Maintaining Your Fillers: How Often Is It?

Foreign. Question we get is how often or what time frame do I need to maintain my fillers? So we'll go over some of the properties of fillers so we better understand that. So the typical fillers we use are called hyaluronic acid or hyaluron. Even though it has a word, acid, it's not acidic, it's just a chemical nature of it. And the hyaluronic acid is found in your tissues, in this case the hyaluronic acids, because they turn over your body all the time. These are cross linked, meaning branches of hyaluronidation are branched together, cross linked so they resist breaking down. However, most of the breakdown occurs within 24 hours of when it's first injected. When we look at a syringe of filler, it's about 98% water and 2% hyaluronic acid. The hyaluronic acid is water loving. So most of what you're feeling is the water. It's like your body, 70% water. In this case it's 98% water. When the injection is done, there's a little bit of trauma from it. And your body makes something called reactive oxygen species. Reactive oxygen species or ROS that break down a certain percentage of the filler. So we lose a little bit over the first few days. And then naturally through time and motion, let's say you do filler on your lips, there's a lot of movement from talking and reactive oxygen species are awakened again and it slowly breaks down and it's redone. Other areas, say the temples under the eyes and nose, where there's very little motion. It could last for years or a decade because there's very little motion. We can't ever say it's permanent because we don't really know that. But it potentially is permanent in certain areas with low motion. The other thing that happens when you do fillers repeatedly is your body starts to more or less ignore it. So if you did fill on your lips once, then you do it a few months later to give it kind of bump it up a little bit. Now you're putting filler inside a filler and there's less reactive oxygen species to expose it to the filler. So we see a little bit less breakdown. And over time, when people get their lips done repeatedly, it starts lasting longer and longer. One example I had when I first learned about this understanding, it was, you know, 20 years ago when these first came out, about 06, 05 or 06 and I had patients that we would do their lip fillers and they got kind of on the fuller side where they were really happy with them and they'd maintain and then I wouldn't see them for five to seven years. They come back and their lips were still fuller than they were to begin with. But they weren't quite as full as they were when they got their third or fourth, fifth treatment. So there is some degree of permanence. And some people think it's from stimulating collagen. There might be something to that. More likely your body starts ignoring the filler when it's been done repeatedly. Now, we can put additives into the filler that can take the hit of the reactive oxygen species. There's certain sugar alcohols that can do that. They can cross link them in different fashions. And these were something that companies do to make them break down less. But that's just the nature, nature of it. Now, the upside to using the hyaluronic acids over other fillers are that they are very predictable and they are reversible. That's a big one. Because problems occasionally do occur. Once in a while it's injected into an artery or vein that can be a problem. It can be dissolved with hyaluronidase which is an enzyme that breaks down hyaluronic acid. Is pretty much instantaneous. So that's the advantage of hyaluronic acid over some other fillers. It might be considered permanent. But we choose to use a hydroc acid over the permanent fillers because they have some characteristics of permanence. Again, doing it repeatedly or in areas with low motion. Adding something to it to keep it from breaking down from reactive oxygen species. Predictability and safety. Now, collagen was the first filler. I had used that back in 03 and 04. That was the only game in town. Was actually a nicer filler to use. It was easier to use in my hands. However it would break down in weeks. So we did abandon that. And then Radiesse is a popular filler. Is made out of something that would be akin to a bone paste. I like that. Now, that case it's 70% of the bone paste and 30% of a carrier. So we lose a carrier. But we're seeing with the calcium also hydroxyapatite or radiesse is that when you inject it into an area that needs, let's say where there's some loss of bone. Chin, cheekbone. These are areas where we don't have much concern about reversibility because there's not critical arteries in those regions. It does turn into your own body's tissue and it's known to last several years. Now it might be permanent. We don't have studies showing something permanent because you know, it's only been out for 20 years. But it does turn into your own tissue. And that's a nice opportunity to use radiesser calcium hydroxyapatite in areas that we don't concern about safety. It's not suitable for say the lips. Some people have used silicone in a micro droplet fashion. And each time you put in a droplet of silicone it makes a. Basically like a scar around it or biofilm. And that's what gives it the volume. We're not crazy about that because when problems occur it has to be removed. And there's other fillers such as Bellafill and Sculptor that are, have some permanence to them that again have some potential issues with nodularity and stuff. So we haven't, haven't been routinely offering those. So how often should you do it would be the one question. Well, for lips, typically we're seeing that somebody gets their lips done about three times in the first year and then about once every year to year and a half after. After that. That seems to be where they get some degree of, you know, has to build. You can't put on three syringes all at once because they kind of globs up. But you can put about a CC at a time, 0.8 to 1 CC at a time. Three times over a year is typical to get a fuller lip because of talking in motion. There are some breakdown and it might be maintained every year to year and a half in filler and other areas such as the cheeks with hyaluronic acid probably lasts about two years. We prefer to use radiesse in that region. When we use it under the eyes or in the temple is very low motion. We use an additive so that so it doesn't break down when you first inject it. And that does last several years, maybe a decade or more. And there's other factors as well. There's. You might have more mobility, your body might be more metabolically active to break them down. But they do last a long time with the exception of the lips. Maybe the nasal labial folds or people use straight hyaluronic acid. I'm not a fad fan of that. That's not the proper way to do that. That will break down as well because of the motion. And then the cheek filler is probably more suitable to use more of a long lasting filler such as Radiesse. Thank you.