American Society of Plastic Surgeons
For Medical Professionals

Injectables Safety with Dr. Anne Taylor

Are you considering a way to soften and reduce the appearance of wrinkles and lines on your face? Before you choose an injectable or filler to smooth and shape your face, the American Society of Plastic Surgeons and the Food and Drug Administration recommend you do your homework. A few things to consider as you plan your procedure include:

  1. Find a board-certified plastic surgeon who specializes in fillers to conduct your procedure.
  2. Talk with your board-certified plastic surgeon about appropriate treatment injection sites and the risks associated with the procedure.
  3. Be aware that FDA has reviewed and approved different products for use in different areas of the face. The FDA may not have reviewed the use of certain soft tissue fillers for all locations in the body.
  4. Ask your board-certified plastic surgeon about their training and experience injecting soft tissue fillers in the face.
  5. Read and discuss the patient labeling for the specific filler you are receiving. Your doctor can provide this information.
  6. Seek immediate medical attention if you develop symptoms such as unusual pain, vision changes, a white appearance of skin near the injection site, or any signs of stroke (including sudden difficulty speaking, numbness or weakness in your face, arms, or legs, difficulty walking, face drooping, severe headache, dizziness, or confusion) during or shortly after the procedure.

In May 2015, the FDA alerted health care providers and consumers about rare but serious injuries that may occur due to unintentional injection of soft tissue fillers into blood vessels in the face. According to the FDA summary, the unintentional injection can block blood vessels and restrict blood supply to tissues occasionally resulting in embolization or the formation of clots in the blood vessels. According to the FDA, symptoms of this injury may include vision impairment, blindness, stroke and damage to the skin or underlying facial structures. Blood vessel blockage has been reported most often in the skin between the eyebrows and nose, in and around the nose, forehead and around the eyes – key locations for fillers. If improperly injected into a blood vessel, the filler could cause permanent scarring.

"Select someone who is trained and knows the anatomy and map of face," says Dr. Anne Taylor, who specializes in cosmetic surgery in Columbus, Ohio, "and only go to a board-certified plastic surgeon's practice."

The American Society of Plastic Surgeons can guide consumers through their choices of which fillers to use while also emphasizing the importance of research and seeking out medical professionals to conduct the minimally-invasive procedures.

"They're predictable and safe," Taylor confirmed. "I would recommend a board-certified plastic surgeon not your family physician or gynecologist to perform the procedure."

Fillers are used to plump up parts of the face that have gotten smaller or deflated due to fat atrophy or aging of the skin, fat and bone, Taylor explained. Dermal fillers are used to plump different areas and depths, and are composed of a variety of formulations. A few examples follow:

Hyaluronic acids are carbohydrate substances already in the body so these products are considered natural and popular because they work well and last up to one year. These fillers act like an inflated cushion to support deflated facial structures and tissues while enhancing the look and feel of the skin. Hyaluronic acid fillers may be used to plump the nasolabial folds, as well as wrinkles and depressed scars.

Collagen is a firm, insoluble and fibrous protein in the human body and often used as a supplement and filler in cosmetic surgery. It's used to touch up wrinkles around the mouth and forehead or to create fuller lips. Many of these fillers may last up to 4 months.

Calcium hydroxylapatite, considered the thickest of facial dermal fillers, is used to fill moderate to severe creases in the face such as frown or marionette lines around the nose and mouth or to contour the cheeks.

"They all have pros and cons and it's important for patients and physicians to discuss the best options," Taylor said. "It's highly personalized and individualized by surgeon and patient. They all work great. They're predictable. But the bottom line is having someone who knows how to do it. Do your homework and find a board-certified plastic surgeon who specializes in cosmetic treatments of the face."

Overall, the products are designed for middle-aged women, she said, and procedures are rarely done on anyone younger than 30 years old. Men interested in the procedures are also on the rise, she said. As the body ages, the face contours appear to cave in and fillers can be added around the eyes, mouth, temples and in the apple of the cheek to make the face appear younger.

"It's important to educate the patient about the pros and cons and understand what is best for them," Taylor said. "If the patient says, 'I want to look a certain way,' the doctor will say, 'this is what we have.' It's hard to educate patients about what to expect, so part of the process is actually trying the products out to find the one you like! Talk to a physician who is experienced in all the fillers, and realize there eventually needs to be some surgery because fillers are temporary."

Read the Food and Drug Administration's May 2015 statement on soft tissue filler safety.


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