Procedures




Reconstructive Plastic Surgery

 
 
 
 
 
Injectable skin and soft tissue fillers

Permanent skin wrinkles or sunken skin and soft tissues can be rejuvenated using injectable fillers.

Hyaluronic Acid (Juvederm®)

Hyaluronic acid is a naturally occurring protein which, when manufactured in the body is used by it to form much of the structural support for our connective tissues.

When injected it acts as a temporary filler, typically lasting for 8 - 12 months when injected into wrinkles and about half as long in lips. That said, different people have different results and the noticeable difference can be longer or sorter in duration than the averages quotes by manufacturers and the licencing authorities such as the FDA in the USA whose data are often quoted.

It should not cause allergic reactions, because synthetic hyaluronic acid has an identical structure to that which is produced in your body naturally – but there is always a theoretical risk of allergy. However, as with anything that is injected, a breach in the skin carries a small risk of infection.

The injections are uncomfortable, but patients rarely need anything for this and Juvederm® formulations that I use mostly have local anaesthetic included in their formulation.

Fat

Using a syringe to extract it from your abdomen, thighs or buttocks, I can then separate off pure fat cells and re-inject them beneath deep wrinkles and troughs in your forehead and facial skin or into your lips to fill them out. Fat aspirates contain stem cells and so as well as “filling”, fat has a rejuvenating effect as well – improving skin quality.

For the technique to work and last, the newly injected fat cells must be successful in deriving a new blood supply in the region into which they are injected. Not all do, so a certain degree of over-injection is necessary on the basis that not all cells will survive. The disadvantage of this, is that you will look swollen for some weeks after your treatment. Getting good results with fat injection is unpredictable and somewhat of an art, but when it works, results are long-lasting with most patients finding at least 50% of the augmentation remains at 6 -12 months with improvements in overlying skin quality which last much longer.

An allergic reaction won’t happen, because you won’t react to your own fat, but as with anything that is injected, a breach in the skin carries a small risk of infection.

You will need local anaesthetic injections both at the sites from which fat is harvested and the site(s) into which fat is being injected.

Poly-L-lactic Acid (Sculptra ™)

The fundamental difference between Sculptra™ and hyaluronic acid fillers such as Juvederm™ or Restylane™ is that it doesn’t give instant results; on the other hand, it tends to give longer lasting results and if you’re likely to need between 2-4 syringes of filler to achieve your facial rejuvenation, the Sculptra may be the more cost effective solution when viewed over 2-3 years.

In a different structural form, this substance has been used extensively in surgical practice for decades as dissolving stitches for the skin and subcutaneous tissues as well as plates and screws used to fix fractures and bone defects.

As an injectable solution (New-Fill™ and then Sculptra™) was first licensed for use in treating HIV patients who, as part of their disease process, had lost facial fat resulting in hollowed, malnourished looking faces. Since its introduction in 1999 over 150,000 patients have been treated with Poly –L-lactic acid, with excellent and sustained results.

It is a long-lasting, biocompatible and biodegradable substance, which I have used in both reconstructive and cosmetic practice. When used on suitable patients, for suitable cosmetic problems, it will gradually produce a natural-looking improvement that may last for up to 2 years.

After an injection of Sculptra™ under the skin, the area in which the injection is placed is stimulated to make new collagen, the skins structural protein, which results in less skin wrinkles and more volume. The improved, more youthful appearance that results can last up to 2 years.

Although results are noticeable within two weeks, improvement continues for weeks after that and a final result can be seen about 3 months after injections.

As with anything that is injected, a breach in the skin carries a small risk of infection.

Sculptra is generally best used for correcting deeper, more pronounced facial wrinkles and folds: between the nose and the mouth (nasolabial folds); the “bracket shaped folds either side of the mouth running toward the chin (marionette lines) and hollowing of the temples upper outer aspects of the face where the forehead merges with the skin beside your eyes. It can also be used on the backs of the hands to plump out old looking withered skin – this is a novel and technically “off-label” use of sculptra.

Cautionary notes
During your consultation I will take a full medical history.

  • I will also ask you about past allergic reactions and allergy-related illnesses; or whether you have any history of abnormal scar formation (especially keloid scars). If you do, then you may not be suitable for these fillers.
  • Likewise patients who take anticoagulant medication (including regular aspirin treatments –whether prescribed by your doctor or self-administered) are not best-suited to these treatments because bruising will spoil the results and the process by which the bruise is repaired by the body will also remove much of the filler.
  • After injections, you may have discomfort, redness, bruising, bleeding, itching and swelling. Bruising is the most common side effect.
  • Other side effects may include small deeply palpable lumps under the skin Most of these can be resolved with massage.
 
 
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