Different options for treating facial wrinkles
To treat wrinkles on the face and on the whole body, there are various approaches depending on the extent of wrinkling, which should be chosen according to individual needs. Pronounced cases can be treated with surgical procedures such as a facelift. In addition, wrinkles in the facial skin can be reduced by resurfacing (dermabrasion), laser treatment or tightening the skin using special thread materials, as in a thread lift. With the patient’s own tissue, e.g. in autologous fat transfer or by shifting tissue from the surrounding area, wrinkles or scarred depressions can be filled from beneath.
In so-called injection therapy, the doctor can inject various substances to lift the skin furrows concerned. These preparations are called tissue fillers and have undergone a technological leap in recent decades through continuous development. As a result, the range of substances and their areas of application has expanded.
Injection of the active substance botulinum toxin, by contrast, is not made into the skin fold to smooth it; it merely paralyses the muscles responsible for the wrinkle and therefore smooths wrinkles indirectly and only temporarily.
Which tissue fillers can be considered?
Depending on the nature and needs of the skin, such as the depth and location of the scars or wrinkles, the different procedures can be used individually or in combination. They are different materials with different effects, durations of effect and tolerability. After an appropriate consultation with your plastic surgeon, the following common substances and methods of tissue augmentation may be considered.
- Collagen fillers
- Hyaluronic acid
- Combination preparations based on collagen, hyaluronic acid or water
- Autologous fat – lipofilling
- Autologous plasma, so-called platelet-rich plasma, also known as PRP therapy or “vampire lift”.
- Calcium hydroxylapatite (CaHA)
- Poly-L-lactic acid
Use of autologous (the body’s own) substances
The body’s own tissue is well tolerated. For large-area filler treatments, fatty tissue is most commonly used, having previously been harvested by liposuction from the abdomen or the inner side of the knee, for example. Connective or scar tissue is also suitable as filling material. Platelet-rich blood plasma, prepared beforehand from the patient’s own venous blood from the arm, can also be injected for tissue restructuring and skin rejuvenation (face, neck, backs of the hands, décolleté, etc.) and to stimulate hair growth.
Collagen or hyaluronic acid-containing products, on the other hand, are in many cases produced from animal tissue.
Nature-identical substances
These are mostly hyaluronic acid, calcium hydroxylapatite and various poly-L-lactic acid products that are reproduced in the laboratory to be identical to the natural substance.
Synthetic substances
These can be, for example, microencapsulated plastic beads that are broken down only slowly by the body. Their effect usually lasts for several years. Natural and nature-identical substances are usually broken down by the body over several months up to 2 years, but sometimes after only a few weeks. Synthetic substances in particular stimulate the body to form new endogenous collagen. This increases the chance of a good long-term result. Substances that are broken down by the body have only a time-limited effect but in return have no harmful effect in the long term. However, like all substances administered into the body, they can cause an allergic reaction. With synthetic substances, the filling effect often lasts considerably longer. However, they can be difficult to remove, particularly if they have been injected.
Is any preparation necessary?
Collagen or collagen-containing combination preparations can trigger allergic reactions. The doctor therefore carries out a test about 4 weeks before the first collagen treatment by injecting a small amount of collagen into the skin of the forearm. The patient must then carefully observe any skin changes at the injection site over the next four weeks. The patient’s conscientious cooperation is the prerequisite for avoiding later complications due to hypersensitivity reactions.
Shortly after the test dose is injected, a small, swollen area of redness (similar to a mosquito bite) may appear at the injection site, which may be slightly painful when pressed. This is a normal reaction to the liquid collagen and no cause for concern.
Please contact your doctor immediately if
- the redness, tenderness or swelling gets worse,
- you notice other skin changes (e.g. a rash),
- you experience prolonged itching or
- fever, breathing problems, swelling of the joints or
- other disturbances of your general well-being (e.g. flu-like symptoms) occur.
If platelet-rich plasma is to be used for your tissue augmentation, some blood is first taken from a vein in your arm. The blood is then further processed using a special procedure to separate the red blood cells (centrifugation). The remaining viscous blood plasma is used directly for injection.
No specific preparation is required for hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, autologous fat or botulinum toxin.
Cost coverage
As a rule, health insurance funds do not cover the costs of these treatments or of any complications requiring treatment. It is therefore always advisable to clarify questions of cost in advance with your doctor and your health insurance fund. Taking out insurance against follow-up costs should also be considered.
How is filler treatment carried out?
Before treatment with collagen, hyaluronic acid or combination preparations containing collagen or hyaluronic acid, the patient should clean their face as usual before the procedure and should not wear make-up. After disinfection, the doctor inserts a small needle into the area of skin concerned and injects the collagen or hyaluronic acid. Local anaesthesia is generally not required, as the injection usually causes hardly any pain. For sensitive patients or if necessary during treatment, pain can be relieved with anaesthetic creams or ice cooling. Immediately afterwards, the skin bulges slightly; this elevation disappears by itself. A small, swollen, tender area of redness may appear at the injection site. This usually subsides within a day. On the lips, the swelling may last somewhat longer. Several injections may be necessary until a satisfactory, longer-lasting result is achieved.
How painful is the treatment?
Injection with certain substances, e.g. hydrogels or calcium hydroxylapatite, is slightly painful. Local anaesthesia before the injection is therefore recommended here.
Autologous fat treatment can usually be carried out under local anaesthesia with twilight sedation. For larger treatment areas, such as the whole face or abdomen, general anaesthesia will be necessary; the anaesthetist will then inform the patient separately about its procedure and risks.
The fatty tissue is gently harvested by liposuction using special cannulas. The abdomen, hips, thighs or knees are usually suitable for this. In the first few hours after treatment, cold packs can be applied to reduce possible swelling. Sutures are removed after 3–5 days on the face and generally after 7–10 days on other parts of the body.
Treatment alternatives
In addition to the wrinkle filler procedures described here, wrinkles can also be treated by injection of botulinum toxin , which has specific advantages but also disadvantages and risks. These aspects can be discussed in detail with the treating doctor during the informed consent consultation.
Are complications to be expected?
Despite all due care, life-threatening complications may occur in some circumstances, requiring further treatment or even surgery. The frequency data are a general estimate intended to help weigh the risks against each other. They do not correspond to the definitions of side effects in medicine package leaflets. Pre-existing conditions and individual characteristics can significantly influence the frequency of complications.
For all the forms of treatment mentioned
- Bleeding during or after the procedure; this can lead to visible bruising that only fades slowly.
- Injury to adjacent nerves or blood vessels; impaired nerve function (abnormal sensations, numbness) is usually only temporary and improves by itself.
- In rare cases, infections at the injection site (e.g. injection abscesses), suppuration or abscesses may develop and delay healing.
