[Duhan Plastic Surgery Wrinkle Removal] - [Filler Procedure]

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Filler procedure

Filler injection for wrinkle correction

Types of fillers by ingredient

1. Hyaluronic acid (Juvederm, Restylane, Teosyal, Perlane)

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

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

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

Depending on the purpose of the filler, it is divided into three types: low concentration for injection just under the epidermis, medium concentration for injection into the dermis, and high concentration for areas below the dermis.

It must be used appropriately for each purpose, and if a high-concentration product is used in the epidermal layer, a side effect may occur in which the skin protrudes, so a filler with the proper concentration for the treatment area must always be used.

Uses: mainly used to correct fine wrinkles around the eyes, between the eyebrows, and around the mouth, as well as sunken scars from acne or chickenpox

2. Polymethyl methacrylate (Artecoll)

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

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

Inflammation and other side effects are not common, but when applied superficially in the skin layer, unevenness may occur, causing the skin to become hard or develop contours.

It is not a filler that can be used in delicate areas.

In deeper areas as well, its viscosity is weak, so it is difficult to expect a strong contour-correction effect for sunken areas.

Uses: correction of small sunken areas; unsuitable for fine wrinkles or precise procedures

3. Polyacrylamide (Aquamid, Interpool, Royamid, Bio-Alcamid)

Its ingredients are a mixture of 2.5% polyacrylamide and 97.5% apyrogen water.

It is considered to have excellent longevity, but after being imported and used in Korea, many cases of side effects such as inflammation were reported, so caution is needed.

Because side effects are reported frequently, some products are banned from import by the Food and Drug Administration.

Uses: use with caution because it often causes inflammation

4. Collagen (Evolence)

Collagen is one of the components in the human body and is a biological material, so it is relatively safe, but side effects such as allergies occasionally occur.

Also, because collagen is absorbed in the body by an enzyme called collagenase, its longevity is lower than that of other fillers.

Uses: used for small sunken areas and correction of fine wrinkles

5. Radiesse (calcium formulation)

It consists of particles of calcium hydroxyapatite, a bone component, in a water gel, so it is a bone-derived material.

Because the particles are hard, it is not suitable for correcting fine wrinkles in the skin, but it can be injected beneath the skin and applied to small sunken scars or for contour correction in small areas.

Procedures in soft tissues such as the lips and other mucosal areas must be approached with caution because they can cause hard nodules.

Uses: small sunken areas, chickenpox scars, acne scars

Features of filler injection (Juvederm) procedures

○ It is safe because it is a biological material.

○ The procedure is convenient and can be performed precisely.

○ Because it is a material with excellent biocompatibility, an allergy test before the procedure is not necessary.

○ Because it is made by cross-linking hyaluronic acid, the effect of the procedure lasts longer.

○ The effect can be confirmed immediately after the procedure.

Scope of application of filler injection (Juvederm)

Forehead wrinkles

Glabella wrinkles

Eye-area wrinkles

Nasal bridge wrinkles

Nasolabial folds

Lip wrinkles

Other fine facial wrinkles

Sunken scars (chickenpox, acne scars)

Hyaluronic acid (Juvederm)

Juvederm is injected into the dermal layer under the wrinkle through a fine 27-gauge needle.

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

By physical force, Juvederm supports the wrinkle from underneath, improving it and remaining in place to help prevent recurrence.

Filler injection (Juvederm) procedure process

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 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.

For 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 immediately and go home.

8. Return after one week to check whether the wrinkles have clearly disappeared.

Examples of filler injection (Juvederm) procedures

Scope of application of filler injection (Juvederm)

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

It is mainly used to correct fine wrinkles.

It is mainly applied to fine forehead wrinkles, fine glabella wrinkles, crow's feet, and nasolabial folds around the mouth.

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

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

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

Cases where no effect is seen with filler injection (Juvederm)

It has little or no effect on very thick and deep wrinkles.

For forehead wrinkles, glabella wrinkles, and deep nasolabial folds around the mouth, the procedure effect is insufficient.

Filler injection is applied to fine wrinkles.

Duration and number of filler injection (Juvederm) procedures

Juvederm is injected into the dermis of the skin to push wrinkles upward.

Juvederm is an advanced hyaluronic acid product in which hyaluronic acid is cross-linked so that the effect lasts longer.

Usually, the effect lasts about one year, and even if it recurs, the original treated area recurs only mildly, so the more it is performed, the more the treatment effect accumulates.

The duration of the effect varies depending on the degree of wrinkles, facial expression habits, and the location of the wrinkles.

In some cases, it can last for several years or more.

The number of procedures depends on the pattern of wrinkle formation, and retreatment can be done as needed; it is not performed according to a fixed schedule.

Side effects of filler injection (Juvederm)

Because it is made by refining the intercellular substance that exists between the dermis and epidermis of the skin and is a highly biocompatible material, it is safe enough that an allergy test before the procedure is not necessary.

For example, in the case of collagen injections, an allergy test is performed to determine biocompatibility, and the procedure is carried out only when it is judged that no allergy will occur. However, for Juvederm, such testing is not necessary.

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

If over-injected, it can be removed again or dissolved with hyaluronidase, an antagonist.

Knowledge you should understand correctly about fillers

Safe fillers should be used.

Fillers containing polyacrylamide ingredients (Aquamid, Interpool, Royamid, Bio-Alcamid, etc.) should be used with caution because cases of side effects such as inflammation have been frequently reported after they were imported and used in Korea.

Some products are currently banned from import by the Food and Drug Administration.

They are advertised as having strong longevity, but because it is difficult to completely remove the injected filler, serious aftereffects may occur after inflammation, so this should be kept in mind.

They must be used for the proper purpose.

There are many types of fillers, and people focus on whether their longevity is strong, but strong longevity is both an advantage and a disadvantage.

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

Therefore, if the filler seeps between tissues and causes problems, serious side effects and aftereffects can result.

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

For example, using them to raise the nose, for under-eye plastic surgery, or in the cheeks, forehead, or lips should be strongly discouraged.

This is because, beyond having only a minor effect, the risk of side effects is very high.

No matter how good a medicine is, if it is used for the wrong purpose it becomes harmful; likewise, even a good filler will inevitably have a higher incidence of side effects if used for the wrong purpose.

Side effects of embolism

No matter how safe a filler is, when injected it can block an artery in the subcutaneous layer and cause embolism.

Because of embolism, tissues or skin supplied by that artery can become necrotic.

Necrosis caused by embolism is a very serious side effect.

Skin tissue that has once become necrotic recovers over a long period while leaving severe scars, so it is a very serious issue.

Therefore, fillers should be used only for small sunken scars or fine wrinkles in the dermis, and it must be kept in mind that if they are injected into deeper areas below the dermis for deep wrinkles or contouring, there is a risk of embolism entering through an artery.

Problems with fillers that have long-lasting effects

Fillers with high viscosity and strong longevity can sometimes cause serious problems.

Strong longevity means the filler hardens firmly, so it can cause uneven protrusions or contours at the treated area, or a feeling that it is not soft like your own flesh but rather a foreign body and firm to the touch.

Therefore, fillers with strong longevity must be used very carefully to avoid side effects.

Correct understanding of filler longevity

For Juvederm, there are three types.

They are labeled with the numbers 18, 24, and 30, and their viscosities differ.

The ingredient is the same, but the higher the number, the higher the viscosity, the better the effect on correcting sunken areas, and the longer the longevity.

You might think that using only the 30, which has the best longevity, would be enough, but they are released in three types because each has a different purpose.

The 18, which has the weakest longevity, is used just below the epidermal layer and is used for the finest and shallowest wrinkles.

If the 30 is used for shallow wrinkles just below the epidermal layer simply because it has better longevity, the treatment area may protrude and cause unevenness, leading to poor results.

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

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

As such, only by using a filler appropriate for the wrinkle or sunken area can the procedure be effective without side effects.

If you judge only by longevity and use it for the wrong purpose, there is a greater risk of side effects, so this must be kept in mind.

Cautions regarding the use of fillers for under-eye procedures and aegyo-sal procedures

Fillers should not be carelessly injected under the eyes.

Fillers are not made for contour plastic surgery.

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

If injected into the under-eye aegyo-sal area or the sunken under-eye area, they can make the eyes look unnatural or cause side effects.

Because fillers are transparent in color, when injected under the eyes they often make the area look pale and awkward.

They can also create a lumpy shape or spread so that the filler protrudes in an unintended place.

Many people experience awkward under-eye shapes or side effects after filler procedures under the eyes, so 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 be applied only to fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, or small sunken scars.

If the filler is not a hyaluronic acid-based filler, once a wrong shape or side effect appears after the procedure, correction is almost impossible.

There are many cases where people inquire about correction at our clinic due to incorrect filler procedures at other hospitals, but even at our clinic there is no special method to correct 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-based filler, there is an antagonist called hyaluronidase.

It is an enzyme that dissolves hyaluronic acid. It was mainly used to reduce swelling in surgical patients, but as many clinics caused problems through indiscriminate filler procedures, hyaluronidase is also used to dissolve hyaluronic acid fillers.

If you received treatment with Restylane, Juvederm, or Perlane, it may be possible to dissolve it with hyaluronidase.

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 where people ask our clinic for correction due to incorrect filler procedures at other hospitals, but even at our clinic there is no special corrective method for this, so filler procedures for contour correction under the eyes, in the nose, or on the face should never be done.

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