NATURE OF THE PROCEDURE
All “fillers” are intended to elevate scars, wrinkles, or other tissue defects. This is done by carefully placing the filler at the level of the skin where it will do the most good – often at the presumed lowest level of the tissue defect. All of these work by adding their volume to the skin to a degree that will improve the previous loss of contour, whether it be from scarring, surgery, injury or wrinkling.
These mimic or replace substances normally found in the dermis (the deeper layer just below the superficial epidermis) that gives support to the skin. Some of these are as follows:
- Restylane, Juvéderm, Lyft, Voluma – Hyaluronic acid is a natural substance found in all living vertebrate organisms. These products are biosynthetically produced, and are not from any human or animal source. They are produced in the laboratory as a natural fermentation product.
- Voluma and Lyft literally gives volume to the upper cheeks. This “lifts” everything, and often obviates the need for other injectables at the nasolabial folds, or the “marionette lines.” It can also help the hollows under your eyes (the tear troughs).
- Radiesse® is one of the newest semi-permanent fillers. It is made from calcium hydroxylapitite. This material has also been used in vocal cord repair and bladder repair. It may last up to 12 months.
- Silk – This is another hyaluronic product made especially for the lips. It is smoother and silkier. This will fill the fine “smoker’s lines” (even if you have never smoked). It will give less chance of overcorrection or “duck lips.” It lasts half as long (three months) but costs roughly half as much.
All filling products come prepackaged in a sterilized disposal one-use only syringe and needle. We never store or re-use any leftover product, even on the same patient.
Side effects may occur. One may be allergic to any product whether ingested, injected, or applied topically. The allergy could present as swelling, itching, unwanted fullness, inflammation, or extremely rarely even be life-threatening. Dr. Coverman, since his first injection in 1981, has never had any patient have anything close to a life-threatening reaction to any injected filler. At worst, he has only seen minimal swelling and redness at the local injected site, and this has always cleared quickly completely, and without any further treatment. There will be a needlestick and any needlestick could inadvertently hit a small blood vessel and cause pain and bruising. Plan your school, work, travel, and social calendar around this – do not have this performed before an important social event because the bruising, although possibly minimal, may still be visible and not even able to be covered by makeup. Typically patients only have pinpoint bruises, but use common sense with your scheduling. Likewise, do not schedule this procedure just prior to a prolonged vacation at the beach or snow skiing. One week ahead of time is fine.
Injection – Because we are placing a needle under your skin somewhat blindly, that needle could be placed unknowingly within a blood vessel. When injected, the filling agent could plug up that blood vessel and cause loss of perfusion and hence tissue death in a local area fed by that vessel. This could present as a bruise, sloughing of the skin, or even ulceration, a scar and pigment. Usually this can be seen as it begins to happen and the procedure can quickly be aborted. Likewise, Dr. Coverman has never had any patient suffer any of the above serious reactions due to the inadvertent retrograde injection into a blood vessel.
Pigmentary change – There could be pigmentary change whether lighter or darker simply from inflammation or even the act of injection. Typically this would be minimal, pinpoint, and will either fade or could be bleached.
Infection – We use fresh needles, fresh product, and never store any unused product. The only syringe you get will be yours, and even if you don’t want the rest of it we will throw it away. We will never use our needles or syringes on anyone else, nor will we save yours to use on you later; it is no longer sterile once opened. We will wipe your skin liberally with alcohol swabs but still there could be infection. Again, Dr. Coverman has never seen any clinically significant infection from any of his treatment sessions. All of our products are purchased directly from the original USA manufacturer; never from a third party, overseas, or the Internet. We pay full price! If you go somewhere else ASK!
Pain – The procedure may be painful and some patients may literally be unable to complete the procedure. Once the syringe has been opened, however, it cannot be used on anyone else and the full fee will have to be paid even though all of the syringe wasn’t used.
Lumpiness – This is a foreign substance, and although safe it is injected just under the skin. One might be able to feel the actual material with the tip of the tongue or his or her fingers, but this is natural and expected. After all, we are injecting product where previously there was none. Rarely this could present as lumpiness or bumpiness which could be visible to others but in time this should fade away as the product itself is dissipated. Again, since 1981 and including literally thousands of injection sessions, Dr. Coverman has never seen any such persistent nodule.
Herpes – Some patients have underlying herpes whether known or not. The trauma of the needlestick itself could cause herpes to flare, and if we are aware of this history we will give you a series of anti-herpes pills to take the day before, the day of, and the after the procedure. Nonetheless, herpes could still “breakthrough” and this outbreak could cause pigment and/or scarring.
There are many alternatives for scarring, tissue defects and wrinkles. One can resurface the skin using lasers. One can use Botox to reduce wrinkles particularly between the eyebrows on the forehead and around the eyes, but this reduces wrinkles by paralyzing the muscles and not necessarily by filling in the wrinkle itself. Botox will not help any type of scar whether from acne or otherwise. It will not help any other tissue defect. Radiofrequency – There are other electronic devices that may claim to help scarring and wrinkles.
Microdermabrasion – Microdermabrasion is purported to help scarring and wrinkles – it is very weak, must be repeated on multiple occasions on a specific schedule, and generally will never approach either temporarily or permanently the effect of even one session of one of the fillers.
Retin A and other creams – Retin A and glycolic acids may stimulate collagen to grow and this collagen growth may and often will to some degree help fill in wrinkles by lifting them up from below. Dr. Coverman does not believe that Retin A or these topical products alone can replace the fillers and certainly cannot perform this improvement as immediately or as dramatically as any of the fillers. Nonetheless, Retin A specifically is FDA approved for wrinkles and any patient contemplating fillers should try to use Retin A or any of the legitimate topical retinoids in a daily basis if tolerated whether they use the fillers or not. Retinol is NOT Retin A!
Facelift – A facelift can obviously improve wrinkles – facelifts have complications including much more severe risk of infection, the risk of an abnormal looking face afterwards, and of course dramatically higher costs.
Permanent implanted devices – One can implant devices in the chin, forehead, or even on the high cheeks to “lift” the sagging skin below. The implantation of these devices has its own risks including scarring, infection, or even migration of these products. One could even be allergic.
Other fillers – There are other fillers including silicone, Artefill and Sculptra. Dr. Coverman does not use nor recommend any of these but you are welcome to consult with other cosmetic surgeons that do and seek out their opinion. After that consultation you may make up your own mind.
Peels – Certain peels can help erase pigmentary defects, wrinkles, and scars, heavier peels including 50% TCA peels and phenol peels and lighter peels are available. The lighter peels will take multiple sessions to work and the heavier peels have their own potential side effects again including infection, scarring, and abnormal pigmentation.