Studies on aging indicate that one of the most important events in facial aging is the reduction of soft tissues and even bone structures under the facial skin. This has taught us that aging does not only affect the skin, but also other tissues. This information has shown that skin stretching operations alone will not be sufficient in the treatment of aging. Volume loss of the subcutaneous tissues reduces the tightness of the skin and causes wrinkles and sags. Volume loss does not occur with aging alone. Accidents, infections, diseases and congenital factors also cause collapse and thinning in various body parts. The most logical and valid method in treatment is to eliminate the deficiency with the same tissue. Placing a tissue taken from a part of the body in another area is called “grafting”. Filling the subcutaneous area by some biologically compatible materials or tissue grafts mechanically expands the skin and reduces the wrinkles. The main types of grafts:
They are the most commonly used grafts. However, they are quite ineffective in adding volume and are mostly used to make skin coverage on injured skin areas.
Cartilage and bone grafts
These are only used to fill small amounts of deficiencies. It is not possible to obtain large amounts of these tissues because their amount in the body is limited.
Removal of excess adipose tissue is an operation that has been performed for a long time. However, the fat tissues that were removed were being discarded in the past. The interest in fillers in recent years has revealed the value of adipose tissue. One of the best filling materials is the fat harvested from the same person. Fat effects not only by volume but also with growth factors and stem cells placed in it. Fat grafting is done by a syringe and specific cannulas or needles. It is safe and reliable. But harvesting fat requires an operating room and anesthesia. Repeated injections may be necessary. Another advantage of adipose tissue is that it can survive for a long time (a couple of years) when stored in a deep freezer (-60 to -80 degrees). In this way, when the patient needs to be refilled in the future, there is no need for fat removal by surgery. Only the patient’s frozen fat is melted and injected as filler.
Artificially produced fillers
Since the 1980s, studies have been carried out on the use of materials produced in the laboratory as filler. Let’s take a brief look:
It was launched under the name Zyderm and Zyplast and initially attracted great attention. However, due to the fact that it causes allergies in some people and dissolves over time, its use has decreased and disappeared.
Commercial fillers that mimic substances in the body
The use of synthetic materials produced in laboratories for filling purposes provides a practical solution. Hyaluronic Acid (HA) and Poly L Lactic Acid are the most frequently used fillers. They come in ready to use syringes and can be injected directly beneath the skin. They can be applied in office conditions. Although their application is easy, the longevity of the effect is not clear. They usually disappear within months or years. HA is a substance found in the body. Therefore, it does not cause foreign body effects when injected. However, it is not suitable to be given in large quantities since it is commercially sold in 1 ml injectors. The good side is that it can be destroyed by another synthetic drug when an undesirable situation occurs.
Fillers containing chemicals that are not present in the body
Recently, non resorbable permanent substances are also available on the market. However, these materials are considered as foreign bodies for the body but are expected to cause no unwanted effects. They may stay for a long time without any problem. But if a complication occurs the treatment is difficult. Their reliability has not yet been fully proven. Prof. Dr. Ege Ozgentas does not use such permanent fillers.
Blood and its substances
Blood taken from a person is treated in the laboratory and the yielded products are injected into the face of the same person. This is called “Vampire Face Lift” or “Stem Cell Facelift”. One of the best known of these products is PRP which means Platelet Rich Plasma. Platelets are small blood elements responsible for coagulation and wound healing. PRP is prepared by centrifuging the whole blood and contains up to 8 times more platelets than normal blood and it is believed to have healing effects over the tissues. It is also used in other fields of medicine like orthopedics and physical therapy. Stem cells are also very popular in medicine and they are the cells which are capable of division and creation of specific tissues. Stem cells are available in blood and tissues and there are some methods to isolate them from the blood. Isolated stem cells may have some regenerative and rejuvenating effects on the skin and other tissues after being injected into them. Although they sound good and popular there is not enough scientific justification of these procedures yet.
Prof. Ozgentas prefers to use autologous (which means taken from the same person) fat injections both for filling and rejuvenating purposes.