What is a Dermal Filler?

A. Dermal or skin fillers

Dermal fillers are substances that are injected into the skin, or underneath the skin, in order to alter the surface contour and any defects. They can be used to diminish or eradicate age lines that appear and to change the contour of various other parts of the face and body. Deep folds and lines can be made shallow, lip definition and volume can be restored or enhanced, the chin, jaw line, cheeks and nose can be altered and improved and volume restored to sunken cheeks and withered hands.

Dermal fillers are either naturally occurring or synthetic substances. Natural dermal fillers are made up of components that are based on substances found naturally in the human body and their effects are not permanent – their effects last from several weeks to 2 years or more depending on the formulation used. They include the following groups of preparations:-

1. Hyaluronate – many brands
2. Calcium hydroxylapatite – Radiesse
3. Polycaprolactone PCL – ELLANSÉ™
4. Lactic acid in a polymerized form – Poly L Lactic Acid

These dermal fillers are non allergenic and don’t require pre-testing. Hyaluronates, polycaprolactone and calcium hydroxylapatite fillers produce immediate correction in lines, creases, indentations and hollows. They are also used for creating definition and fullness in various structures including the lips, nose, ears, chin, cheeks, jaw and hands. Poly-L-Lactic acid works differently to the above three fillers in that it does not produce any immediate correction but takes from 6 to 12 weeks to do so. During this period of time the dermis is stimulated to produce its own collagen fibres and the resulting filling effects are much longer lasting.
Each of the three categories of fillers stimulate the production of natural fibres like collagen to varying degrees. The hyaluronates 1, stimulate some fibre production but its benefit relies primarily on its ability to retain water to create volume whereas Poly L Lactic acid 4, relies almost entirely on its ability to stimulate the production of fibrous tissue to achieve similar but longer lasting results. Polycaprolactone 3, and Calcium hydroxyl apatite 2, lie somewhere in between in its mode of action in that it has an immediate volumising effect but is equally effective in stimulating collagen production

Synthetic dermal fillers such as acrylates do not occur naturally in the human body and are much longer lasting or permanent. We do not advise the use of permanent fillers in most instances however, because as the face changes in shape with age, synthetic fillers do not degrade and their presence beneath the skin may become obvious and unsightly.

The following is a summary of the main characteristics of the types of natural dermal filler and their application.

1. Hyaluronates

This filler is a clear gel like carbohydrate substance with varying densities and viscosities. It acts like a magnet drawing water to itself, plumping the area it was injected into. It remains effective for 3 to 12 months depending on the product brand used and the site of injection. It is ideal for someone contemplating fillers for the first time for filling out lines, defining lips and plumping out thinned skin. It has an immediate volumising effect but is only a mild stimulant of collagen production. Its duration of action is not as long lasting as other types of fillers. Brand names of hyaluronates include Restylane, Perlane, Lipp, Vital, Sub-Q, Hydrafill, Isogel, Juvederm, Belotero, Teosal

2. Calcium hydroxylapatite

Calcium hydroxylapatite is found naturally in the connective tissue of the skeletal structure. It is a white paste like substance that has been used for some 30 years in orthopedic and orthodontic procedures. It has been used as a dermal filler for over 5 years.
The product has an immediate volumising effect and strongly stimulates the production of collagen beneath the skin. As a result the effects are longer lasting – approximately 18 months or more depending on the area being treated. This product has to be injected more deeply than the hyaluronate fillers and so is not suitable for superficial lines or for areas where the skin is thin. It is suitable for deep lines, for filling hollows and for reshaping and recreating nasal bridges and jaw lines. Brand names include Radiesse – for more information go to www.radiesse.com

3. Polycaprolactone – ELLANSÉ™ comes in 4 tunable longevity options designed to last 1, 2, 3, and 4 years. It is a well known totally bioresorbable soft medical polymer. It is FDA approved and is used in numerous CE marked products.It has been used for several decades and has been used for dental and arthroscopic implants. It is placed beneath the skin and is great for restoring depressions and lost volume in different parts of the face. For more information go to http://ellanse.com/

4. Poly L Lactic Acid

Lactic acid is produced in the human body. Poly L Lactic Acid – produced from the polymerisation of lactic acid – has been used throughout Europe for nearly 10 years – it has proved to be particularly useful for improving the appearance of skin where there is loss of elasticity and volume. It is especially useful in the face where there are multiple lines, hollowed and sunken cheeks and sunken eyes. The restorative and plumping effect of this substance is due to its ability to stimulate collagen production. The treatment requires a number of treatment sessions at 2 – 4 weekly intervals. The filling effect is gradual and becomes evident after several weeks. The benefits of this filler, though slower to appear, are comparatively longer lasting than other fillers – around 2 years or more. The brand name for this filler is Sculptra – for more information go to www.sculptra.com

B. How fillers work and what they are used for

Dermal fillers can be injected into different layers of the skin, or under the skin, and as a result of their filling effect they can change and improve the outline and contour of different parts of the anatomy including the face, neck, chest, hands and other body parts. Lines and wrinkles can be reduced or eradicated, the shape of the nose, cheeks, lips, jaw and chin can be altered, sunken and withered areas, eg hollow cheeks and withered hands, can be filled and rejuvenated. Shrunken lips with loss of volume and outline can be restored to their former youthful appearance. Saddle noses can be re-contured and straightened, hollow cheeks can be plumped out, chins can be enhanced and jaw lines improved.

They are used for:-

1. Line and wrinkle eradication
2. Remodelling of facial and other body parts

1. Line and wrinkle eradication

Lines, wrinkles and folds have different depths ranging from deep skin folds such as the lines running from the outside of the nostrils down to the angle of the mouth – the nasolabial lines – to superficial lines and wrinkles around the eyes. Lines appear with the aging process and some appear earlier in some individuals and ethnic groups than in others. Unlike Botox which is used to prevent lines forming by inactivating the muscles directly responsible for causing the skin to crease, dermal fillers do not inactivate the muscles of facial expression but instead fill out the lines and creases in the skin that have already formed.
Fillers can be used to eradicate deep skin creases – e.g the naso-labial folds – by injecting under the skin, but can also be used to fill out more superficial lines and wrinkles by injecting into the more superficial layers of the skin.

2. Remodelling of facial and other body parts

Fillers can also be used to restore, to build up, to define or change the contour of structures like the lips, nose, chin, jaw line and cheeks for example. The filler creates and occupies a space in or beneath the skin thus changing the appearance of the surface contour. Lines can be eradicated, lips can be outlined and their substance restored to their original youthful appearance. Saddle defects to the nose can be straightened. Hollow cheeks can be filled out and sunken cheeks can be lifted. Indented or pitted scars can be leveled. Fillers can improve facial features dramatically without the need to resort to major plastic surgery with all its attendant drawbacks and costs.

For areas that need to be reduced such as jowls, double chins, chubby cheeks and eyebags See sections on Spot Fat Removal and Skin Tightening by RF.

Lip remodelling

Lips are a central feature of the face and lips can become thinner, wrinkly, sunken and lack definition with age. There is loss of hyaluronates and other connective tissue components such as collagen and elastin. The lip border looses its definition and firmness and radial lip lines develop. The body of the lips start to wither and as volume is lost they begin to shrink in size. Fortunately these degenerative effects can be reversed with the help of dermal fillers. Loss of naturally occurring hyaluronates in the dermis can be replaced, the lip margin or vermillion border can be redefined, the body of the lips can be restored and years taken off your appearance. Individuals with inherited small or thin lips can have them enhanced bringing some balance to their appearance. Preparations like Lipp, Softline, Isogel and Hydrafill can reverse the

Nose reshaping

Saddle defects and other depressed or irregular areas in the ridge of the nose can be corrected with semi permanent fillers like Radiesse or permanent fillers like Aquamid. To compliment the effect of fillers Botox can be used to lift up the tip of the nose somewhat.

Cheeks and cheek bone remodeling

Hollow and sunken cheeks and cheek bones can be filled using dermal fillers like Radiesse, Sub-Q, Sculptra and Aquamid. If chubby cheeks or jowls are present Spot Fat Removal injections can be used to reduce these.

Jaw line remodeling

Fillers can be used to improve the jaw line by filling in contours giving the jaw a straight and better defined appearance. Radiesse is ideal for this application. If jowls are present these can be reduced using spot fat dissolving injections followed by skin tightening. See section on fat reduction and Radio Frequency Skin Tightening.

Chin remodelling

Small chins can be enhanced and deep crease lines can be reduced using a dermal fillers like Radiesse. If the chin is knobbly a liile Botox can be used to soften it. Double chins can be eliminated using Spot Fat Removal injections aided by Radio Frequency Skin Tightening.

Eye bag reduction

Eye bags can be improved with careful placement of a soft filler. However they will more often be improved with initial Spot Fat Removal injections and Radio Frequency skin tightening.

Scar revision

The appearance of pitted or indented scars can often time be improved and leveled with fillers like Radiesse or Restylane.

Other areas

Other areas that can be improved include the hands, the chest – decolletage area and any other part. Please ask.

C. Questions and Answers

Are dermal fillers suitable for me

Dermal fillers have numerous uses and benefits to suit every type of problem as outlined in the sections above. A proper assessment and discussion is necessary beforehand.

Are there alternatives to dermal fillers

There are other ways that facial lines and creases can be treated – however each has its advantages, drawbacks and limitations. Botox is particularly suitable for the prevention of lines of the upper part of the face. Surgery may represent the best option if the problems are too advanced. Other treatments include the use of lasers, radiofrequency, infra red, micro-needling and chemical peels. These may be equally or more suitable in eradicating certain facial lines than dermal fillers. To view the alternatives click on the words outlined in blue and follow the links. Once you have surveyed the alternatives ask to have a free consultation with the clinic doctor.

How long does the procedure take and will the benefits last

The procedure can take anything from 10 minutes to an hour or more depending on the extent and complexity of the procedure. Benefits can last from 3 to 36 months or longer depending on the filler type, quantity used and the area of application. Other factors, such as depth of injection, skin type, age, lifestyle, general metabolic and muscle activity have an effect on longevity Fillers may be repeated periodically as required. There are no age limitations for adults.

What does the procedure involve

Dermal fillers are administered by injecting the product into different levels of the skin or lips as required. The products are sterile as are the syringes and needles. The procedure can take as little as ten minutes to over an hour depending on the complexity of the task. Local anaesthetic nerve blocks and or local anaesthetic creams may be used for certain procedures to minimize any discomfort. Varying amounts of the product is injected so as to create the desired aesthetic result. A review of the procedure is usually done within a week or two and again after 4 to 6 weeks. Adjustments and top ups may be required.

Is there any pain or discomfort

The treatments may involve nerve blocks or local anaesthetic creams to anaesthetize the area to be treated. This provides the best pain free option and although it may not always be possible to achieve complete local anaesthesia, discomfort is significantly reduced. Some bruising may result from the injection. Varying amounts of redness and swelling can be expected around the treatment area but will begin to fade within the first few days. However complete recovery may take a while longer as some residual inflammation and varying degrees of lumpiness may persist for a while afterwards. Resolution of any adverse features can usually be expected.

Are there any contra-indications

It is not advisable to have any filler if you have had any form of reaction to the product or any of its components previously although this is very uncommon. Other contraindications include the following:- being pregnant or breast feeding, a history of any autoimmune disorders or if on any immunosuppressive or steroid treatments, anaphylactic reactions, local infections or inflammatory problems such as acne, bleeding tendencies or recent anticoagulant therapy or taking of substances that thin your blood. If you have had a history of herpes around the mouth you will need to be given some antiviral preventative treatment before the procedure.

Are there any complications or risks

The procedure is generally free from major problems but may be accompanied by some local bruising and inflammation which normally settles with time. Rarely, abscess formation and granulomas have occurred requiring specific treatment. Very rarely tissue necrosis has occurred when an artery has been inadvertently injected. With improved injection protocols the incidence of these is negligible.

Is there any downtime from the procedure

As with all other minor procedures you will need to set some recovery time aside to allow for inflammation and discomfort to settle down – this will vary with the procedure performed. This may be as short as several hours or may be as long as a week or so. There may be some bruising and this can also last for a week or longer. Make-up may usually be applied immediately after treatment and with certain treatments you may be able to carry on as normal within a matter of hours. Some treatments can be very quick and effective and have a minimal impact on your time but others may take much longer to settle down.

For more information go to www.chepstowlaserclinic.co.uk