Fillers

+ What are temporary fillers?

This is a product that is injected into facial wrinkles to blunt or camouflage the wrinkle and gives a more youthful appearance to the face. It can also be used to increase volume in certain areas of the face to give the appearance of a fuller more youthful face.

+ What are the types of fillers?

The original fillers were a form of collagen taken from cows (bovine collagen) or shark collagen. There was a significant allergic reaction risk with these products. Patients having collagen injections required a skin test and a waiting period for one week before undergoing treatment.

Today, collagen has been replaced by an injectable product called hyaluronic acid, which is a clear gel like substance. It comes in varying viscosities designed for different uses within the face (very fine wrinkles, deeper wrinkle, and volume filling).

There are a number of products available, each produced by different pharmaceutical companies. The more common product names are Resytlane and Juvéderm.

Allergic reaction to these products is rare and pre injection skin testing is not necessary.

+ How is the Filler injected and how long does it last?

Using a very fine needle, the desired crease being treated is injected, filling out the crease to blunt or eliminate it. Deeper creases require more filler.

Patients requesting a volume increase to certain areas of the face (like the cheeks or lips) will require more volume and a different viscosity of hyaluronic acid product to achieve this result.

The duration of the effect is very patient variable. Typically the effects are between 3- 6 months although some patients enjoy the effects for a year to 18 months.

+ Are there risks with temporary filler injections?

Hyaluronic acid filler injection is very operator dependant. An experienced medically trained practioner is advisable.

Dr. Giuffre has a highly trained Registered Nurse that treats patients with temporary filler and Botox in his surgical suite under supervision.

Please see https://www.meadowlarksurgicalcosmetic.com

Placing filler around or in the eyelid skin is inadvisable.

Rare allergic reactions are treated with an injection of a product called hyaluronidase, an enzyme, which eliminates the local filler.

These fillers are temporary and their effects are short lived.

Patients can trial the temporary product to see the cosmetic effect before proceeding to more permanent fillers (fat grafting). This has application to patients considering a permanent increase in facial volume around the temple, cheek bones, cheek and upper and lower lips.

+ Risks for temporary filler enhancement for facial creases:

• Scarring (rare)
• Infection (rare)
• Pigmentation change which can be darker or lighter pigmentation to the area treated
• Prolonged redness (erythema)
• Early Recurrence of the wrinkling (under filling)
• Overfilling leaving a contour deformity. This is more likely with very thin skin like the eyelid skin.
• Prolonged irregular surface of the skin (seen with filling of the eyelids -this is not recommended)
• Skin damage (necrosis)
• Allergic reaction
• Asymmetry
• Expense

+ What is fat grafting?

This surgical technique takes fat from one part of a patient’s body using a form of liposuction. This fat is then prepared and then injected into another part of the patient’s body that requires filling or correction of a contour abnormality or increased tissue volume. Only the patient’s own fat can be used (a friend or relative cannot donate some of their fat).

+ How is it done?

The procedure can be done under local anaesthesia (freezing) if the area of fat grating is small or under general anaesthesia if the area is too large to freeze properly.

• Fat is removed from an area in the body (tummy, thighs, hips or a heavy neck) using a liposuction technique.
• The fat is then prepared and then loaded into small syringes for injection into the desired area using a very small cannula (this is like a small injection needle with a blunt end)
• The desired amount of fat is then injected into the area to be treated.
• There are minimal if any sutures and virtually no scarring
• The patient is allowed to shower the following day and often can return to work the next day unless a large area of fat harvesting and grafting was done. A week off work would be advisable if there is significant bruising.
• Strenuous exercise should be avoided for 3 weeks

+ When is facial fat grafting done?

This technique can be done as an isolated procedure to correct specific cosmetic concern in the face, or it can be done in combination with other facial surgery like a facelift or brow lift or eyelid surgery.

Please see FAQ Facelift & FAQ Browlift

Common areas that are fat grafted in the facial area are:

• the upper cheek bone area (Malar Projection)
• the temple areas (these tend to hollow out as the face ages)
• the lower cheek area which can hollow as the face ages
• the nasolabial creases
• the lips (upper and lower)
• the chin and around the jowl area of the jaw line

+ What are the risks of Fat grafting to the face?

With any surgery there are surgical and anesthetic risks.

Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:

• Infection
• Bruising
• Bleeding (hematoma)
• Swelling
• Sensation change
• Discomfort

Rejection:

When fat is removed as a fat graft, it no longer has a blood supply and is essentially dead. If it does not get a new blood supply, the fat cells will die and turn to oil. Your body will remove the oil as waste. When the fat graft is injected in to the recipient site (like a cheek), it must survive by being nourished by a new blood supply from the recipient site. A recipient site that is healthy and minimally scarred will grow blood vessels into the fat graft and keep the fat alive. Only the fat graft that has a blood supply will remain and provide the contour fill correction desired.

Symmetry:

If more fat graft survives on one side of the face compared to the other side, then some degree of asymmetry may result.

The donor site, where the fat is taken from using a liposuction technique (*Please see FAQ Liposuction) will be reduced in size. If a large amount of fat is removed, some degree of skin looseness may result. This area may be bruised and swollen after surgery for a number of weeks

Time off work and exercise

*This list is not complete.

During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.

+ How often do I need to come back for a checkup after the surgery?

Postoperative visits include:

• A 1 week post operative visit.
• A 6 week visit in the office to review the preoperative photograph and the surgical result.
• The patient is allowed to shower the following day.
• Aggressive sports activity should be avoided for 3-4 weeks.

If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.

After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.

+ Will AHS (Alberta Health Services) cover Fat Graft surgery?

Fat graft surgery for Facial cosmetics surgery is not covered by Alberta Health Services.

+ Can I finance the costs of the surgery? How do I do this?

Dr. Giuffre does not provide in house financing for cosmetic procedures.

There are a number of companies across Canada that will finance cosmetic surgery, similar to car financing or mortgages.

Please refer to the links provided for this information. Dr. Giuffre has no financial or business relationship or affiliation with any of these companies.