Contour plastic, or philling: mechanism of action and methodology

Contour plastic, or filling to fill-up is an injection filling of skin and subcutaneous fat defects (wrinkles, folds, atrophic scars), as well as changing the contours of the face (the area of cheekbones, cheeks, chin, nose), shape and the volume of the lips with the help of filler drugs.

The first of the absorbable drugs, and of the philling drugs in general, appeared drugs based on bovine collagen. And now in cosmetology still use such preparations of collagen, as ziderm, zyplast, cosmoderm. However, these preparations are often allergic reactions, and after the epidemic of mad cow, they were generally banned for some time in some countries. But they can be a good alternative in patients with high activity of the enzyme hyaluronidase, in which the use of hyaluronic acid preparations is ineffective.

Hyaluronic acid preparations of natural origin, synthesized from cock-scallops ("Hylaform"), have many advantages, but more often than preparations of synthetic hyaluronic acid give allergic reactions. The most progressive are preparations of stabilized hyaluronic acid of synthetic origin (restylane and its variants, juviderm, surdijr matridex, etc.). They practically do not cause allergic reactions, do not migrate in tissues, have a pronounced biorevitalizing effect. Such drugs as matrix and matrix combine hyaluronic and polylactic acid, and in addition to replenishing the volume with hyaluronic acid, they have a more pronounced biorevitalizing effect than just hyaluronic acid. In addition, another type of implant is polylactic acid (the drug Newfill). The mechanism of its action is stimulation of the production of collagen and elastin. It is introduced in several stages (after 2-3 weeks) and requires special precautions to prevent tissue fibrosis in the area of injection, the formation of intradermal nodules. The angle of needle insertion is 45 °, the preparation is injected deeply and after completion of the procedure, the tissues are kneaded sufficiently aggressively at the injection site for 10-15 min.

There is a large number of preparations for philling. Making a choice in favor of any of them, it should be noted that the safest are the absorbable drugs. The first procedure for correction should always begin with such drugs and in the future, if possible continue to use them. The most progressive are preparations of stabilized hyaluronic acid of synthetic origin. If the patient insists on the introduction of non-absorbable implants, there may be a choice between such drugs as artekoll, dermalife or biopolymer gel. Their use is associated with a high risk of fibrosis, and with the introduction of a biopolymer gel, especially when the large volume of this drug is instantly introduced, even its migration is possible. Given this possibility, serious grounds for the use of permanent fillers are necessary. In case of making a decision on their application, special attention should be paid to the preparation of all documentation that indicates the familiarity of patients with the possible consequences of such a procedure.

[1], [2], [3], [4],

Indications and contraindications for conduction

Filling is the optimal method for eliminating such signs of age-related changes as perioral wrinkles, deep nasolabial folds, "folds of sorrow" from the corners of the mouth to the chin, and "fatigue folds" from the inner corners of the eyes, horizontal wrinkles on the neck. You can raise the lowered corners of the lips, make the lips more bulky or emphasize their outline. Such signs of aging as "sunken" cheeks, "sharpened" cheekbones, a change in the lower contour of the lens, are also amenable to a good correction with this method. At the same time, philling is also used in young patients. The most common reason for their treatment is the desire to change the shape or volume of the lips. Fine preparations based on hyaluronic acid of synthetic origin, which can be used for this purpose, - Restylane lipp. Surgilips.

The second most frequent reason for the treatment of young patients is the desire to get rid of atrophic scars. In particular the acne scars. As you know, this is a serious problem in cosmetology, and even such methods as laser resurfacing or deep chemical pilins can not fully solve it. With the help of philling it is possible to correct them almost perfectly in one session without a long period of rehabilitation. Filling can also be used to correct other cosmetic deficiencies, for example, impressions in the central part of the chin (the so-called "pit") or the irregular shape of the chin, nose (so-called "hollow"), etc. Optimal indications for the use of non-absorbable drugs are nasolabial folds, brow creases, lip contour.

Contraindications for philling are similar to those for mesotherapy.

Filling technique

The skin at the site of the alleged injection is treated with an antiseptic. You can use an anesthetic. To do this, apply the preparation for local anesthesia (Emla cream) and leave it under the film for 5-25 minutes. In some cases, conductor anesthesia is used. Use retrograde (usual, fan, cross) and pointwise enter the drug. Different viscous preparations of one manufacturer can be introduced at different depths one above the other (for example, restylline tach over restylane). This technique is called a "sandwich". Most often, the drugs are injected parallel to the skin or at an angle of 45 °. The level of administration is determined by the fact that the preparation is intended for the correction of what problems and what density it has, and also whether it is a resorbable or permanent drug. So, for example, preparations restiline fainline, or juviderm 18, matrix, intended for correction of superficial skin defects, are introduced into the uppermost layer of the dermis, under the basement membrane (sub-basal). Restylane, or juviderm 24, the matrix is introduced somewhat deeper, to the level of the middle third of the dermis, and restylane, perlayn, or juviderm 30, and the matrix - to the level of the lower third. Hepasssyvayuschiesya drugs are always injected deeply into the lower third of the dermis

After the injection, it is recommended to softly knead the tissue in the correction zone within 1-2 minutes, after which it is possible to apply ice. When introducing fillers, preference should be given to hypocorrection and repeated injections 3-4 weeks after the first administration of the drug.

[5], [6], [7], [8]

Complications of philling and ways of their elimination

Proper use of modern absorbable drugs does not give serious complications. Perhaps the formation of petechiae or small hematomas, especially if the patient has problems with blood coagulability.

It should be warned about the undesirability of using anticoagulant drugs before the procedure, and also not to spend it during menstruation.

Very rarely, with a tendency to hyperpigmentation, the appearance of a pigment in the zone of drug administration is possible. Especially the risk of its occurrence with hypercorrection, i.e., excessive introduction of the drug into the corrected area, is increased.

Puffiness after the procedure can be of varying severity and decreases on the second day after the introduction of the filler. When using conductive anesthesia, it is more noticeable. In the area of the lips can last up to seven days.

[9], [10], [11], [12], [13]