Facial Fillers

All medical procedures have risks and fillers are no exception. The most common risks include some minor bruising or swelling. Allergic reactions are rare, but they can occur months or years after the initial treatment, usually in the form of a hard bump. Most fillers are made from hyaluronic acid, which is fully dissolvable. Finally, there are reports of accidentally injecting into a blood vessel, which could cause a scar, stroke, or vision loss. Fortunately, this is exceedingly rare, and we take many precautions to avoid this problem. The full list of potential complications will be reviewed with you at your consultation.

There are many filler products, and more are emerging every day. Most are made from hyaluronic acid building blocks, which is the safest, and is dissolvable. Within the hyaluronic acid products, there are many manufacturers. Each product has its own unique biologic behavior based on many of its properties. And then there are the non-dissolvable products. Some are being marketed as “collagen builders”, typically lasting a few years, while others are permanent. Dr. Enzer and Ashley Wright, N.P. will evaluate your needs and formulate a plan customized to you for your treatment to give you the best result possible.

All filler manufacturers must receive a license for use in the United States from the FDA. They typically apply for use in one area of the face. Sometimes they apply for additional areas afterwards. State and federal laws permit “off label” use, meaning we are allowed to inject an approved product into other areas of the body and this is done routinely. While mainly used for the face, virtually all areas of the body can be injected with filler. Do you have something in mind? Please discuss which area you would like to receive fillers when you have your consultation with Dr. Enzer or Ashley Wright, N.P.

While there are distinct differences about what each can achieve, fillers and fat transfer share the common goal of volume restoration. While there are a few permanent fillers, most fillers used today last a few years. Fat transfer, while slightly less predictable and requiring a minor surgery, is more natural and lasts many years.

For those interested in a longer-lasting and more natural solution, we recommend fat transfer. This procedure can be used for lip augmentation, to smooth nasolabial lines, fill cheeks, or to fill other depressions on the face or body. Fat transfer uses one’s own fat, thereby eliminating any risk of rejection or allergic reaction. There are minimal pain and discomfort with this procedure, which can be done either in Dr. Enzer’s office or in an outpatient facility.

Several years ago, Dr. Enzer devised a technique for full face fat transfer, which, in some cases, replaces the need for more invasive face-lifting. This procedure has become very popular across the country, as it gives patients a more natural correction to facial aging. It has also been recently discovered that the fat we transfer has the highest concentration of stem cells in our bodies. These stem cells, once transferred to the face, become activated to take on the characteristics of their new environment. This results in a much more youthful quality to the skin, in addition to regaining volume lost to aging.

Fat transfer procedures are very dependent on the experience of the cosmetic surgeon, and poor outcomes can be seen, including non-survival of the transferred fat, lumps, irregular grooves, or asymmetry. Dr. Enzer has over 20 years of successful experience with fat transfer, being one of the first to offer this procedure in Southern New England.

At Enzer & Associates, P.C. we will review your directions for what to do, and what to avoid immediately after your treatment, and we will also give you written directions.

The most common instructions indicate the following: You might have some bruising or swelling. We sometimes suggest using cool compresses for 1-2 days in the treated area and sleep slightly elevated with an extra pillow.

Makeup should be avoided for at least six hours, and preferably one day. Wait one day to exercise. Avoid any facial massage or placing a mask on your face for at least one week. There may be additional instructions, especially for specific face or body areas.

The most common problems seen after filler procedures are swelling and bruising. Here are Dr. Enzer’s recommendations to help minimize any side effects and make your treatment a comfortable and pleasant experience.

• Stop any blood-thinning medications or supplements one week before your appointment. This includes Warfarin, Xarelto, Eliquis, Pradaxa, and also aspirin, ibuprofen products, and arthritis medications (NSAIDS). It also includes many herbal supplements such as glucosamine, garlic, ginseng, and others.
• Eat a fresh pineapple before your appointment. It must be fresh—not frozen or canned. Fresh pineapple contains bromelain, a natural anti-inflammatory. Discontinue eating the pineapple if you experience mouth irritation!
• If you don’t like pineapple, take Arnica Montana and/or bromelain supplements the day of your appointment and for 2 to 3 days afterward. These supplements have natural anti-inflammatory properties that help minimize bruising and swelling. We sell these supplements in our office, but you may also purchase them from a natural foods store.
• Apply cold applications to the treatment area every hour for 10 minutes for the first 8 hours after your procedure.
• Avoid vigorous exercise for 24 hours after your procedure.
• Do not massage or apply pressure to the area for 3 weeks after your procedure, unless instructed to do so by Dr. Enzer. This includes spa facials and wearing swim goggles.

Every medical procedure has risks. The most common problem seen after fillers is bruising and swelling. This can be controlled with frequent cold applications and taking Tylenol. Our main concern with facial fillers is to avoid asymmetry and over-or under-correction.

Some patients may notice bumpiness to the area or bluish discoloration, especially if it is an area with very thin skin, such as under the eyes. We recommend waiting at least three weeks for the filler product to settle in before deciding if you need a touch-up or revision. There are also very rare but serious risks such as infection, an allergic reaction, or even blockage of a blood vessel by the filler. You should notify Dr. Enzer immediately of any of these concerns.