Filler Injections

This patient underwent tear trough filler treatment. The treatment enhanced the transitions from her lower eyelids to her cheeks which resulted in improvement in hollows and dark circles. The ‘after’ photo is four weeks after the injections.

• What are fillers and what can they treat?

  Lines and folds (such as the ’tear trough’ visible beneath the lower eyelid and the nasolabial fold) develop due to anatomic changes that occur over time including loosening of tissues, and loss of volume (fat) in the face. These folds and lines can be improved by compensating for the lost volume using injectable fillers. Adding volume to the face can also provide some ‘lift’ of the tissues. The combination of lift and volume results in a youthful appearance. Common areas treated with filler include the cheek, the nasolabial folds, the tear trough, and the lips. There are a variety of different fillers with different properties. Dr. Mettu has extensive training in anatomy, oculofacial plastic surgery, and facial injections and will identify the best filler for you based upon your concerns and your examination.

• Am I a candidate for injections?

  Age is not a factor in determining candidacy. Each patient is unique and has different needs and desires and the best treatment plan to address your concerns will be discussed after evaluation by Dr. Mettu. If you have active inflammatory conditions affecting the face, Dr. Mettu recommends avoiding elective cosmetic injections. If anticoagulation cannot be held due to medical reasons, some injections with fillers may be deferred due to the inherent risks of bleeding. Finally, if there is any known allergy to any of the substances used for injections, you may not be a candidate.

• Can I receive the injections on the same day as my consultation?

  Filler injections are not performed on the same day as the initial consultation. A return visit is scheduled to inject filler. Every patient has different needs with regard to the areas to be treated and the amount of filler that may be injected. Thus, the appropriate amount of time can be allotted to help you get the best result possible. Filler injections will be deferred if there is history of dental procedures within the past month as this could increase risk of infection.

• What are the risks of filler injections?

  Risks include, bleeding, infection, scarring, inflammatory reactions, decreased blood flow leading to permanent tissue damage including blindness. Dr. Mettu is an ophthalmologist with subspecialty training in Oculofacial Plastic Surgery and Neuro-Ophthalmology. He has an extensive knowledge of eye, facial, and neuro anatomy. Dr. Mettu routinely performs injections around the eye and on the face and only employs techniques that minimize these risks. Being a surgeon, Dr. Mettu recognizes the importance of sterile technique and considers filler to be a surgical implant. He uses a sterile technique to minimize the risk of infection, an uncommon but challenging problem that can occur after filler injections.

• How are the filler injections given?

  Ice and/or topical anesthetic cream may be applied before the procedure to help with comfort. In certain areas and with certain fillers, local "blocks" are given. This involves giving small volume injections of local anesthetic containing lidocaine to specific nerves. The “blocks” numb the area prior to treatment. After the treated areas have been numbed, the area to be treated and surrounding parts of the face will then be sterilized using a ’surgical prep’. Sterile technique is used to inject the filler. Some filler products are premixed with an anesthetic called lidocaine which will also make the treated area more comfortable. A small needle or cannula is used to give the injections. Dr. Mettu performs all of the injections.

• What can I expect after filler injections?

  Swelling is expected after filler injections. Bruising may also occur. Both should improve over the course of a few days, though bruising sometimes persists for a week or more. Based on a recent consensus report (reference below), Dr. Mettu gives the following recommendations to filler patients:

  Avoid extreme cold or heat for 48 hours

  Avoid massaging the treated area

  Avoid strenuous physical activity

  Sleep with your head elevated for one night

  A skin care routine may be followed only once 24 have passed

  Patients should not undergo dental procedures that might lead to gum bleeding in the 3–4 weeks following facial filler treatment

  In those patients with a predisposition to bruising, a vitamin K cream or arnica gel may be useful to speed up its resolution

  REFERENCE: Urdiales-Gálvez F, Delgado NE, Figueiredo V, Lajo-Plaza JV, Mira M, Ortíz-Martí F, Del Rio-Reyes R, Romero-Álvarez N, Del Cueto SR, Segurado MA,Rebenaque CV. Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic Plast Surg. 2017 Jun;41(3):667-677.

• What different types of fillers do you use?

  We use hyaluronic acid (HA) based filler which can be reversed with hyaluronidase if needed. Dr. Mettu is able to treat any part of the face (lips, fine lines, tear troughs, nasolabial folds, marionette lines, cheek/midface, etc.) with HA based fillers.

• Does the consult fee go towards filler treatment?

  No, the consult fee is separate. The overall cost of filler treatment will depend on the number of syringes used as the cost is per 1 mL syringe. Our pricing can be found here.

• How much filler do you use for tear troughs?

  For tear trough treatments, Dr. Mettu does not inject more than 1 mL in the first session. Sometimes, results can be optimized with additional treatment sessions using additional filler.

• Have more questions?

  Send us an email at hello@raleigheyeandface.sprucecare.com