Wrinkle Treatment with Hyaluronic Acid – Treatment with Fillers

Due to the addition of an anesthetic in the ampoules, the treatment is minimally painful. Lip treatment is probably the most uncomfortable of all treatments, as there are many nerve endings here, which is why we apply a strong anesthetic cream beforehand in my practice. Additionally, for particularly pain-sensitive patients, we have some tricks to make the treatment less uncomfortable.

This question cannot be answered generally. It depends on your wishes and expectations, as well as the region and your individual anatomical conditions. My personal opinion is that less is often more. Only in very rare cases would I inject more than 1ml of hyaluronic acid into one region in a single session. It is better to build up the region gradually and reinject if necessary. This allows the tissue time to adapt well and avoids an unnatural appearance.

Hyaluronic acid can be dissolved again with the help of an enzyme called Hylase or Hyaluronidase. This is used when the result is not satisfactory, or in the case of unwanted side effects, such as small nodules. Nevertheless, the fact that hyaluronic acid can, in principle, be dissolved again should not lead one to undergo treatment thoughtlessly or with dubious providers.

On the one hand, dissolving a poorly placed filler also incurs costs, and on the other hand, I unfortunately often have to turn away patients in my practice who come to me wishing to dissolve unsightly filler results that were performed in other practices (sometimes abroad or by somewhat “questionable” providers) because the result is anything but what was expected. The problem is that only pure hyaluronic acid can actually be dissolved. If it is not clear what kind of filler was used, because the patient does not know and the previous practitioner is “untraceable,” unfortunately, dissolution with Hylase cannot be performed. Another reason to pay close attention to where you get treated.

On the one hand, fat grafting should be mentioned here, where fat is taken from another part of the body, often during liposuction. However, it should be noted that the results are not always precisely predictable, as only a portion of the autologous fat takes, and the rest is broken down. For this reason, more fat must be transplanted than is required, and the final result can only be assessed after some time.

Furthermore, there are also injections with materials such as calcium hydroxylapatite or poly-L-lactic acid, like the biostimulator Sculptra, which stimulate the body’s own collagen synthesis and thus contribute to skin tightening.

In addition, there are various types of permanent silicone-based fillers, which actually belong to the past, as their disadvantages clearly outweigh any benefits, and sometimes very unpleasant side effects can occur. I strongly advise against the use of such silicone materials for wrinkle treatments. Not only can they not be dissolved, but they sometimes also have a tendency to “migrate” and “slip.” Unfortunately, I still occasionally see patients who, due to poor advice, have to live with the consequences of such treatments. In these cases, surgical removal of the poorly placed material by an experienced plastic surgeon is usually the only option, and even then, scars remain.

The answer to these questions depends on several factors. Depending on the region injected and the type of hyaluronic acid product used, the result can last between 6 months and over a year.

In regions that are highly mobile, filler is broken down faster than in areas with little movement, such as the tear trough. Soft fillers placed superficially have a shorter duration than firmer materials injected deeper.

Naturally, I exclusively use highest quality hyaluronic acid from reputable EU-approved manufacturers. Depending on the region, I believe different products are best suited, and for some regions, such as the tear trough, some companies have actually developed special hyaluronic acid products that possess precisely the properties best suited for that specific area. I strongly advise you to only have filler treatments performed by experienced doctors to ensure that only certified and safe materials are used.

• Patients should be healthy.

• There should be no acute infections in the area to be treated, for example, herpes infections during lip augmentation.

• In the 10 days prior to the planned treatment, no pain-relieving or fever-reducing medications such as Aspirin, Ibuprofen, or Diclofenac should have been taken. It is advisable to pause the intake of any dietary supplements and vitamins for a few days.

• No antibiotics or cortisone intake 10 days before treatment.

• You should avoid alcohol the day before and on the day of treatment.

• A minimum of four weeks should pass between vaccinations and treatment.

• If you are on therapy with strong blood-thinning medications, consultation with your treating internist and a strict risk assessment should be carried out before treatment with hyaluronic acid products.

• Dental treatments should have been completed at least two weeks prior (exception: normal oral hygiene).

• Makeup should not be applied to the treated area until the following day at the earliest.

• For one week after the injection, avoid saunas, steam baths, solariums, and intense sunbathing.

• No cosmetic treatments such as lymphatic drainage, dermabrasion, or permanent makeup in the treated area for two weeks.

• Cooling is allowed.

• No vaccinations for the next four weeks.

• No alcohol on the day of treatment.

• No dental treatments for the next two weeks.

• No sports for 48 hours.

• For lip injections, no kissing for 24 hours.

In certain cases, hyaluronic acid injections cannot be performed. These include, for example:

• Pregnancy

• Breastfeeding

• Patients under 18 years of age are not treated with hyaluronic acid without exception.

• Certain autoimmune diseases such as rheumatic diseases or lupus (SLE).

• Acute or chronic infections

• Untreated dental infections

• Acute cold sores

• Ongoing antibiotic therapy

• Existing therapy with blood-thinning medications

• Known allergy to hyaluronic acid or local anesthetics

• Chemotherapy within the last 12 months

• Known wound healing disorders

More precise details concerning your individual situation should be discussed with your treating physician in a personal consultation.

Occasionally, small hematomas, slight swelling, and minor tenderness of the treated area may occur. However, these symptoms usually subside after one to two days.

In rare cases, hyaluronic acid can cause an allergic reaction.

Occasionally, especially if the practitioner is not sufficiently well-trained, vascular occlusions can occur. Therefore, it is important to discuss all possible side effects with your treating physician beforehand to ensure that hyaluronic acid treatment is suitable for you.

Some patients find it pleasant to cool the treated area at home. Your doctor can best advise you on your individual case. Makeup should not be applied to the treated area until the following day.

After a lip injection, you should avoid kissing for 24 hours.

Since slight swelling or small bruises can occur after any injection, and especially after lip injections with hyaluronic acid, these can even persist for several days, I recommend not scheduling the injection immediately before important social events. However, you can easily resume your normal daily activities immediately after the treatment.

The answer to this question is a clear NO, and the same applies to breastfeeding. Hyaluronic acid products are not approved for pregnant and breastfeeding women and should therefore not be injected. Dissolving hyaluronic acid with Hylase is also strictly prohibited during pregnancy.

Depending on the region injected with hyaluronic acid, the treatment itself takes between 10 and 30 minutes. However, you should also allow time for the preceding consultation and informational discussion, as well as for photo documentation. In total, you should therefore expect to spend about 45 minutes to an hour during your visit.

Different hyaluronic acid products can vary in their physical properties, such as firmness or elasticity. Depending on the region being injected and the depth at which the material is placed in the skin, different product properties are required. For example, if I want to inject a highly mobile region like the lips, a filler material is important that does not lose its shape despite the many movements our lips make daily. If I want to treat very fine superficial wrinkles, I need a very soft filler that integrates very well into the tissue and is not visible even when placed very superficially. If, on the other hand, I want to emphasize the cheeks and cheekbones, a product with more firmness is required to effectively shape the tissue.

Thin, older skin or a very delicate face can only tolerate softer fillers so that the material remains invisible.

For special regions, such as the tear trough, it is particularly important to choose a product that does not retain water afterwards, to prevent unwanted swelling in the eye area.

A doctor with sufficient experience will select the optimal product depending on the region to be treated and the patient’s wishes and expectations.

This depends on the individual situation and is handled differently from case to case. A sharp needle allows for particularly precise injections, and even the smallest amounts can be injected very superficially. A soft cannula, on the other hand, is less traumatic and allows for the treatment of larger areas and particularly delicate regions such as the tear trough.

For wrinkles that are primarily caused by increased facial expressions (e.g., frown lines or worry lines on the forehead), treatment with Botulinum toxin is a more suitable method than a hyaluronic filler. A hyaluronic acid injection would not yield optimal results.