The use of autologous fillers, meaning the patient’s own tissues for filling, is always our first choice. Permanent fillers are not used in our clinic as they pose a risk to patient health, and among temporary fillers, only “Hyaluronic Acid” is used.
Why Are Dermal Fillers Necessary?
Although the resorption of facial bones may sound like a very early stage, it begins from the age of 25. As this microscopic resorption process progresses, your hormones also begin to decrease. This process continues with a reduction in the renewal rate of protein structure; the skin, muscles, and underlying fatty tissue lose their collagen structure and sag. Along with the shrinkage in facial bones, the soft tissues covering the bone also loosen.
In addition to this biological process, briefly called aging, the skin also loses its youthful and vibrant appearance over time due to other reasons such as sun exposure, millions of repetitive facial expressions throughout life, and smoking. Soft tissue fillers are used to fill lines and wrinkles caused by all these factors.
When soft tissue fillers are injected under the skin for a smoother and younger-looking complexion, they correct sunken areas and wrinkles, and help redefine facial contours. This injection procedure can also be combined with facelift and skin rejuvenation treatments.
Areas of Application and Limitations
Filler materials are used for a wide variety of purposes, such as correcting wrinkles, facial lines, sunken cheeks, contours, and treating certain types of scars. They can also be used to enhance cheekbones, and on the forehead and back of the hands.
For deep lines around the mouth (radial lines) and in other areas, fillers alone may not provide sufficient results. In such cases, rejuvenation methods like chemical peeling, laser, dermabrasion, and new technologies such as Carbon Dioxide Fraxel Laser are recommended. Combining fillers with laser rejuvenation techniques helps achieve more successful results by exfoliating the upper layer of the skin.
In cases of looser skin structure than normal, or facial and forehead muscles that are much more active than normal, deep lines can be more effectively eliminated through surgical techniques like forehead and facelift cosmetic procedures. While it is possible to use fillers in conjunction with surgical interventions, using only fillers in this manner does not offer results as effective as surgical methods.
Our aesthetic surgeons are physicians specialized in the use of fillers and all other cosmetic surgical procedures, and they can offer you many different alternatives according to your needs. You can decide on the most suitable method for you together with your surgeon.
Injections from Our Own Tissues
Tissue Cocktail injections (micro-mini tissue injections):
This concept was introduced by Prof. Dr. Onur Erol in the 1990s. Initially, the promising results presented at international congresses were met with skepticism, but over the years, they have gained acceptance from almost every plastic surgeon and have become an “indispensable” category. Today, there is a consensus that tissue injections are not only limited to restoring lost or distorted contours but also bring vitality and youth to the skin through cell transplantation. Does fatty tissue bring this vitality and youth because it acts like stem cells? Research is currently being conducted in many countries to answer this question. Tissue injections are now also used preventatively at early ages (25 years) to delay aging.
Skin fragments removed during facelift, tummy tuck, breast reduction, or scar treatment consist of a mixture of muscle, fascia, and a small amount of fatty tissue. The dermis layer obtained from these tissues is the most valuable. When these vascular-rich tissues are injected under the skin as micrografts with a needle, their survival rate by revascularizing with surrounding vessels at the injection site is over 90%. This method is much more effective than fat injection and is therefore preferred. Its disadvantage is that it can only be obtained from excised pieces. If tissue fragments are removed from our patients during any surgery, we strongly recommend that a portion of these be immediately used for facial wrinkles, and the remainder be stored frozen at -196 degrees. Biological structures taken from oneself are called “autotransplants,” while those taken from another living organism (cattle, pigs, etc.) and prepared are called “heterotransplants.” This group belongs to the autotransplant category.
These filler materials revitalize in the injected area by receiving blood vessels from the surroundings and maintain their viability there as the body’s own tissue. The survival rate for fats is 50%, while for micrografts obtained from a mixture of dermis, fascia, fat, and muscle particles injected as a tissue cocktail, it is 90-95%. These tissues vascularize and survive there, but over time, they may again undergo resorption as part of our body due to our facial expressions and tissue loss. This resorption can vary depending on individuals’ structures, ages, and living conditions. The advantage of such tissue materials is that they are the person’s own tissue; the disadvantage is the need to harvest them from the patient each time. However, with a new method we have recently developed, fat or tissue particles taken for the first time can be stored for years by freezing them at -196 degrees, thus allowing them to be used again in the patient as a ready-made material without needing to be re-harvested.
Important Note: However, this method is similar to the technology used in In Vitro Fertilization, and tissues stored in regular freezers without this technology may lose their viability. Therefore, if this technology is not available, fat and tissue cocktails must be administered fresh immediately.
Fat Injections
The fat injection procedure, also known as “autologous fat transplantation” or “micro-lipo-injection,” can be defined as the removal of fat with a needle from the patient’s abdomen, thighs, hips, and other fat-containing body areas, and injecting it under the facial skin. Fat is most commonly applied to fill sunken cheeks, smile lines between the mouth and nose, correct depressions and irregularities in the skin, erase forehead lines, and plump the lips.
After both the donor and recipient sites are cleaned and numbed with local anesthesia, fat is extracted from the specified areas using a thick-tipped syringe or a thin liposuction cannula connected to a suction device. The harvested fat is processed as needed and then injected into the recipient site. Sometimes a thin tape is applied over the injection site. When used for purposes other than facial lines, such as filling sunken cheeks, correcting forehead depressions, or increasing chin fullness, it is natural to observe temporary swelling and localized bumps on the face after fat injection.
Patients who have undergone procedures in large areas should rest for a short period. However, most patients return to their normal daily activities immediately after treatment. Some swelling or redness can be expected in both the recipient and donor sites. You should avoid sun exposure for approximately one week until the redness or bruising at the injection sites subsides, and ensure necessary protection with sunscreen or foundation. The longevity of results obtained with fat injection varies from patient to patient. In some patients, this period can be expressed as one year or longer. In the majority of patients, almost half of the fullness achieved in the first week disappears after six months. This is because the fullness in the first weeks is due to swelling. After three months, it becomes more or less clear how much tissue has vascularized and remained there. New injections can be repeated after 3, 6, or 12 months to improve the result. While initial applications may be done two or three times in the first year, once a year may suffice in subsequent years. It is much more rational to apply them as reinforcements before your lines deepen further.
Location of Treatment Application
Dermal fillers can generally be administered in a surgeon’s office. However, if you have been admitted to a clinic or hospital for a facelift, neck lift, brow lift, or any similar procedure, filler injections can also be performed simultaneously in the hospital.
Type of Anesthesia: Both the recipient and donor areas are numbed with local anesthesia. Additionally, sedation may be used. However, in cases requiring sedation (tranquilizer), arrangements must be made for the patient to be driven home after the procedure.
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