FILLING

It refers to the technique used for the treatment of deep wrinkles, bands, cavities as well as for lips contour augmentation.

WRINKLES

Deep wrinkles and lines (e.g. laughter lines) can be lessened by injecting or implanting determined substances into the dermis. These must be placed right under the dermis in order to elevate the cavity, i.e, the wrinkle, and remove it. A wide range of materials can be used:

• Fat (lipofilling): it is usually obtained from the abdomen through liposuction. Its main advantage lies on its non-allergenic results, since it is the own's patient fat. However, its effect is temporary. The fat is re-absorbed and it disappears in 3-6 months after the injection. Occasionally, and because of repeated treatments, the wrinkles do disappear. However, this is not due to the treatment itself but to the series of traumatisms that appear after several injections. Dr. Coleman's technique has been recently introduced, which seems to obtain better results regarding long-term permanence of the injected fat. This fat is centrifuged before being injected in order to eliminate fat-free acids, which cause the adipocytes death.
• Collagen: collagen is injected into the dermis to fill the cavity. The collagen that is currently available has got a bovine origin, so there is a risk for allergic reaction. Like lipofilling, its effect is temporary and it is re-absorbed between 3 and 6 months afterwards. Another kind of substance has recently appeared in theU.S., Dermalogen, which is collagen with human origin and it seems to offer a more lasting permanence.
• Hyaluronic Ac.: it is a relatively new product that does not provoke any allergic reaction apparently. However, its permanence lasts no more than one year. Dermalive is a combination of hyaluronic acid and particles of acryllic hydrogel, which do stay.
• Artecoll^r: it is a compound of methylmetacrylate microspheres. Its effect is more definitive since the organism covers these microspeheres with both connective tissue and scar, so the result stays in spite of the collagen reabsorption. Nowadays, it is one of the most useful products for wrinkles, laughter lines and lips filling.
• Goretex^r: is expanded polytetrafluoretylane. It is quite an innocuous material, that is, it is well tolerated by the organism, with no rejection at all. This material is being used for vascular implants, tights for herniae, etc. It is especially useful for filling the laughter lines and the frowning wrinkles. The result is everlasting. At the very beginning there is maybe a sensation of having a foreign body in the skin, but this effect disappears quite soon. Goretex can be either formed by filaments or by a small diameter tube (Softform).
• Silicone: the use of liquid silicone for injections is absolutely banished by Health Depts. Its effect is definitive but it causes a lot of problems (granulomata, fistules,etc) that require extremely difficult treatment.

LIPS

For people with very thin lips, due to physionomy or ageing, lips contour can be augmentated by injecting or implanting specific materials. Above mentioned materials are used, though Artecoll is one of the most useful. On the other hand, there are some surgical techniques for those patients who do not wish to have foreign bodies.

BOTOX

Or botulinum toxin. It is the toxin's active fragment produced by the Clostridium botulinum. It provokes a muscular paralysis since it interrupts the transmissions from the nerve.

It is used in those zones with active wrinkles: crow's-feet, neck bands, frowning wrinkles and forehead's lines. It does not require anaesthesia and the result is the disappearance of the wrinkles due to muscular paralysis. The effect starts four or five days after the injection and lasts approximately three months.

LASER

Resurfacing with laser is a very recent technique. Its applications for health treatment have been thouroughly analysed during these last years, especially for Plastic Surgery and Dermatology. There are several kinds of laser and its applications difer according to the sort of beam used. Nowadays, vascular marks, tattoos and pygmentations are being successfully treated with laser. However, this success mainly refers to its application for facial rejuvenation. The used laser is CO_2,Erbium-CO_2,Erbium-YAG. Thanks to the technology, the laser beam can be emitted in a very short span of time with determined energy so that tissue can evaporate without being burnt. The laser destroys the most superficial layers of both dermis and epidermis. Thus, it stimulates skin and collagen regeneration, i.e, a new skin is formed. On top of that, it causes a retraction of the skin, 'ironing' the thinnest wrinkles. It is especially useful for periocular lines, crow's-feet and lips wrinkles.

Its main disadvantage is that it requires pre-and-postoperative skincare treatments. The initial cures are troublesome since it is a new skin and therefore, it needs moisturizing, protection against infections (especially herpes) and high sun protection. A redenning may occur, depending on the skin type. This can last almost three months.

PEELING

It consists of using chemical products that exfoliate (peeling) the most superficial skin layers, with the same effect as laser's. A new epidermis and collagen are created. Thus, peeling is useful for small wrinkles. There are several kinds of peeling:

- Glycolic acid: up to 50% or 70%. There are also some cosmetic products that contain this acid at an 8% or 15% and that produce a similar effect to that of peeling.

- TCA. Trichloracetic: at a 25% or 30%. I also use TCA for the eyelids, along with trasconjunctive blepharoplasty.

- Phenol. It needs to be performed in the operating theatre.