatment is applied beforehand, depending on the area to be applied. Anesthetic creams or injection anesthesia are used. Therefore, the feeling of pain is very, very low.
A month is applied to each area. Can this product be used?
No. Hyaluronic acid-containing fillers increase in hardness from thinner to thicker depending on the cross-link they contain. Thin fillings retain more water, while thick fillings create more volume effect. Fillers of different thicknesses are used for each region and application. As the fillings become thicker, that is, their hardness increases, they are placed deeper, while thinner fillings are applied more surface.
Is the application called youth vaccination also a filling application?
No. The application called youth vaccine also contains hyaluronic acid, but it is in liquid form, not in gel consistency. This application is actually a mesotherapy application. Instead of its plumping effect, hyaluronic acid's water retention and skin renewal properties are used. It is a procedure applied in a total of 3 sessions, 2-3 weeks apart.
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