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Filler Injection for Wrinkle Correction

Types of Fillers

◎ Hyaluronic acid (Juvederm, Restylane, Teosyal, Perlane)

Hyaluronic acid is an intercellular substance that exists between the dermis and epidermis of the skin. It binds cells together and acts as a lubricant between cells, making it a biological substance.

The ingredient in hyaluronic acid–Juvederm is non-animal-derived hyaluronic acid.

It is the most widely used filler, and because it is a biological substance, it is a safe filler with a very low possibility of side effects or inflammation.

It is also divided into three types depending on its use: low concentration, which is injected just beneath the epidermis; medium concentration, which is injected into the dermis; and high concentration, which is injected into areas below the dermis.

It must be used according to its purpose, and if a high concentration is used in the epidermal layer, side effects such as skin protrusion may occur, so it is important to use a filler with the appropriate concentration for the treatment area.

Uses: mainly used for fine wrinkles around the eyes, glabella, and mouth, and for correcting depressed scars from acne or chickenpox

◎ Polymethyl methacrylate (Artecoll)

Artecoll consists of PMMA (polymethyl methacrylate) particles suspended in a 3.5% collagen solution at a 1:3 ratio.

PMMA (polymethyl methacrylate), also called methacrylic resin, is one type of thermoplastic.

Inflammatory side effects are not common, but if the treatment is done superficially in the skin layer, uneven skin texture may occur, causing the skin to become hard or irregular.

It is a filler that cannot be used in delicate areas.

In deeper areas, its viscosity is weak, so it is difficult to expect a strong contour-correcting effect for depressed areas.

Uses: correction of small depressed areas; not suitable for fine wrinkles or delicate procedures

◎ Polyacrylamide (Aquamid, Interpol, Royamid, Bio-Alcamid)

The ingredients are a mixture of polyacrylamide (2.5%) and apyrogen water (97.5%).

It is considered to have excellent durability, but since it was imported and used domestically, many cases of side effects such as inflammation have been reported, so caution is needed.

Because side effect cases are frequent, some products have been banned from import by the Ministry of Food and Drug Safety.

Uses: caution is needed because it often causes inflammation

◎ Collagen (Evolence)

Collagen is one of the components in the human body, so it is a relatively safe preparation because it is a biological substance, but allergic reactions and other side effects may occasionally occur.

Also, because collagen is absorbed in the body by an enzyme called collagenase, its longevity is inferior to other fillers.

Uses: used to correct small depressed areas and fine wrinkles

◎ Radiesse (calcium preparation)

This is bone-derived material, consisting of calcium hydroxyapatite particles in a water gel.

Because the particles are hard, it is unsuitable for correcting fine wrinkles in the skin, but it can be injected under the skin and used for correcting small depressed scars or contour irregularities in small areas.

Submucosal procedures in soft tissues such as the lips should be approached with caution, as they may cause hard lumps.

Uses: small depressed areas, chickenpox or acne scars

Features of Filler Injections (Juvederm) Treatment

It is safe because it is a biological substance.
The procedure is easy and allows precise treatment.
Because it is a highly biocompatible material, no allergy test is needed before treatment.
Since it is made by cross-linking hyaluronic acid, it maintains its effect for a long time.
The effect can be seen immediately after the procedure.

Areas That Can Be Corrected with Filler Injections (Juvederm)

○ Forehead wrinkles

○ Glabellar wrinkles

○ Crow's feet

○ Nose bridge wrinkles

○ Nasolabial folds

○ Lip wrinkles

○ Other fine facial wrinkles

○ Depressed scars (chickenpox, acne scars)

Hyaluronic Acid (Juvederm)

Juvederm is injected into the dermis beneath the wrinkle through a fine 27-gauge syringe.

After Juvederm is injected, the increased volume pushes the wrinkle upward.

By providing physical support from below, Juvederm lifts the wrinkle, improving it and remaining in place to suppress recurrence.

Filler Injection (Juvederm) Procedure

1. Apply a topical anesthetic (EMLA) to the area where wrinkle correction is desired.

2. Apply it evenly over the area with wrinkles.

3. Seal it with plastic wrap so that the anesthetic does not dry out.

4. After sealing with plastic wrap, wait about 30 to 40 minutes for the anesthetic to absorb.

5. After 30 to 40 minutes, wipe off the topical anesthetic (EMLA).

6. Inject Juvederm along the wrinkle line.

In the case of eye-area wrinkles, the procedure takes about 10 minutes, and because anesthesia is used, there is almost no pain.

7. After the procedure, you can apply makeup and go home right away.

8. Return one week later to check whether the wrinkles have been clearly reduced.

Examples of Filler Injection (Juvederm) Treatment

Range of Application for Filler Injection (Juvederm)

As with most fillers, Juvederm is not very effective for deep wrinkles.

It is mainly used to correct fine wrinkles.

The wrinkles it is mainly applied to are fine forehead wrinkles, fine glabellar wrinkles, crow's feet, and nasolabial folds around the mouth.

It is also used effectively for acne scars, chickenpox scars, and other scars.

Fillers should not be used for deep expression lines or facial contour correction.

Because the effect is minimal or there is a risk of side effects, caution is necessary.

Cases Where Filler Injection (Juvederm) Does Not Work Well

It is weak or nearly ineffective for very thick and deep wrinkles.

For forehead wrinkles, glabellar vertical lines, and deeply sunken nasolabial folds around the mouth, the treatment effect is insufficient.

Filler injections are for fine wrinkles.

Duration of Effect and Number of Treatments for Filler Injection (Juvederm)

Juvederm is injected into the dermis of the skin to lift wrinkles.

Juvederm is an advanced hyaluronic acid made by cross-linking hyaluronic acid so that its effects last longer.

Usually, the effect lasts for about one year, and even if it recurs, the originally treated area tends to recur only mildly, so the more treatments are done, the more the effect accumulates.

The duration varies depending on the individual's wrinkle severity, facial expression habits, and wrinkle location.

In some cases, it may last for several years or longer.

The number of treatments depends on the pattern of wrinkle formation, and repeat treatment can be done as needed; it is not performed on a fixed schedule.

Side Effects of Filler Injection (Juvederm)

It is made by purifying an intercellular substance that exists between the dermis and the outer skin layer, and because it is highly biocompatible, it is safe enough that allergy testing before treatment is not necessary.

For example, in the case of collagen injections, an allergy test is performed to determine biocompatibility, and treatment is done only when it is judged that no allergy will occur. However, with Juvederm, such testing is not needed.

Another side effect is that if too much Juvederm is injected into one area due to the practitioner's inexperience, the injection site may protrude more than the surrounding normal skin.

If overinjected, it can be removed again or dissolved with hyaluronidase, an antagonist.

Correct Knowledge You Should Know About Fillers

You must use safe fillers.

Fillers made with polyacrylamide ingredients (Aquamid, Interpol, Royamid, Bio-Alcamid, etc.) have frequently been reported to cause side effects such as inflammation after being imported and used domestically, so caution is needed.

Some products are currently banned from import by the Ministry of Food and Drug Safety.

Although they are advertised as having high durability, you should note that once an injected filler causes a problem, it is difficult to remove completely, and severe aftereffects can occur if inflammation develops.

It must be used for the right purpose.

There are many types of fillers, and people tend to focus on whether they are long-lasting, but high durability is both an advantage and a disadvantage.

If a problem occurs, most fillers are difficult to remove.

Therefore, if a filler spreads between tissues and causes problems, you may suffer serious side effects and aftereffects.

The use of fillers should be limited to correcting fine wrinkles and small depressed scars.

For example, using them to raise the nose bridge, for under-eye surgery, or for the cheeks, forehead, or lips is strongly discouraged.

This is not only because the effect is weak, but also because the risk of side effects is very high.

Just as even a good medicine becomes harmful if used for the wrong purpose, a good filler will inevitably have a higher rate of side effects if used inappropriately.

Side Effects of Embolism

Even safe fillers can cause embolism by blocking an artery in the subcutaneous layer when injected.

Because of embolism, necrosis can occur in the tissue or skin supplied by the artery.

Necrosis caused by embolism is a serious side effect.

Skin tissue that has undergone necrosis recovers over a long period of time, leaving severe scars, so this is a serious issue.

Fillers should be used only for small depressed scars or fine wrinkles in the dermis, and if they are injected into deeper areas below the dermis for deep wrinkles or contour correction, you must keep in mind that there is a risk of embolism entering the artery.

Problems with Long-Lasting Fillers

Fillers with high viscosity and strong durability can easily cause serious problems.

High durability means that the filler hardens firmly, which can lead to uneven protrusions or irregular contours at the treatment area, and it may not feel soft like your own tissue but instead create a foreign-body sensation and a hard feel.

Therefore, long-lasting fillers must be used very carefully to avoid side effects.

Correct Understanding of Filler Longevity

As an example of Juvederm, there are three types of Juvederm.

They are labeled with the numbers 18, 24, and 30, indicating different viscosities.

Although the ingredients are the same, the higher the number, the higher the viscosity, the better the effect on depressed areas, and the longer the duration.

You might think only the 30 type with the best durability should be used, but because each type has a different purpose, they are released in three varieties.

The least durable 18 type is a filler injected just beneath the epidermis, and it is used for the finest and shallowest wrinkles.

If 30, which has better durability, is used for shallow wrinkles just below the epidermis, the treated area may protrude and create unevenness, leading to poor results.

Therefore, for shallow wrinkles, the low-viscosity 18 product should be used to ensure safety and effectiveness.

The purpose of 30 is to be injected just below the dermis, making it suitable for correcting deep wrinkles or depressed scars.

In this way, only by using the filler appropriate for the wrinkle or depressed area can an effective treatment be achieved without side effects.

If it is judged only by durability and used in a way that does not match the purpose, there is a high risk of side effects, so this must be kept in mind.

Cautions About Using Fillers for Under-Eye Surgery or Aegyo-sal Procedures

Fillers should not be indiscriminately used under the eyes.

Fillers are not made for contouring.

They are simply for correcting fine wrinkles and small depressed scars.

Injecting them for under-eye aegyo-sal procedures or into depressed under-eye areas can make the eyes look unnatural or cause side effects.

Because fillers are transparent in color, injecting them under the eyes often makes the area look pale and awkward.

They can also create uneven shapes, or the filler can spread and cause protrusion in an unintended area.

Fillers are not meant to be used under the eyes; they should be used to correct fine wrinkles around the eyes.

Many people complain of unnatural under-eye appearance or side effects after under-eye filler procedures, and to avoid following in their footsteps, fillers should never be injected under the eyes.

They should also not be injected into the nose, lips, or cheeks.

They should only be applied to fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, and small depressed scars.

If the filler is not a hyaluronic acid filler, once a wrong shape or side effects appear after treatment, correction is almost impossible.

There are many cases in which patients come to our clinic for correction after incorrect filler procedures at other hospitals, but even at our clinic there is no special correction method for this, so caution is necessary.

How to Address Side Effects Caused by Using Fillers for the Wrong Purpose

If the filler is a hyaluronic acid filler, there is an antagonist called hyaluronidase.

It is an enzyme that dissolves hyaluronic acid, and although it was mainly used to reduce swelling after surgery, many hospitals now also use hyaluronidase to dissolve hyaluronic acid fillers when problems arise from indiscriminate filler procedures.

If you were treated with Restylane, Juvederm, or Perlane, hyaluronidase can be used to dissolve it.

However, for fillers made of other ingredients, there is no antagonist that can dissolve them, so if side effects occur, correction is almost impossible.

There are many cases in which patients ask our clinic for correction due to incorrect filler procedures at other hospitals, but even at our clinic there is no special correction method for this, so filler procedures for contour correction under the eyes, nose, or face should never be done.

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