DERMAL FILLERS, HYALURONIC ACID

Nowadays, acts of cosmetic medicine are increasingly performed, and the demand for hyaluronic acid injections is increasing the same way. The products used have greatly evolved and they have become extremely reliable, without inconveniences. These products, whose fluidity can resemble gel, will help to restore the volume to certain areas of the patient’s face or to fill the wrinkles or the folds.

The filler injection can be done alone or in combination with another cosmetic medicine such as botox, or a resurfacing (Peeling, laser, dermabrasion). Also, it can be used to maintain the result of a surgical procedure such as a facelift or a facial lipostructuring.

An injection of hyaluronic acid allows to quickly and easily correct the first signs of face aging or certain unsightly elements in younger patients.

An injection of hyaluronic acid makes it possible to correct:

– Folds: the most frequent are the nasolabial fold wrinkles (they start from the sides of the nostrils and end at the corners of the lips) and the marionette lines (which originate from the corners of the lips) lowering the corners of the lips, giving a sad appearance to the mouth.

– Wrinkles and fine lines: on the forehead, between the eyebrows (called frown lines), crow’s feet wrinkles, near the lips (Figure 1).

Figure 1: Filling of the wrinkles and folds

– Lips: To reduce the vertical lines, draw the contour of the lips (mouth frown), or make them slightly larger if they are too thin (Figure 2).

Figure 2: Lips correction

– Digging of the face or lack of volume: hollow cheeks, tear troughs, cheekbones … (Figure 3).

Figure 3: Filling with volumator hyaluronic acid

Fillers injections products such as hyaluronic acid will alleviate these impediments without completely suppressing them. The duration of the correction varies from 8 to 12 months, according to the products. To maintain the result, the injection must be renewed every 6 months or every year, because Dr. Jean-Charles BAYOL uses products that completely resorb but offer a total safety.

Other defects may exist such as a sagging tissue (responsible for the appearance of jowls) or an excess of skin (around the eyelids). They can only be treated with cosmetic surgery (facelift) or blepharoplasty. The anomalies of the surface of the skin (skin damaged by the sun, brown spots) will be corrected by a resurfacing  (peeling, laser, dermabrasion).

The injections of hyaluronic acid can be carried out from the age of 30 in both women and men, sometimes sooner in case of lips that are too thin.

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The hyaluronic acid is the most used product for the filling of the face, because it is a completely resorbable product, synthetic and therefore very little allergenic.

Hyaluronic acid naturally exists in the skin and binds to water molecules, giving the skin its softness and elasticity. The amount of hyaluronic acid present in the skin decreases with age, which results in a reduction in hydration of the dermis and an increase in the formation of wrinkles.

An injection of hyaluronic acid under the skin will make it possible to fill or restore volume, but also to rehydrate the skin. It is a subcutaneous gel injection, more or less deep, depending on the viscosity of the product. The thicker the product is, the deeper it will be injected, the more fluid, the more superficially the injections will be.

If there is a need for a substantial correction of a digging of the face, a lack of volume, or the patient is allergic to filling products (very rare), the injection can advantageously be replaced by a reinjection of autologous fat, facial lipofilling or lipostructuring.

Doctor Jean-Charles BAYOL will ask you to find what bothers you and what you want to correct. It is important to specify previous injections, possible contraindications, allergies and possible history of herpes labialis. The clinical examination will allow you to choose the most suitable product to correct the impediment.

The treatment can be performed at Laclinic-Montreux (neat Sion and Fribourg), or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by train).

Because they promote bleeding and bruising, it is essential to refrain from taking aspirin or anti-inflammatory medicine 5 days before and 5 days after surgery.

On the day of the injection, it will be paramount not to expose your face to the sun.

Dr. Jean-Charles BAYOL almost systematically performs a troncular locoregional anesthesia in order to anesthetize the cheeks and the lips. The local anesthesia makes it possible to serenely experience the injection of a filling product without any pain.

A session of hyaluronic acid injection lasts from 20 minutes to one hour according to the number of zone to be treated and the quantity of product to be injected.

Dr. Jean-Charles BAYOL uses the retro-tracing injection method: the needle is inserted; the product is deposited while withdrawing the needle. This technique gives the best cosmetic result.

The number of syringes required is variable and depends on many parameters, including the size of the impediment to be corrected. This will be assessed beforehand as accurately as possible.

A card will be given to you after the session, mentioning the date of the procedure, the nature and the reference of the product as well as the zones which have been treated.

A control is systematically performed 15 days to 3 weeks after the procedure to evaluate the result and perform additional injections if necessary.

One must remain calm in the hours that follow the injection. Alcohol, aspirin, anti-inflammatories and sun should be avoided during this period.

Swelling (edema), bruises and redness of the skin may appear after the injection. These signs are mostly moderate, disappear within a few days and can be easily camouflaged with makeup.

Note that at the level of the lips, these signs can be more important because the lips are richly vascularized.

Less frequently, skin sensitivity, itching, paleness or, on the contrary, hyperpigmentation can be seen during the first few days around the injection zones.

One can also observe irregularities due to the inhomogeneous distribution of the edema, or an aspect of hypercorrection that will gradually disappear.

It is necessary to wait a few days for the edema, the redness and the ecchymosis to disappear, and for the product to integrate.

The injection of hyaluronic acid makes it possible to correct the defect(s) in a discrete and natural way. It also gives a younger and less fatigued appearance to the patient’s face. It should be remembered that, contrary to an injection of botulinum toxin, an injection of a filling product does not paralyze the facial muscles and therefore does not diminish their mobility and the facial expression.

The treated defects are very clearly attenuated by the injections but do not disappear completely and especially the deep and old wrinkles that can never be completely suppressed.

An injection lasts 8 to 12 months depending on the product and the area to be treated. Hyaluronic acid is absorbed more quickly in areas of high mobility such as the lips. The correction being temporary, a new injection must be carried out after several months to maintain the result.

Any medical act, however small, may involve risks and uncertainties.

An injection of a filling product must be performed by an cosmetic surgeon who has been trained in hyaluronic acid injection techniques. Possible side effects are:

– Allergic reactions: they are exceptional. They could happen in reaction with collagen which is virtually no longer used.

– Local reactions: they occur after the injection (see paragraph “after the injection”) and disappear in a few hours to a few days.

– Herpes labialis: If you are prone to herpes outbreaks, you may be prescribed a preventive anti-herpetic treatment after the injection session.

– Acute or chronic inflammatory reactions: they can occur if an injection of hyaluronic acid is carried out on an area that has already been treated with a non resorbable product. A careful questioning before the treatment will detect it.

– Granulomas: this is a very rare but unpredictable complication. The granulomas are small hard balls under the skin more or less sensitive and more or less visible. This is an inflammatory reaction that has developed around the filling product. It may appear several days to several weeks after the injection. These reactions, which could have been seen with non-resorbable products (now prohibited), are exceptional with resorbable products such as hyaluronic acid. When they occur, they regress spontaneously in a few weeks, exceptionally, they require a small localized excision.

– Extremely rare complications: exceptional cases of persistent redness, abscesses or cutaneous necrosis have been described.

Injections of hyaluronic acid and fillers are simple and effective ways to correct the first signs of facial aging. Dr. Jean-Charles BAYOL, specializing in facial surgery and anatomy, has been trained in the techniques of hyaluronic acid injection. He frequently gives training courses to his colleagues.

It is important to take the time to listen to your motivations that must remain realistic.

It is also important to explain what these treatments can do for you and what they cannot correct. In this case, other medical or surgical treatments may be considered:

• Sagging of the facial tissue (jowls) and excess skin (around the eyelids) that can only be surgically corrected with a facelift and / or a blepharoplasty .
• A loss of volume of the middle third of the face can be corrected by a facial lipostructuring under local anesthesia.