Skin Injection Treatments (Injectables)

Almost everyone has skin imperfections of some kind. But for some people, wrinkles, acne scars, chickenpox marks or other imperfections are uncomfortably noticeable.

In the past, there was no practical option for removing or reducing such surface imperfections. However, today a number of different methods can be employed – including injections – to produce smooth, clear skin and attractive facial contours.

If you're considering an injection procedure to smooth your skin, the following information will provide you with a good introduction to the available options. For more detailed information about how these procedures may help you, we recommend that you schedule a consultation with Dr. Kremer.

What are some of the most common benefits of these procedures?

The most common benefit of injectable treatments is the elimination of unwanted wrinkles on the surface of the skin. In addition, injections can give patients a more youthful appearance by re-establishing pleasing contours.

Injectables work best on two kinds of wrinkles: those caused by movement of the muscle (such as those that appear around the mouth and eyes when smiling or frowning) and those caused by gravity (i.e., sagging skin). There are a number of different kinds of injectables, each with its own risks and benefits.

A nunmber of different substances are being used, each associated with certain advantages and disadvantages. The presently most widely used injectable substances are listed below. Please note that one has to differenciate between temporary ("resorbable") and permanent ("non-resorbable") fillers.

Resorbable Fillers:

Hyaluronic acid is a biotechnologically generated clear and viscous gel which at this point is not known to cause allergies or other rejection reactions as it is chemically identical in all living species. Hyaluronic acid is injected with a very fine needle into the deep dermal layer of the skin. As the body degrades and resorbs hyaluronic acid, results last up to 5-6 months. Treatments can be administered repeatedly. Scientific studies have demonstrated that treatments with hyaluronic acid seem to enhance the bodys own capacity to reproduce hyluronic acid. Due to ist non-allergenic nature, hyaluronic acid has taken over collagens position as the most popular and convenient injectable filler.

Collagen is made from BSE-free bovine skin and tendon material. Even though highly purified, bovine collagen is known to be able to cause allergic reactions in certain patients. For this reason, a sensitivity skin test is mandatory a few weeks before the planned treatment. Collagen is also applied with a very fine needle and injected into the deep dermal skin layer. As the body resorbs collagen over time, the results last for about 6-7 months. Treatments can be repeated as desired.

Many other resorbable products are available on the market, however, Dr. Michael A. Kremer, MD, relies on the above mentioned products proven to be safe over a quite long period of time.

Permanent Fillers:

Fat-injections are applied with so called "Coleman"-needles that have a significantly larger diameter than single-use injection needles. Fat is being "borrowed" from certain regions of the body - commonly fromthe lower tummy, the flanks ("love handle region") as well as the thighs - and is then being washed, centrifuged and separated from water and cell debris before injection. Fine, superficial wrinkles cannot be treated by fat injections as fat cannot be injected into the superficial skin layers but only deep into the subcutaneous fatty tissues and muscles. Therefore it is an ideal filler for larger areas of tissue atrophy or surface irregularities. Basically, fat injections can be addressed as permanent, taking into consideration that 60-70% of the injected, very delicate fat cells survive the procedure. For this reason, overcorrection is peformed in fat injection in order to compensate for the expected volum eloss over the first couple of months. From Dr. Michael Kremers experience more fat than initially needed is extracted during the procedure which can then be stored frozen in an ice box. Nach spätestens einem halben Jahr kann dann das gefrorene Fett aufgetaut und nachgespritzt werden, um kleinere Volumendefizite durch die eingetretene Resorption auszugleichen. Die Fettzellen im gefrorenen Fett sind nicht mehr vital, d.h. nur das enthaltene eigene Kollagen ist für den Volumengewinn verantwortlich. Aus der Erfahrung von Dr. Michael Kremer ist der dann aber gewonnene Volumengewinn über viele Jahre dauerhaft, nur der mit dem Altern verbundene allgemeine Verlust an Bindegewebsvolumen führt dazu, dass weitere Unterspritzungen nach Jahren evtl. wieder gewünscht werden. Insgesamt hängt der Erfolg einer Fettunterspritzung von vielen Faktoren ab, so z.B. von der Durchblutung der behandelten Region (z.B. Gesicht besser als Unterschenkel), Qualität des Gewebes (Falten besser als Narben), Menge des unterspritzten Fetts sowie der Behandlungstechnik. 

Please feel free to read more about fat injections, also called lipostructure, here.

Die Industrie "erfindet" ständig "neue" dauerhafte Filler, mit denen jedoch dann immer nur wenig klinische Erfahrungen vorliegen. Dr. Michael Kremer hat sich auf die dauerhafte Unterspritzung von Lippen mit hoch-reinem, CE-zertifizierten Silikonöl (PMS 350) spezialisiert, über welches nunmehr klinische Erfahrungen seit über 15 Jahren vorliegen. Insgesamt ist Silikon, d.h. eigentlich das SilikonPolymer Polysiloxane, seit über 40 Jahren erforscht, es gehört mit mehreren 100.000 Behandlungen weltweit zu den am besten untersuchten Füllmaterialien. Es ist eine neutrale Substanz, die weder Allergien noch bösartige Reaktionen im Körper auslöst, auch verbleibt es am Implantationsort, d.h. es wandert nicht im Körper. Beim Unterspritzen werden sog. "Mikro-Implantate" gesetzt, die vom Körper innerhalb von 6-8 Wochen mit körpereigenem Bindegewebe ummantelt werden. Das neu gebildete Gewebe wird von kleinen Blutgefäßen versorgt, danach kommt es zu keiner weiteren Gewebeneubildung. Das Besondere an PMS 350 ist, dass das Volumen, welches benötigt wird, nicht durch das Material selbst entsteht, sondern durch das neue körpereigene Bindegewebe. Daher muss zunächst eine Unterkorrektur angestrebt werden, bis die durch körpereigenes Bindegewebe bedingte Volumenzunahme beendet ist. Dann kann entschieden werden, ob eine weitere Unterspritzung notwendig ist. Das Silikonöl muss ausreichend tief unterspritzt werden, damit keine Unregelmäßigkeiten an der Oberfläche sichtbar werden. Silikonöl kann wie andere dauerhaft eingespritzte Substanzen nicht wieder entfernt werden, der Volumeneffekt unterliegt aber der natürlichen Alterung des Bindegewebes, so dass auf Dauer evtl. weitere Unterspritzungen gewünscht werden.

Dr. Michael Kremer Dr. Kremer lehnt eine Unterspritzung mit den Mitteln Dermalife und Artecoll ab, da er regelmäßig Patienten in seiner Sprechstunde sieht, die nicht mehr wieder gut zu machende Fremdkörperreaktionen durchgemacht haben, die mit Verdickungen und Verfärbungen der Haut einhergehen. Diese Fremdkörperreaktion als Reiz auf diese eingebrachten Materialien ist eine andere als die nach CE-zertifiziertem Silikonöl. Diese sehr unschönen Folgezustände sind leider nur mit operativen Ausschneidungen dieser entstellten Bereiche möglich, was zu dauerhaften Narben führt. Interessanterweise bevorzugen Patienten, die das durchgemacht haben, lieber feine Operationsnarben als die über lange Zeit gehabten wulstigen Hautverdickungen, welche auf eine Fremdkörperreaktion mit den nicht abbaubaren, in Dermalife und Artecoll enthaltenen Kügelchen zurückzuführen sind.

Eine dauerhafte Methode zur Faltenunterfütterung, die jedoch reversibel ist, ist das Einziehen von weichen Kunststofffäden aus PTFE (Avanta™, SoftForm™, Goretex™). Dies Materialien werden meist in örtlicher Betäubung unter die Haut eingezogen, dazu werden meist nur zwei kleine Schnitte benötigt. Das Material wird dann in die Form eines kleinen Schlauches gebracht und mit einer speziellen Nadel eingesetzt. Das Material bleibt unverändert ortständig, weil sich Narbegewebe um das Material herum bildet. Dies ermöglicht auch eine leichte Entfernbarkeit, falls dies später einmal erwünscht sein sollte oder falls eine Infektion auftritt, was in 2-5% passieren kann und dann eher in den ersten Wochen nach der Behandlung auftritt.

Die Entscheidung, welches Material verwendet werden soll, ist also recht komplex und wird von Dr. Michael Kremer nach einer genauen Untersuchung im Detail mit ihnen abgestimmt werden.

What will happen at the initial consultation?

During the consultation, you and Dr. Kremer will discuss the changes that you would like to make in your appearance. He will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required.

Be sure to ask all the questions you have about the procedure. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

How are these procedures performed?

Injections are most commonly made between the surface layers of the skin and the underlying fat. The material that you and Dr. Kremer decide upon is placed into a syringe. A needle is placed under the skin at the site of correction, and the material is injected along the lines of the wrinkle, scar or other recessed area. The injectable material plumps and tightens the skin, thereby smoothing out the skin contour.

Where will the procedure be performed?

Injectable procedures are performed on an outpatient basis in the office. In more extensive or combined procedures sedation may be required. Collagen and Cymetra can almost always be injected without anything other than a topical anesthetic cream.

How long do these procedures take?

Time, of course, depends on the extent of the procedure, which normally takes between 15 and 60 minutes.

How much pain is there?

The amount of pain during an injection treatment varies from patient to patient. However, the discomfort associated with injectables is relatively mild. In many cases, injectables are given without anesthesia.

Patients may experience some discomfort during and immediately following the procedure. Injections done on the cheek, chin and close to the eyes are usually less painful than those around the lips, but this varies from patient to patient. If you are particularly concerned about pain, be sure to discuss this with Dr. Kremer before the day of the procedure.

What can I expect after the procedure?

For the first 24-48 hours following the procedure, most people experience some swelling and redness at the site of injection. Itching and very mild discomfort is not uncommon. However, most of these symptoms fade away within a day or two.

What is the recovery period like?

The recovery period for injection treatments is relatively short. Bruising is usually minimal, and swelling depends on the extent of the procedure.

Patients should stay away from activities that can aggravate the injection site. Heavy exercise and alcohol consumption should be avoided for the first few days following the procedure.

Ideal candidate:

In general, the best candidates are:

• Individuals with scarring, sagging or wrinkling on the face
• Individuals with loss of fat, plumpness or high contours of the soft tissues in the face
• In good physical health
• Psychologically stable
• Wanting to improve their appearance
• Realistic in their expectations
• Aware of the options and the limitations

This is only a partial list of the criteria that Dr. Kremer will consider in determining whether or not this procedure is appropriate for you. Be sure to ask Dr. Kremer if he considers you an ideal candidate for injectable treatments.

What is the long-term outcome like for most people?

Most patients who have had an injectable procedure are pleased with the results. The treatments can, in many cases, significantly reduce facial wrinkling and sagging skin. However, most injection treatments have a relatively short life span. Collagen is quickly absorbed by the body, and most of the filler from these injections disappears within a year. Other injectable materials are associated with more frequent side effects. Be sure to discuss all of the various options with Dr. Kremer, who will help you to decide which is the best option for you.

Alloderm - A portion of the sheet alloderm may remain permanently, or it may eventually be completely absorbed. In any case, it lasts longer than most injectables, including collagen. There is not enough long-term information on Cymetra to know if a portion of it will last permanently, but early reports suggest that it probably will not.

Collagen -Standard collagen will be completely reabsorbed within a few months. Autologen lasts somewhat longer. Some lucky patients may have collagen last 5-6 months, but most will find that 3-4 months is typical. Occasionally, it lasts only 2-3 months. While they like the results, some people are frustrated by the need for frequent injections.

Fat - A portion of the injected fat will remain in place permanently, but a second or even third procedure may be needed to completely correct sagging or wrinkling. Fat is perhaps the only injectable material available for recreating a youthful look in those patients requiring large volumes for a fuller, more youthful-looking facial structure.

Alternatives:

Recently, a new method of fat injection has gained popularity. This procedure is called lipostructure. Like fat injections, this treatment calls for a removal of fat from the patient’s own body. However, lipostructure is significantly different from traditional fat injections because it attempts to keep these fat cells alive. The idea behind lipostructure is that by keeping the fat cells alive, they will not be reabsorbed into the body, and the results will last longer.

Consult Dr. Kremer to see if lipostructure is an option for you.

Risks:

One of the risks associated with injectable procedures is the risk of infection. However, under most circumstances, this risk is minimal. Depending on the filler material that you and Dr. Kremer choose, there may also be a risk of an allergic reaction or rejection of the material by your body.

Be sure to:

• Tell Dr. Kremer about any allergies you have (to foods, drugs, environmental elements)
• Tell Dr. Kremer about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription)
• Carefully follow any instructions Dr. Kremer gives you regarding eating and drinking and smoking.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to treatment/surgery.
• Please inform Dr. Kremer immediately in case you should experience fever or symptoms of an infection after surgery.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. 

The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer. He will be able to answer specific questions related to your situation.