Soft Tissue Fillers

Please read this carefully and write your notes on this sheet to discuss with  Dr. Sahar Ghannam during your Consultation.

What are Soft Tissue Fillers? Soft tissue fillers are pliable substances that can be injected into the skin to erase fine lines and wrinkles, plump the lips, fill out hollows cheeks, rejuvenate the hands, improve scars, elevate deep folds and repair various facial imperfections. The result is a smoother, more youthful appearance with minimal (down time) and maximum safety.

From silicon to bovine collagen and one's own fat donor tissue to the most advanced hyaluronic acids, the variety of soft tissue fillers has greatly expanded the anti-aging and skin-saving repertoire of the Dermatologic Surgeon.

And, since filler substances do not involve major surgery and are greatly cost effective, men and women are seeking out these (real-time) cosmetic solutions in greater number than ever before.

Why might you need soft tissue fillers? The aging process generally causes a loss of volume in fatty tissue as the underlying collagen and elastin begin to deteriorate. This most commonly occurs around the eyes and mouth, cheeks, jaw lines, the brow and bridge of the nose. These age related changes produces crows feet.

Laugh lines, folds and furrows on the forehead, and (hills and valleys) on the lower third of the face. Soft tissue fillers have the unique ability to diffusely fill and contour the aging face allowing Dr. Sahar Ghannam, who is a certified Dermatologic Surgeon, to sculpt and restore the appearance of your skin.

How do soft tissue fillers work? A filler substance is injected beneath the surface of the skin (each filler is injected at a certain level) where it corrects the lines and wrinkles by temporarily plumping and smoothing out the depression.

What is the best filler? There is no best filler; there is only filler that will suit your needs and expectations. Dr. Sahar Ghannam will discuss your options.

Are these fillers permanent? No. some of the fillers that are called permanent actually stays anywhere between 3-5 years, but now there are fillers that stay anywhere between 6 months to 2 years.

Why not use permanent fillers? The only permanent fillers that we know off for many years were the silicon. There are alleged permanent fillers all over the world which are still in the testing or the very beginning phase. Dr. Sahar Ghannam is so concerned about you and your health and will never use any filler which is still under testing or not approved. When she is totally sure of the fillers safety, she will use it.

I heard silicon is pre-cancerous is this true? No silicon is pre-cancerous, but it had gained very bad publicity wrongly. Since it has been in the market for so long, more than 30 years, here is what we know. Silicon is the granule of the sand and in some patients it had caused a granuloma (a benign tumor which needed surgery to get it out).

What are the draw backs of permanent fillers? 

v Since it is permanent, so you can never remove it if you do not like it (fashion wear off) you have to live with it.

v Since it is permanent and only injected in certain parts of your face, when the rest of the face changes with age, the part injected does not change and gives a weird, unnatural look.

v Again, most permanent fillers do not permit re-injection of any other filler with.

If you are interested in Perfectha, Perlane and Teosyal read this section.

What are these? They are made of hyaluronic acid in the form of a crystal clear gel. Hyaluronic acid is the gel that the collagen and elastin lives in. 

Why should we inject hyaluronic acid and not collagen? Collagen comes from animals (protein) so it is antigenic. Collagen used to come from cows and pigs. And due to the diseases that they can transmit it is not favorable filler.

Furthermore, when we are using collagen we used to make 2 sensitivity tests 4-6 weeks apart (on the arm) to check for any signs of allergy, this is not the case with hyaluronic acid.

So can hyaluronic acid cause allergy? In the far majority of patient, in about (99.99%), it did not cause any allergy because it is Biocompatible. Meaning that, it is the same material in all living creatures.

So how did it cause allergy? It was reported once, since it approval in the world, about 7-8 years ago, that the cause was not the material itself but the impurity within the manufacture and was never reported afterwards.

If allergic reaction happens, is it dangerous? No, if allergy happens and this is very rare. It will only look like eczema and can easily be treated.

So is it safe? Yes, hyaluronic acid occurs naturally in the body and therefore it also dissolves naturally with time and is integrated into your body's tissue.

What is the difference between them?  

v The entire product have a range 20 mg/cc - 24 mg/cc strength of hyaluronic acid, they just vary in gel particle size.

v This variability makes the tailoring of injections according to the depth of the wrinkle and desired lip enhancement.

v They are also made by different companies.

How long does it last? It last approximately from 8 months – 1 year. A collagen injection lasts only 4-6 months at the most.

How much does it cost? They all cost 120KD per syringe. 

I heard that other hyaluronic acid fillers are much cheaper. So, why these are expensive?

Good question. This is the reason; hyaluronic acid was/ is used to treat joint stiffness. They tried to use this hyaluronic acid for face augmentation but it lasted and lasts only for 2 weeks (this is the one that is cheap). On the other hand the hyaluronic filler is high molecular weight/cross linked and so they stay longer 1 year. That's why they are more expensive.

How will I look after the treatment? Following your injections, normal activities can be resumed immediately. Discomfort is minimal. The treatment site may have a little swelling, which may last for few hours. There may be slight bruising which can be covered with makeup.

If you are interested in lipo-transfer (fat injections) read this section:

How is the procedure done? Using a special needle attached to a syringe, fat is removed from a donor site where your fat is most tightly packed, such as your abdomen or your buttocks. Once removed, your fat is processed to remove excess fluids and then re-injected using another needle, which is placed just under your skin beneath the wrinkle. This process may be repeated until the desired correction has been achieved.

Is it a major operation? No, fat transfer can be performed is an outpatient procedure, but for safety and sterile purposes Dr. Sahar Ghannam prefers to perform it in the operating theatre. But you will not go to sleep, it is done under local anesthesia, you go home directly afterwards.

What areas can benefit from fat transfer? With fat transfer, it is possible to have fat lipo-sucted from your thighs and then transferred to any area of your body. Re injected fats lasts longer in larger areas of non movable, so it is very successful for the correction of sunken cheeks because this area does not move that often.

Fat transfer can also correct atrophic aging of the hands, post surgical and post traumatic defects. But not every area of the body responds well to fat transfer, the breast for instance, are out. Injecting fat into the breast makes it much more difficult to detect breast cancer wit mammograms.

Can it be combined with other procedures? Harvesting the fat cells for re-injection is often performed in conjunction with other procedures, such as liposuction, tummy tuck or cosmetic breast surgery. In combination, the plastic surgeon and I can harvest a larger amount in fat, then freezes and stores your fat for future injections when they are necessary.

How long will it last? That is so variable, in some patients it lasted for only few months, others as long as 3 years. Because it is your own so no one can tell you when the fat will go until you perform it.

How long can it be freezed? It can be freezed for re-injection for about one year. Re-injections are done in the clinic.

How will I look after the transfer? As I mentioned, you will be able to go home directly after the transfer, but there will be some swelling at the treatment site that may last few days, maximum of a week.

There may be some bruising which can be covered with makeup.

Can the operation be repeated? Yes, it is an (a la carte) procedure. When you want more or other areas injected, it is very possible, since the material (fat) is available and freezed.

What if I lose or gain weight? This may be a problem; it is for the best to keep your regular balanced weight.

There is a probability, since these are your own fat, when you lose weight you may lose the injected fat too. This does not happen with the hyaluronic acid (restalyne and perlane).

What are the disadvantages of fat transfer?

v We have to lipo suck fat from the body; some people do not have excess fat to suck.

v No one can state how long the fat will stay in the face.

What are the advantages of fat transfer?

v There is no chance for an allergic reaction.

v There is no limit to the augmentation; we are not limited to the ampoule volume.

v Can be stored in the freezer and used for 1 year when needed.

v Considered the cheapest substance for augmentation.