Upper cheek and midface fullness may be lost, the lips may thin, the temporal area may be deflated. With this in mind, there has been a paradigm shift in the approach to aesthetic enhancement and rejuvenation, this is through restoration of volume.

There is a wide array of injectable fillers available such as hyaluronic acid fillers or fat injections (from your own body). The ideal filler will be determined by your particular anatomy and the amount of volume necessary to restore youth. The aim in any facial nonsurgical approach is to create a harmonious beautiful face.

Injectables and Facial Fillers with Dr Cigdem Unal

Any facial cosmetic treatment protocole can be viewed like the steps of a ladder, with the lowest step being the most simple and effective means to achieve a result, i.e. nonsurgical, and the upper steps being those associated with more intervention and downtime, i.e., surgery. Dr. Unal approaches all facial aesthetic treatments by focusing on attaining the most beautiful and most effective results by using "the lowest steps" of that ladder, which will maximize beauty and safety while minimizing downtime.

With so many fillers to choose from, how do you determine the best facial filler for you? Dr. Unal will spend time to understand your specific desires, and will then assess your anatomic requirements. Cosmetic treatment plans of the face will be personally formulated taking into consideration your anatomy, skin type, elasticity to achieve your goals.

As a double-board certified plastic surgeon, Dr. Unal aims to achieve the most natural result with the safest combination of approaches.

The 3 cornerstones of these rejuvenating treatments are methods that:

1. RELAXATION OF UNWANTED WRINKLES - softens the effects of muscle action with Botox Cosmetic or Dysport,
2. RESTORING LOST VOLUME - facial fillers restore volume to areas where soft tissue has dissipated or where shadows and lines become more prominent, including hyaluronic acid fillers and fat grafting
3. RESURFACING OF SKIN - addresses tone and texture of skin, and resurface by means of a variety modalities, chemical peel, dermabrasion or microneedling

These nonsurgical cosmetic injectable treatments can be a rapid and effective means of maintaining and restoring youth and beauty. Of course, in situations where "resuspension" is required (a drooping jowl, neck laxity, or excess eyelid skin), procedures that require more downtime may be required.

Preparation and Procedure for Facial Fillers and Injectables

Dr. Cigdem Unal recommends that any nonsteroidal anti-inflammatory medications are avoided for approximately ten days prior to facial filler treatments to minimize the potential for bruising.

Injectable treatments are performed exclusively by Dr. Cigdem Unal in her Nisantasi practice in

Istanbul. Hyaluronic acid fillers are administered after a topical anesthetic has been applied. Otherwise, no other anesthetics are required for facial filler injections since they themselves contain local anaesthetic. Anatomic landmarks and areas to be treated will be marked, and the injections take several minutes to perform. Dr. Unal favors the use of blunt-tipped needles that are extremely gentle, which dramatically decrease post-treatment bruising and increase the ability to inject facial fillers with meticulousness. Downtime after facial fillers is most often minimal or nonexistent.

Choosing the best facial filler for each anatomic region of the face requires experience.

The right filler will be chosen based on your specific anatomic needs. Occasionally, different fillers may be selected in the same treatment session, as thedifferent anatomic areas may require different fillers of varying covalent bond consistency of hyaluronic acid. While not a comprehensive list, some of the facial fillers most commonly recommended by Dr. Cigdem Unal are:

Hyaluronic acid facial fillers

In youth, hyaluronic acid is abundant in our tissues, and dissipates as we age. Hyaluronic acid fillers used today are crystal-clear in form, non-animal-derived, hypoallergenic, and safe. Hyaluronic acid fillers come in different concentrations: according to the depth of application, formulations have varying molecular concentration. For finer, more superficial fill and wrinkle corrections, the density of products are less. Concentrated hyaluronic acid products are used for more intermediate depth fill and correction of deeper lines.

Additionally, they contain xylocaine, a local anesthetic that makes the injection process much more comfortable. They maintain volume fill for between six and 12 months; in areas that are prone to more motion, including the lips and nasolabial folds, 6 to 9 months is common. In regions that are less mobile, such as the cheek, tear trough, or glabella (the vertical lines between the brows), hyaluronic acid fillers may last for 12 to 15 months. Among the many indications for the family of hyaluronic acid fillers, they can be used to fill the nasolabial fold, Marionette lines, the tear trough, cheeks, lips, and glabellar lines, chin or temporal region.

Injectable fillers that contain hydroxyapatite, are well suited for intermediate depth and deeper facial volume restoration, with applicability in the nasolabial fold region and cheeks. They may last for 12 months or more.

Fat Grafting

Autologous fat grafting is an outstanding means of restoring youthful volume and fullness to the face. Belly, inner thighs and waist; mainly where there is excess body fat, are the most common areas where the fat is taken from.

The fat cells are removed using a very small cannula, and are then prepared as fat grafts. The fat grafts are then transferred into an area of wrinkling or hollowness using a small cannula or needle.
Because these fat graft cells are your own, they will not be rejected. Although there is some resorption of the transferred fat, fat grafts last considerably longer than most fillers containing hyaluronic acid. As the fat grafts are your own tissue, they become incorporated as soft, natural tissue that is indistinguishable from the native soft tissue in the area.

Fat grafts to the face can often be performed under local anesthesia, although some may opt for light sedation during this procedure. Unlike the other facial filler treatments listed above that do not require local anesthetics (other than topical gel) and are associated with minimal or no downtime, there may be a bit more bruising and swelling with fat grafting to the face. The longevity of fat grafts may be the greatest, as when the fat cells transferred "take" as grafts, they are permanent.