Autologus Fat / Restylane / Perlane / Sub-Q and Juvederm
These substances (except fat) are based on hyaluronic acid, a connective tissue substance. The development of this has mainly been at Pharmacia and Q-met in Sweden and have been excellent for filling out wrinkles and folds, e.g. in the glabella area (between the eyebrows) and furthermore the nasolabial folds, the long fold beside the nose going down towards the corners of the mouth.
The lips have been a popular area. The safety in using these substances has been good. The disadvantage is that the body resorbs the substances after 3-5 month, even though the effect may sometimes last longer, probably due to some fibrosis formation. Augmentation of the lips also disappears eventually and usually after 3-6 months. The Swedish price for one treatment is SEK3-3500:- so treatment eventually becomes expensive. The alternative is autologous material (see fat injections). Another substance of the hyaluronic acid family is Sub-Q, frequently used for volume augmentation above the malar bone. The effect remains somewhat longer.
A number of foreign and permanent substances have been used in augmentation of e.g. the lips. At the Institute of Plastic Surgery we do not use permanent fillers in lips since they frequently cause inflammation, hard globules and even visible deformities and pain.
For more than 10 years we have used autologous material at the Institute of Plastic Surgery, such as fat, fascia (the fibrous cover over muscles) and so-called derma-fat grafts (the deepest part of the skin, sometimes covered with fat underneath in order to further increase the volume.
Such autologous material is excellent to fill out defects and also to augment the malar areas and the lips. Defects after trauma and/or tumours can also be filled out with these materials. This should be done when there is no longer any risk of tumour recurrence. A small group of people break down and resorb the fat very fast. In these instances we change from autologous fat to autologous fascia or derma-graft, which renders less oedema immediately and becomes very stable. As with all autologous material, they can be used 1-3 times or more if needed. This is not only a disadvantage but makes the patient participate in the treatment and final result. The hard bone is replaced by a likewise hard surface. Too much fat becomes flabby. Excess of skin cannot be corrected by using only fat. Tension is the final solution. You will need a mid-face lift performed in order to become elegant.
This surgery is performed at the Institute of Plastic Surgery, Western Harbour, Malmö, Sweden.
Some years ago we discussed extensively the creation of groups with plastic surgeons, dentists, skin specialists, specially trained hair-dressers, dieticians, aerobics instructors and physiotherapists. We did actually create such a group but, to a great extent, people themselves have found what they need. Professionals of all kinds are aware of this and have focused on the appropriate treatments. A group of specialists PT (Personal Trainers) has developed appropriate programmes, which they design for each individual. We have a close relationship to two of them.