Hyaluronic acid and other fillers

Filler is a gel injected beneath the surface of the skin. When injected into the skin, filler smooths wrinkles and increases tissue volume.

Over 90 percent of all filler treatments worldwide are done with hyaluronic acid. Hyaluronic acid is a familiar substance to the skin. It is a large sugar molecule that binds a lot of water. As a person ages, the natural hyaluronic acid concentration in the skin decreases, resulting in a reduction of tissue volume. As tissue volume decreases, the skin becomes saggy and wrinkled. The decrease in hyaluronic acid also manifests as dryness in the skin.

Filler treatments with hyaluronic acid help counteract these signs of aging. During the treatment, the skin’s own hyaluronic acid reserves are replenished. Tissue volume increases, which smooths wrinkles and plumps features. Filler treatments using hyaluronic acid always provide temporary results. An enzyme called hyaluronidase gradually breaks down the hyaluronic acid injected into the skin over the course of months.

There is some research evidence suggesting that filler treatment with hyaluronic acid gel may also stimulate collagen production in the skin. However, if the goal is to initiate new collagen production, the best results are achieved with calcium-based fillers (such as Radiesse or Crystalys). When using collagen-stimulating fillers, the results are long-lasting. Although the filler itself degrades, the collagen formed in the skin continues to firm the features long after the filler has broken down.

It is also possible to combine hyaluronic acid and calcium hydroxyapatite, which is one of the most significant innovations in the field of filler treatments. When these two effective and safe fillers are combined, comprehensive results are achieved: hyaluronic acid plumps while calcium hydroxyapatite stimulates collagen production in the skin.

The fillers used by Cityklinik are safe. They have been studied and used for over ten years.

Filler treatments are mainly done on the face.

The fullness, elasticity, and firmness of the skin, as well as the clarity of facial features, decrease over the years. Changes occur in the skin, but also muscles and bones atrophy over time. All these changes manifest as wrinkles and sagging of facial features. Filler can correct some of the signs of aging. Hyaluronic acid restores youthful roundness to the face, and calcium-based filler builds the skin’s support structure from within.

Filler can be injected into the lips to reshape and resize them. Filler injected into the cheeks clarifies sagging facial features and brings youthful roundness to the midface. The shape of the chin and nose can also be corrected with fillers. The nasolabial folds, running from the sides of the nose to the corners of the mouth, are also one of the most typical treatment areas for filler. Some wrinkles and signs of aging in the upper face can be corrected with filler to some extent. However, often, botulinum toxin provides the best results in rejuvenating the forehead and corners of the eyes.

Filler treatments are also done on the neck and décolletage areas, although relatively less so in Finland. Hand rejuvenation with fillers is slowly becoming a rising trend, even here in the Nordic countries.

Filler treatments are not primarily pampering treatments. On average, the more experienced the injector, the less painful the filler treatment. However, it’s clear that, for example, injections performed on the lips always cause some discomfort unless the area around the mouth is numbed.

At Cityklinikka, various types of numbing methods are used:

• Topical numbing cream – numbs the surface of the skin: the needle prick is felt, but not as much as without topical numbing.
• Nerve block during lip augmentation – this is a so-called dental anesthesia: the lips are numbed for a few hours, and the filler treatment is painless.
• Numbing injections – before the filler treatment, the area can be numbed by injecting a numbing agent into the skin with a needle: the numbing itself may cause slight discomfort, but the filler treatment is painless.
• Fillers containing lidocaine – some fillers contain a numbing agent: the first injection may be felt, but then the area becomes numb.

After possible numbing, filler gel is injected beneath the skin. The procedure is quick and simple when performed by a professional. The treatment lasts from fifteen minutes to half an hour. After the treatment, the patient can sit down for a moment and apply a cold pack to the treatment area.

Immediately after the treatment, there are visible injection marks on the skin. These can be covered with makeup, but natural products should be avoided due to the risk of infection. Bruising and swelling are possible. If the filler treatment is done on the lips, swelling is almost always present.

After the procedure, the patient receives home care instructions. It is important to follow these instructions. Cityklinikka doctors recommend the use of arnica-based healing creams. These help reduce bruising, swelling, and redness. If bruises occur, using an arnica cream helps treat them faster than without it.

The results of the filler treatment are visible immediately after the procedure. It is important to remember that the results will further improve over the following two weeks. Therefore, the final outcome can be reliably assessed 2-4 weeks after the treatment.

The duration of the results depends on several factors. Among others, the following factors influence the longevity of the final result:

• The density of the filler used
• The number of filler treatments performed in the area (After a few sessions, the filler begins to stay in the tissues longer.)
• The amount of filler used
• The patient’s metabolism
• The level of activity in the patient’s lifestyle

Since exercise accelerates metabolism, it is advisable to limit vigorous exercise before and after the treatment if you want the treatment results to last as long as possible.

After the filler treatment, extreme temperatures should be avoided. It is advisable to take a break from sunbathing, using tanning beds, saunas, and ice swimming for a couple of weeks.

• Bruising occurs in relatively few patients. However, it is always possible. If bruising is to be avoided, the treatment is performed with a cannula.
• Swelling is a typical side effect of filler treatment during the first few days.
• Redness is almost always present. Redness usually diminishes within the first hour following the treatment. Makeup can also be used to cover redness.
• Irregularities may sometimes occur. Ask the practitioner if the area should be massaged or not.
• There is always a risk of infection whenever the skin is pierced with a needle. By performing the filler treatment in appropriate conditions and understanding the importance of asepsis, the risks of infection can be minimized. Patients can prevent infection by following the post-treatment instructions they receive. The skin should not be touched. If makeup is applied immediately after the procedure, care should be taken to ensure the cleanliness of the makeup product.
• According to some estimates, the likelihood of severe complications (such as necrosis, blindness) is approximately 0.0005 %.
• According to studies, injections made with calcium-based fillers are not associated with any serious side effects.

Hyaluronic acid can be removed if necessary with an enzyme called hyaluronidase. This enzyme is the same one present in the human body, breaking down the body’s own – and injected into the skin – hyaluronic acid.

There are many reasons for removing filler:

• The patient is not satisfied with the results of the filler treatment. There is too much filler.
• The patient becomes tired of their filled lips and wants their “natural lips” back.
• Swelling in the treatment area does not subside. This sometimes occurs after tear trough filling.
• Lumps and bumps in the lips do not disappear despite massage.
• In rare cases, the patient may be allergic to some ingredient in the filler.

Cityklinikka’s doctor, Piotr Sikorski, specializes in removing hyaluronic acid fillers. The demand for hyaluronidase treatments has increased somewhat in the past year.

Usually, lidocaine (an anesthetic agent) is mixed with hyaluronidase, so the procedure is not excessively painful. Before the procedure, it is important to understand a few facts:

Hyaluronidase treatment is not as precise a procedure as the filler treatment itself. For example, when removing bumps in the lips, it is possible that hyaluronic acid may be removed from areas where it is not desired.

The dosing of hyaluronidase can sometimes be challenging. Therefore, melting hyaluronic acid gel may require multiple treatment sessions. If highly dense hyaluronic acid gel has been injected into the skin, the melting process may take longer than usual and require more hyaluronidase.
The results of the procedure may be visible immediately after the treatment. However, the final outcome is usually observed 1-3 days later.

Hyaluronic acid (HA) is an organic compound found in the body. It has a large molecular size, which prevents it from penetrating deeply into the skin from the surface.

On the surface of the skin – for example, when using cosmetic products – hyaluronic acid acts as a moisturizing ingredient. Because the HA molecule can bind to water a thousand times its own weight, it is widely used in moisturizers. The hyaluronic acid in cosmetic products moisturizes the outermost layer of the skin.

When hyaluronic acid is injected beneath the skin’s surface, it attracts moisture and thus adds fullness to the features. Hyaluronic acid is naturally present in the dermis, the skin’s middle layer. However, as the skin ages, the hyaluronic acid content decreases. Injecting hyaluronic acid into aging skin replenishes the skin’s own hyaluronic acid reserves.

The hyaluronic acid used in high-quality fillers is 99 percent identical to the hyaluronic acid naturally present in the skin. The difference lies in longevity. The longevity of hyaluronic acid in fillers has been extended by adding a very small amount of stabilizing agent.

HYALURONIC ACID IN THE SKIN

The hyaluronic acid in the skin is fluid and rapidly degradable. The body’s own hyaluronic acid molecules degrade within 1-2 days. The degradation and renewal cycle is thus very fast.

HYALURONIC ACID IN FILLERS

When developing fillers, the aim has been to create a gel-like, stable form of hyaluronic acid. It wouldn’t make sense to inject hyaluronic acid into the skin if it were to degrade within two days of the procedure.

Hyaluronic acid can be made long-lasting by creating cross-linked bonds between long hyaluronic acid chains. These cross-linked bonds keep the hyaluronic acid molecules of the fillers together for several months. Cross-linking is mainly achieved through the use of BDDE compound. BDDE (or another stabilizing compound) is the only part of fillers that is not present in the body’s own hyaluronic acid.

Hyaluronic acid gel increases the volume of subcutaneous tissue. This effect is noticed immediately after filler treatment. Because hyaluronic acid binds water, the skin’s moisture balance also improves.

After filler treatment, wrinkles and lines are lifted from within: shallow and moderate wrinkles disappear completely, and deep wrinkles become significantly shallower and smoother. The skin becomes smoother, moisturized, and radiant. Sagging features lift somewhat.

Calcium hydroxylapatite gel increases tissue volume similarly to hyaluronic acid gel. When the gel is introduced under a wrinkle, the skin lifts, and the wrinkle becomes shallower. When the gel is injected, for example, into the cheeks, the cheekbones lift, and the skin rises somewhat.

Calcium-based fillers have another mode of action. Calcium micro-particles stimulate the fibroblast cells in the skin to produce new collagen. As collagen increases, the skin tightens from within. The collagen formed by the breakdown of calcium particles keeps the features firm for a long time.

Calcium-based fillers do not bind water like hyaluronic acid gels. Therefore, they can also be used to clarify the contours of the lower face. With Radiesse or Crystalys, it is possible to create a firmer jawline without the fear of water accumulation in “hamster pouches.”

The Liquid Facelift is an Israeli service innovation that has been researched for years.

The effectiveness of the treatment is based on a novel combination of hyaluronic acid and calcium hydroxylapatite. Micro-particles containing calcium hydroxylapatite are embedded within stabilized hyaluronic acid. The treatment utilizes fillers from Luminera, including Hydryalix and Crystalys.

The Liquid Facelift offers the benefits of both hyaluronic acid and calcium-based fillers:

Hyaluronic acid effectively fills features.
Calcium micro-particles stimulate the skin for collagen regeneration, leading to skin firmness in the months following the treatment.

A Liquid Facelift injection contains 2.5 milliliters of filler. With this amount, all problem areas of the face can be addressed. The results can be likened to a minor facelift, especially if the upper face is treated with Botox after the procedure. Hence the name “liquid facelift.”

However, please note that if there is significant excess tissue, injection therapy may not be the best option. Significant tissue laxity is most effectively addressed with surgical facelift.