Die perfekten Lippen, keine Falten, ewige Jugend! Um solche Ziele zu erreichen wird in den letzten Jahren immer öfter zu künstlichen Hilfsmittel gegriffen! Ein bisschen Hyaluronsäure hier, ein bisschen Botox da und schon werden Makel ausgeglichen und der Schritt zur ewigen Jugend kleiner und kleiner.
Heute möchten wir über ein hot-Topic der letzten Jahre sprechen- die Hyaluronsäure.
Welche Filler gibt es überhaupt?
Schon seit ca. 100 Jahren werden so genannte Filler in der ästhetischen Medizin eingesetzt. Neben der rein ästhetischen und kosmetischen Anwendung werden Filler auch für die Wiederherstellung nach Unfällen oder von angeborenen Defekten herangezogen.
Begonnen wurde Ende des 19. Jahrhunderts, indem man Fett im Gesichtsbereich injizierte. Es folgten zahlreiche unterschiedliche künstliche Materialien, die in den Körper injiziert wurden. Begonnen mit flüssigem Paraffin, das aufgrund seiner Giftigkeit zu heftigen Nebenwirkungen führte, bis hin zu flüssigem Silikon, das auch mit Nebenwirkungen einherging, konnte sich eigentlich nur Hyaluronsäure durchsetzen und wird heutzutage in ca. 95% aller ästhetischen Anwendungen herangezogen.
Hyaluronsäure ist chemisch gesehen ein Glykosaminoglykan und besteht aus langen Ketten. Diese Ketten sind durch kleine Brücken miteinander verbunden. Je länger die Ketten und je mehr Brücken in einem Filler vorkommen, desto zähflüssiger ist der Filler. Zähflüssig heißt einerseits schwieriger zu injizieren und schlechter formbar, jedoch auch länger haltbar. Deswegen werden Filler mit vielen Brücken und langen Ketten für eher tiefer liegende Injektionen wie das Wangen-Lift, bei denen das Jochbein verstärkt werden sollte, angewandt. Diese Filler halten bis zu 18 Monate und werden in dieser Zeit durch den Körper langsam abgebaut.
Kurze Ketten mit wenig Brücken sind besser für oberflächliche Anwendungen geeignet. Diese Filler kann man auch nach Injektion gut modellieren und verformen. Die typischen Krähenfüße werden klassischerweise mit diesen Präperaten behandelt. Neben besserer Injektion sollte man auch einen kürzeren Effekt beachten. Meist halten solche kurzkettige-Hyaluronsäure Filler nur bis zu 3 Monate.
Für Lippen nimmt man meist Mischpräperate, da die Lippen einerseits weich bleiben und nach Injektion immer nachgeformt werden sollten und andererseits eine deutliche Kontur erzielt werden soll. Der Effekt kann bis zu 12 Monaten andauern.
Filler-Behandlung mit oder ohne Betäubung?
Eine schwierige Frage! Fast alle Menschen haben Angst vor Spritzen und es gibt mit Sicherheit keinen, der sowas angenehm findet. Hyaluron-Filler werden jedoch mit sehr kleinen und feinen Nadeln injiziert. Die dadurch entstehende Verletzung ist minimal und blutet kaum! Natürlich ist das Pieksen unangenehm, jedoch gibt es keinen Patienten, der im Nachhinein von Schmerzen spricht.
Zusätzlich ist vielen Fillern das Medikament „Lidocain“ beigemischt. Dies bewirkt eine lokale Betäubung der Region. Die meisten Ärzte stechen deshalb bei einer Injektion im Lippenbereich von Außen nach Innen. Dadurch ist die nächste Einstichstelle schon betäubt und wird fast nicht mehr gespürt.
Es gibt zusätzlich die Möglichkeit einer lokalen Betäubung ähnlich wie beim Zahnarzt.
Die meisten Patienten berichten, dass das Modulieren nach Injektion der schmerzhafteste Teil der ganzen Behandlung war. Leider ist dies auch der wichtigste Teil. Durch Drücken werden mögliche Unebenheiten ausgeglichen. Zusätzlich kann man den Filler umverteilen und bestimmte Regionen speziell betonen. So wird oft bei Lippen durch Drücken die Kontur nachgeschärft. In der Unterlippe wird oft mit Hilfe eines Holzspatels bzw. Fadens eine Grube erzeugt, um den oft gewünschten Kussmund perfekt zu formen.
Wie injiziert man am besten?
Es ist grundsätzlich zu sagen, dass es nicht die „EINE PERFEKTE INJEKTIONSMETHODE“ gibt. Jeder Arzt spritzt ein bisschen unterschiedlich und je nach Arzt und Injektionsstelle wird angezeichnet oder eben nicht. Bei den meisten Fillern im Handel befindet sich genau 1ml in einer Spritze. Ist dies zu viel, bieten viele Ärzte an, den Rest bis zur nächsten Behandlung im Kühlschrank zu lagern. Je nach Wunsch wird pro Problemstelle zwischen 0,5ml und 2,5 ml injiziert. Besonders viel Hyaluronsäure braucht erfahrungsgemäß hierbei immer die Nasolabialfalte.
Es ist auch zu sagen, dass oft das „zu injizierende“ Areal für ein ästhetisch und harmonisch optimales Ergebnis, nicht immer das Areal ist, das dem Patienten negativ auffällt.
Sprich: wenn die Nasolabialfalte stört, kann man eventuell durch Setzen eines Depots am Jochbein die ganze Wange etwas anheben und so die Nasolabialfalte etwas retuschieren (Falte zwischen Nase und Mundwinkel).
Bei den meisten Lippen reicht ein Volumen von 1-2 ml. Die Nachbehandlung ist essentiell. Nur durch Drücken und Modellierung der Injektionsstelle kann ein optimales Ergebnis erzielt werden. Dies ist meist unangenehmer als die Behandlung an sich!
Was sollte man nach der Injektion beachten?
In den Stunden nach der Injektion ist Kühlung essentiell. Durch die Einstiche, werden körpereigene Reparaturmechanismen aktiviert- das Gebiet kann sich röten und schwillt an . Kühlung hemmt die Bildung der Schwellung und beugt meist einer bläulichen Verfärbung vor. Das endgültige Ergebnis wird erst nach einigen Tagen sichtbar. Manchmal kommt es vor, dass bei der Injektion ein kleines Blutgefäß angestochen wurde. Dies ist nicht weiter schlimm, jedoch kann sich der Bereich bläulich verfärben. Auch dies sollte nach 3-5 Tagen komplett verschwunden sein und kann auch anfänglich durch Kühlung behandelt werden (dadurch ziehen sich die Blutgefäße zusammen, es wir weniger Blut in die betroffenen Stellen transportiert und weniger Blut kann aus dem Blutgefäß austreten).
Sollte sich in der Stunde nach Injektion ein Areal, das nicht unterspritzt worden ist, rötlich verfärben und schmerzen, sollte der Arzt seines Vertrauens kontaktiert werden- hierbei wurde möglicherweise Hyaluron in ein Blutgefäß gespritzt. Hyaluronidase, eine Substanz, die Hyaluronsäure abbaut muss womöglich nachgespritzt werden. Dies kommt jedoch sehr selten vor (erfahrene ästhetische Chirurgen haben in ihrer gesamten Karriere nur 1-2 Fälle gesehen) und kann relativ schnell behoben werden.
Wichtig ist, dass man das Gebiet in den Stunden und Tagen nach Injektion in Ruhe lässt. Durch Herumdrücken usw. kann das Behandlungsergebnis zerstört und der Filler verformt werden. Auch wenn Bereiche initial asymmetrisch und ungleich aussehen, kann dies auch ein Ergebnis der Schwellung sein. Wenn man nach einigen Tagen noch immer nicht zufrieden ist, dann zurück zum Arzt seines Vertrauens!
Dieser Artikel entstand in Zusammenarbeit mit Doz. Dr. Georg Huemer.
Das folgende Beispiel einer schönen Lippenunterspritzung zeigt dabei ein Ergebnis, welches durch mehrere Sitzungen erzielt wurde.
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