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Fillers with hyaluronic acid and autologous fat – replacing volume where it is missing
Not every wrinkle is caused by facial expressions. Where volume is lost, fillers help: hyaluronic acid for targeted and correctable results – or autologous fat for extensive, long-lasting volume restoration.
Skin ageing begins earlier than many people think: from around the age of 25, elasticity declines, and from around 30 it becomes visible. There are two types of wrinkles. Dynamic wrinkles are caused by muscle movement – they are treated with a wrinkle treatment that relaxes the muscles. Static wrinkles and sunken areas are caused by volume loss – this is where fillers help.
Hyaluronic acid
Hyaluronic acid is a substance produced naturally by the body that binds water and gives the skin fullness. For fillers, it is produced biotechnologically and cross-linked to varying degrees:
- thin, fluid gels for fine lines in the upper layers of the skin
- firmer gels for deep wrinkles and building up volume, for example in the cheeks or chin
- particularly soft gels for the lips
One advantage: hyaluronic acid can be dissolved again with an enzyme if a result needs to be corrected. Allergic reactions are very rare. Depending on the product and area, the effect lasts about 4 to 12 months; thin, fluid gels are broken down more quickly than firm ones.
Typical areas of use are nasolabial folds and marionette lines, tear troughs and dark circles under the eyes, lips and lip contour, as well as volume restoration in the cheeks, temples and chin.
Autologous fat (lipofilling)
In lipofilling, the body’s own fat is used, for example from the abdomen or thighs. It is gently harvested with a fine cannula, cleaned and introduced under the skin in small portions in a fan-like pattern. In this way, sunken areas can be filled over a wide area: hollow cheeks, cheekbones, deep wrinkles, dark circles under the eyes, drooping corners of the mouth or uneven contours on the chin.
Autologous fat is the body’s own material and is well tolerated. However, not all of the fat takes: some of it is broken down in the first few weeks, while the remaining portion generally stays permanently. A second session is therefore sometimes advisable. Because fat is harvested and introduced, lipofilling is a minor surgical procedure with a few days of recovery.
Which substance for whom?
| Hyaluronic acid | Autologous fat | |
|---|---|---|
| Suitable for | targeted wrinkles, lips, smaller volume deficits | extensive volume restoration, larger sunken areas |
| Duration | about 4–12 months, depending on the product | some is broken down, the rest generally stays permanently |
| Correctable | yes, by dissolving with an enzyme | only to a limited extent |
| Effort | injection, about 15 minutes | minor procedure with fat harvesting |
| Downtime | usually none | a few days to about two weeks |
I advise against substances that do not break down or cannot be removed – such as free silicone or mixed preparations containing particles. Late reactions can then often only be treated surgically.
Process: preparation, procedure, aftercare
The first question is whether facial expressions or volume loss is the cause. This determines which substance is suitable. We decide on the place of treatment during the consultation.
- 01before the treatmentPreliminary consultation
Analysis of where volume is missing; clarification of medical history, medication and contraindications; informed-consent discussion.
- 02day of treatmentTreatment
Hyaluronic acid: injection in about 15 minutes. Autologous fat: harvesting and introduction under local anaesthesia or twilight sedation, on an outpatient basis.
- 03days to two weeksAftercare
Cooling, no massaging, no sport for a short time, no sauna, no intense sun.
- Hyaluronic acid anaesthetic cream or local anaesthesia, injection with a fine needle or blunt cannula.
- Autologous fat Fat is gently harvested, cleaned and introduced in small portions.
- Afterwards Cooling; with hyaluronic acid you can usually resume everyday life immediately, with autologous fat plan a few days of rest.
- First few daysslight swelling, redness or small bruises are normal; do not massage the treated areas
- After a few dayswith hyaluronic acid, swelling usually subsides
- Up to 2 weeksafter autologous fat, the swelling lasts longer
- First few weekssome of the autologous fat is broken down; whether a second session is advisable becomes clear afterwards
- Month 4–12hyaluronic acid is broken down depending on the product and area; a repeat treatment is possible
Contact us immediately if unusual symptoms occur after the treatment. An injection into a blood vessel is very rare but must be treated immediately.
Risks and contraindications
Possible effects include bruising, swelling, small nodules or irregularities and – very rarely – inflammation or an injection into a blood vessel, which must be treated immediately. That is why fillers belong in experienced hands with precise knowledge of anatomy. Treatment is not carried out, among other things, in the case of acute inflammation in the treatment area, during pregnancy and breastfeeding, with certain autoimmune diseases or while taking certain medications – we clarify this in the preliminary consultation.
Frequently asked questions
Will I look “overfilled” afterwards?
Not with moderate treatment. The aim is to replace lost volume – not to change the face. It is better to treat in two steps than too much at once.
Can hyaluronic acid be combined with a wrinkle treatment?
Yes, this is often advisable: the wrinkle treatment relaxes the facial expressions, and hyaluronic acid fills what has been caused by volume loss.
When is autologous fat the better choice?
When larger areas are to be filled extensively and you would like a long-lasting result with the body’s own material. For lips and fine corrections, hyaluronic acid is usually more suitable.
Will health insurance cover filler treatment?
For aesthetic reasons, generally not. After the preliminary consultation, you will receive an individual cost estimate.