Many facial irregularities can be improved with dermal fillers, also known as "filler" substances. When injected into the skin, they can create volumes or restore them if they have diminished over time. They can also fill in grooves and wrinkles, such as nasolabial folds, labiomental lines, or periocular and lip contour wrinkles.
The Bartoletti Cavalieri Associated Medical Practice is part of the National Consensus Conference on fillers, and in accordance with official guidelines on the use of fillers, it does not use permanent fillers and strongly discourages patients from requesting them.
The Italian Society of Aesthetic Medicine (SIME), of which Dr. Bartoletti is the President, has been one of the most active proponents at the Ministry of Health for guidelines on the safe use of fillers. Therefore, at our studio, only absorbable fillers are used, and permanent substances are not used.
Hyaluronic Acid
It is a natural constituent of human connective tissues. It has a very large molecule of a polysaccharide nature and plays important roles in the skin, including providing volume, firmness, and tone, thanks to its ability to bind a significant amount of water molecules (up to 100 times its dry weight).
Its presence in the skin decreases with aging, contributing to the decline in the mechanical properties of the skin.
One characteristic of hyaluronic acid filler is its ability to integrate well into tissues. Additionally, even when injected in small quantities, it binds a lot of water and tends to occupy a significant amount of space, making it a good "volume expander." Cells have the tools to metabolize the injected hyaluronic acid, which gradually disappears, breaking down into its components, which are harmless and reusable.
The hyaluronic acid available in the market today is of bacterial synthesis and exhibits excellent biocompatibility, which minimizes the possibility of allergic reactions. Thanks to its gel formulation, it's possible to achieve very natural results in filling wrinkles, creases, and depressions, as well as in volumetric augmentation of areas like cheeks and lips.
Depending on the density and structure of the filler used, the duration of corrections varies from a minimum of 4-6 months for fluid products and superficial corrections to a maximum of 12 months for more substantial products and deep corrections. Some factors, such as cigarette smoking and intense sun exposure, can accelerate the absorption, and the speed of absorption is linked to individual biochemical characteristics, overall health, and the patient's lifestyle.
Some pathological conditions require careful consideration on how appropriate the treatment can be. These include dermatopathies, inflammatory conditions of any nature present in the areas to be treated, certain autoimmune diseases, and all systemic conditions of a certain severity.
Like any injection, even when the treatment is correctly performed, unwanted reactions can occur: transient erythema (redness), mild and transient swelling, slight bleeding or small hematomas with swelling and bruising, local pain (lasting for a few hours), localized infections.
Other side effects are related to the biological activity of hyaluronic acid: some patients have experienced persistent swelling and erythema in the injection areas for over 24-48 hours, which in the treatment of the lips, in exceptional cases, can last up to 7 days. Mostly, these are localized phenomena that disappear spontaneously; in sporadic situations, the use of specific pharmacological support may be required. Rarely, palpable hardening or granularity in the implant area can occur, always transient. Isolated cases of abscess-like, sterile swellings have also been described, occurring 3-4 weeks after the implant, with spontaneous regression in 6-8 weeks.
Calcium Hydroxyapatite
Calcium hydroxyapatite is a unique filler approved by the FDA (Food and Drug Administration) in the United States for the correction of moderate to severe facial folds and wrinkles. In Europe, Radiesse filler is CE certified for plastic and reconstructive surgery, including the augmentation of the intradermal and subcutaneous soft tissue of the facial area.
The filler consists of 30% synthetic microspheres of calcium hydroxyapatite suspended in an aqueous gel solution (70%). These microspheres are composed of calcium and phosphate ions, substances also naturally present in epidermal tissue. Therefore, it is a 100% biocompatible product that does not require prior allergy testing.
During the injection, the gel in which the calcium hydroxyapatite microspheres are immersed provides an immediate corrective and filling action. Then, over the course of several months, the gel is degraded by macrophages, while the hydroxyapatite particles remain, and new collagen is synthesized around them. The duration of the implant is generally longer than that of other absorbable fillers, ranging from 12 to 18 months on average.
Calcium hydroxyapatite is mainly indicated for volumetric definition in facial areas where volume is provided by bony prominences, such as the cheekbones and jawline. You may experience slight discomfort during the injection, and for a few hours after the treatment, there may be mild local tenderness. Small bruises may appear in the treated areas, but they typically disappear within a week.
Poly-L-lactic Acid
Poly-L-lactic acid (PLLA) is a synthetic, biodegradable, immunologically inert, and absorbable polymer. Its action involves increasing dermal volume through neo-collagenesis (increased collagen production). The microparticles it is composed of, when injected with a fine needle into the subdermal layer, slowly degrade over the next 12-30 months until complete absorption, stimulating the surrounding tissue to produce new collagen. This slow and progressive collagen production increases the volume of atrophic areas.
To achieve satisfactory results, patients with minor defects typically require 2-3 sessions, while those with more severe alterations may need 5 or 6. To maintain the results obtained from a treatment cycle, a touch-up is necessary every 8-12 months.
Rhinofiller
"Rhinofiller" is a technique that allows for nose reshaping and can serve as an alternative to traditional surgical rhinoplasty. It involves the injection of a specific filler into certain areas of the nose to harmonize its shape, correct asymmetries, and address humps, including those resulting from trauma. It is also possible to treat the nasal bridge to soften the curve or the nasolabial angle to correct the appearance of a drooping tip. These are minimal volume changes, but they can significantly impact the optical perception of the face, allowing for significant nose remodeling in some cases or making subtle and imperceptible modifications in others. A single session is usually sufficient for immediate results, which is a significant advantage compared to the invasiveness of surgical intervention and its lengthy post-operative recovery period.