Dermal Fillers

What is a Dermal Filler?

Dermal fillers are substances that are injected into or under the skin.

They can be used to diminish or eradicate age lines and to change the contour of various parts of the facial anatomy. 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.

Natural dermal fillers are made up of components that are based on substances found naturally in the human body. Their effects last for many 6 to 18 months or more depending on the formulation and the amount used.

Popular fillers made up of substances found in your body are composed of mainly two substances

1. A carbohydrate filler made from hyaluronate – there are many brands
2. A mineral based filler made up from calcium hydroxylapatite – called Radiesse

These dermal fillers are non allergenic and don’t require pre-testing. Hyaluronates 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. The mineral based filler also stimulate the production of natural collagen fibres to varying degrees. The Hyaluronates relies primarily on its ability to create volume and to long lasting hydration. Calcium hydroxyl apatite has an immediate volumising effect but is also effective in stimulating collagen production.

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 6 to 18 months depending on the product and volume used and where it is injected. It is ideal for someone contemplating fillers for the first time for filling out lines, defining lips and plumping out thinned skin. Brand names of hyaluronates include Restylane, Lipp, Juvederm, Belotero, Teosal and others.

2. Calcium hydroxylapatite – Radiesse

Calcium hydroxylapatite is found naturally in the connective tissue of the skeletal structure. It is has been used as a dermal filler for over 15 years. The product has an immediate volumising effect and strongly stimulates the production of collagen beneath the skin. As a result the effects tend to be much longer lasting – approximately 12 – 18 months or more depending on the area being treated. This product is not suitable for filling very superficial lines or for areas where the skin is thin. It is suitable for deeper lines, for filling hollows and for reshaping and recreating nasal bridges and jaw lines. Brand names include Radiesse – for more information go to

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 and sunken and withered areas can be filled and rejuvenated. Shrunken lips with loss of volume and outline can be restored to their former youthful appearance as well as correcting imbalances.

They are used for:-

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 levelled. Fillers can improve facial features dramatically without the need to resort to major plastic surgery with all its attendant drawbacks and costs.

3. 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 loses 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.

4. Cheeks and cheek bone remodelling

Hollow and sunken cheeks and cheek bones can be filled using dermal fillers like Radiesse and Belotero Intense. Jaw lines can be contoured. Radiesse and Intense is ideal for this application.

Questions and Answers

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.

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.

The procedure can take anything from 20 minutes to an hour or more depending on the extent of the procedure. Results can last from 3 to 18 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.

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.

The treatments may involve the use of local anaesthetic creams or injections if preferred to anaesthetize the area to be treated. Use of anaesthetic cream is a simple option significantly reduces discomfort and pain. Some bruising and swelling may result from the injections.

It is not advisable to have any filler if you have had any form of reaction to any of the products or 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.

The procedure is generally free from major problems but may be accompanied by some local bruising and inflammation which normally settles with time. Very rarely, granulomas have occurred with abscess formation. Very rarely an artery may be compromised by the filler when inadvertently injected and the circulation may become impaired. These complications have occurred but are very unlikely.

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. The swelling may only last several hours but may be a present for a day or longer. Bruising may happen following a bleed and can remain 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.