Contour plastic surgery, or filling: mechanism of action and methodology of carrying out

Contour plastic surgery, or filling (English: to fill - to fill), is an injection filling of skin defects and subcutaneous fat (wrinkles, folds, atrophic scars), as well as changing the contours of the face (cheekbones, cheeks, chin, nose), the shape and volume of the lips using filler preparations.

The first of the absorbable preparations, and of the filling preparations in general, were preparations based on bovine collagen. And now in cosmetology such collagen preparations as Ziderm, Ziplast, Cosmoderm are still used. However, allergic reactions to these preparations are not uncommon, and after the mad cow disease epidemic, they were generally banned for some time in some countries. But they can become a good alternative for patients with high activity of the hyaluronidase enzyme, for whom the use of hyaluronic acid preparations is ineffective.

Natural hyaluronic acid preparations synthesized from cockscombs ("Hylaform") have many advantages, but they cause allergic reactions more often than synthetic hyaluronic acid preparations. The most progressive are preparations of stabilized hyaluronic acid of synthetic origin (Restylane and its varieties, Juvederm, Surgiderm Matridex, etc.). They practically do not cause allergic reactions, do not migrate in tissues, and have a pronounced biorevitalizing effect. Preparations such as Matridex and Matridur combine hyaluronic and polylactic acid, and in addition to replenishing volume due to hyaluronic acid, they have a more pronounced biorevitalizing effect than just hyaluronic acid. In addition, another type of implant is polylactic acid (Newfill). Its mechanism of action is stimulation of collagen and elastin production. It is administered in several stages (after 2-3 weeks) and requires special precautions to prevent tissue fibrosis in the injection area and the formation of intradermal nodules. The angle of needle insertion is 45°, the drug is administered deeply and after the procedure is completed, tissue kneading at the injection site is performed quite aggressively for 10-15 minutes.

There are many preparations for filling. When choosing one of them, it should be taken into account that the safest are absorbable preparations. The first correction procedure should always be started with such preparations and, if possible, continue to use them in the future. The most progressive are preparations of stabilized hyaluronic acid of synthetic origin. If the patient insists on the introduction of non-absorbable implants, it is possible to choose between such preparations as Artecoll, Dermalife or biopolymer gel. Their use is associated with a high risk of fibrosis, and when introducing a biopolymer gel, especially with a single injection of a large volume of this preparation, its migration is even possible. Given this likelihood, serious grounds are needed for the use of permanent fillers. In case of a decision to use them, special attention should be paid to the execution of all documentation indicating that patients have been familiarized with the possible consequences of such a procedure.

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Indications and contraindications for the procedure

Filling is an optimal method for eliminating such signs of age-related changes as perioral wrinkles, deep nasolabial folds, "sorrow lines" running from the corners of the mouth to the chin, and "fatigue lines" running from the inner corners of the eyes, horizontal wrinkles on the neck. You can lift the drooping corners of the lips, make the lips more voluminous or emphasize their contour. Such signs of aging as "sunken" cheeks, "sharpened" cheekbones, changes in the lower contour of lenses, can also be corrected quite well using this method. At the same time, filling is also used in young patients. The most common reason for their appeal is the desire to change the shape or volume of the lips. Excellent preparations based on synthetic hyaluronic acid that can be used for this purpose are Restylane lipp. Surgilips.

The second most common reason for young patients to seek help is the desire to get rid of atrophic scars, in particular post-acne scars. As is known, this is a serious problem in cosmetology and even methods such as laser resurfacing or deep chemical peeling cannot fully solve it. With the help of filling, it is possible to correct them almost perfectly in one session without a long rehabilitation period. Filling can also be used to correct other cosmetic defects, such as a depression in the central part of the chin (the so-called "pit") or an irregular shape of the chin, nose (the so-called "hollow"), etc. The optimal indications for the use of non-absorbable drugs are the correction of nasolabial folds, brow folds, and lip contours.

Contraindications for filling are similar to those for mesotherapy.

Filling technique

The skin at the site of the proposed injection is treated with an antiseptic. Application anesthesia can be used. For this, a local anesthetic (Emla cream) is applied and left under the film for 5-25 minutes. In some cases, conduction anesthesia is used. Retrograde (regular, fan, cross) and point injection of the drug are used. Drugs of different viscosity from the same manufacturer can be injected at different depths one above the other (for example, Restylane Touch above Restylane). This technique is called a "sandwich". Most often, drugs are injected parallel to the skin or at an angle of 45°. The level of injection is determined by the problems the drug is intended to correct and its density, as well as whether it is an absorbable or permanent drug. For example, Restylane Fineline, or Juvederm 18, Matridur, intended for correction of superficial skin defects, are injected into the uppermost layer of the dermis, under the basement membrane (subbasally). Restylane, or Juvederm 24, Matridur are injected somewhat deeper, to the level of the middle third of the dermis, and Restylane, Perlane, or Juvederm 30, Matridex - to the level of the lower third. Non-resolving preparations are always injected deeply, into the lower third of the dermis.

After the injection, it is recommended to lightly knead the tissue in the correction area for 1-2 minutes, after which ice can be applied. When injecting fillers, preference should be given to hypocorrection and repeated injections 3-4 weeks after the first injection of the drug.

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Complications of filling and ways to eliminate them

Correct use of modern absorbable drugs does not cause serious complications. Formation of petechiae or small hematomas is possible, especially if the patient has problems with blood clotting.

It is necessary to warn about the undesirability of using anticoagulant drugs before the procedure, and also not to perform it during menstruation.

Very rarely, with a tendency to hyperpigmentation, pigment may appear in the area where the drug is injected. The risk of its occurrence is especially high with hypercorrection, i.e. excessive injection of the drug into the area being corrected.

Swelling after the procedure can be of varying degrees of severity and subsides on the second day after the filler is administered. When using conduction anesthesia, it is more noticeable. In the lip area, it can last up to seven days.

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