Dermal fillers are made of various kinds of natural and man-made or synthetic materials that have been developed over the years for injection into the skin. They help to restore our skin to its former youthful appearance, as the material is injected into areas where it needs to be plumped up again and made to look firmer. Dermal fillers come in different thicknesses, and in general, the thicker the product, the deeper it is injected into the dermal layer of the skin to help plump out fine to deep lines and wrinkles, such as naso-labial folds (nose to mouth lines), fill scars, contour the cheeks and chin or augment lips. Dermal fillers tend to be broadly classified as being either non-permanent (resorbable) or permanent (non-resorbable) in their effect. In the 1980s Collagen was the first dermal filler approved in the US. However, the leading dermal fillers used by most UK & India practitioners are hyaluronic acid based products. Other non-permanent fillers to be developed include ones using polylactic acid and calcium hydroxylapatite. Permanent fillers are not widely used but can give a longer lasting effect, or even a permanent effect, and may be recommended in some cases. Private costs vary depending on the type of dermal filler used.
As the skin ages, it gradually loses some of its collagen and fat. These are the materials that prevent the skin from becoming saggy. Thus, as we age, our skin can become thinner and more wrinkled and lined. Dermal fillers help to restore our skin to its former youthful appearance. Material is injected into the skin in areas where it needs to be plumped up again and made to look firmer. Fillers come in different thicknesses, and in general, the thicker the product, the deeper it is injected into the dermis (middle layer of the skin – see diagram below) to help plump out fine to deep lines and wrinkles.
For treatment of lines and wrinkles, an anaesthetic cream is sometimes applied to the area 20 minutes or so prior to injection. This helps to numb the area to be treated and reduces pain when the needle is inserted into the skin. Before injections in the lips, a dental or lip block may be used, where a small amount of lignocaine/lidocaine (an anaesthetic like the ones used by dentists) is injected into the lip area to help to numb them prior to treatment. However, as dermal filler products have developed in recent years, we now find that many hyaluronic acid based gels are available with the addition of 0.3% lidocaine combined with the gel in the syringe. This provides an instant relief from pain upon injection and removes the need for a separate nerve block or topical anaesthesia. Different injection techniques are used depending on the type of filler and the area being treated. For filling out wrinkles, the two main techniques are: linear threading technique, where the full length of the needle is inserted into the middle of the wrinkle and the material is then injected while pulling the needle slowly backwards; serial puncture technique, where several injections are made in a line along the wrinkle or fold to lift the wrinkle; for plumping out the face, or filling larger areas such as hollow cheeks, either a fan technique or cross hatching technique is employed. Follow-up treatment Depending on the type of filler used, and the area treated, top up treatments are usually required to maintain the effect.
Depending on the area injected and the type of filler or pain control used, patients may find the procedure relatively painless to mildly uncomfortable. Treatments around the nose or lip areas are usually more painful. The obvious, immediate and most common side effect is slight bleeding after the needle has been inserted into the skin. Other risks include mild bruising, tenderness, redness and swelling that may also occur around the site of injection. These signs may take 2 – 3 days to vanish completely, especially around the lips where there is little flesh and the skin is tender. Rarely, allergic type reactions can occur after treatment with some fillers. These include prolonged redness, swelling, itching and or hardness and bumps in the skin. Such signs may appear at some or all of the points of injection. Sometimes, they can last for several months or longer, but this is extremely unusual. If you have a history of cold sores, or fever blisters in the treated area, filler injections may cause them to break out again. In these cases, your practitioner may recommend that you take an anti-herpes medicine before treatment to help reduce the likelihood of an outbreak of cold sores. Very occasionally, delayed side effects can occur many months after the first treatment. These side-effects usually appear as red lumps showing up underneath the skin. Sometimes, these may be permanent. There is some evidence that these may be more common and more difficult to treat with some of the permanent fillers. It has been reported in clinical journals that very rarely the use of dermal fillers can lead to blindness due to incorrect placement of the product and/or migration. The study by Lazzeri published in April 2012 entitled ‘Blindness following cosmetic injections of the face’ compared the data from twenty-nine clinical articles which described 32 patients in which blindness was a direct consequence of a cosmetic injection procedure of the face. In 15 patients, blindness occurred after injections of adipose tissue (from fat transfer); in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate (PMMA), hyaluronic acid, and calcium hydroxyapatite.
It is important that you follow the advice of your practitioner carefully after dermal filler treatment. This will help you to gain maximum effect from the procedure and reduce the risk of complications. Post-treatment advice may include: o iced water soaks or ice packs to help to reduce swelling (although this is generally not required); o the use of pain-killers such as paracetamol, if required for a few days after treatment; o arnica (a homeopathic remedy) cream or tablets are sometimes recommended a few days before and a few days after treatment as there is some evidence that this can reduce bruising; o bruising and swelling should go down after a couple of days, but if you continue to experience very painful swelling and bruising, or if any blistering occurs, you should contact your practitioner; o similarly, if you experience any delayed reactions such as lumpy redness occurring any time after treatment, you should contact the person who treated you immediately
As in any treatment to the skin, injections should be avoided in areas where the skin is swollen or where infections are present – e.g. active acne. This will reduce the risk of infection at the injection site after the treatment. If you have even the slightest allergic reaction to a particular filler, it cannot be used and you will need to use a different brand. Dermal fillers have not been tested in pregnant women, so their use would normally be not advised by practitioners if you are expecting a child. If you have suffered from a disease of the auto-immune system, you are likely to be allergic to bovine collagen and so it cannot be used. You need to give your doctor a detailed medical history to avoid such outcomes. Conditions which are not suited to the use of bovine collagen include: rheumatoid arthritis; psoriatic arthritis; systemic or discoid lupus erythematosus; or polymyositis.