Hyaluronic Acid Dermal Fillers
Injectable hyaluronic acid products are “fillers” used to fill in wrinkles and depressions such as acne scars. Hyaluronic acid is a substance produced in the dermis of the human skin that becomes depleted over time as one ages. Hyaluronic acid is able to hold 1000 times its own weight in water and is widely seen to contribute to the plumpness and fullness of the skin. These products are widely used to fill in the creases from the nose to the mouth, acne scars, chicken pox scars, plump lips, and lift the corners of the mouth in those individuals with a frowning appearance. These products are not used to fill in sullen cheeks, thin skin on the back of the hand, or thin wrinkles such as seen around the eyes.
These products are injected into the second layer of the skin with or without anesthesia. As this can be quite a painful procedure, topical, local, or regional anesthesia is usually recommended. Topical anesthesia may be done with topical EMLA 1 hour prior or LMX .5 hours prior to the procedure. Local anesthesia is usually not done because those injections may distort the region intended to be filled with the substance. Regional anesthesia is usually done by dental blocks as is usually done by the dentist. Other than anesthesia, there is no other preoperative procedure that must occur.
The effects of the injections are immediate and are often overemphasized since swelling and redness acutely accompany the injection. There is no post-operative care that must be undertaken by the patient after injections except for ice packs that may be placed on the area immediately after the injection and for some times afterwards to minimize swelling, redness, and pain.
The effects of the injections should last for 5-8 months. Complications of the injections include pain, bleeding, bruising, lumpiness, or unevenness. In addition, rarer and more serious complications such as arterial occlusion and/or skin necrosis may occur. The effects of the injections are temporary, and any unevenness or lumpiness will resolve within 5-8 months. Corrections or modifications should be done 2-4 weeks after the initial injections in order to assess the final appearance prior to re-injection.
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