Dermal Fillers: All You Need to Know

What are Injectable Dermal Fillers?

If you have been considering fillers, here are some information to understand before any syringe touches your skin.

Injectable dermal fillers work by, well, filling the hollows under the skin to restore volume loss due to aging besides supporting the anchoring complex to prevent sagging while simultaneously smoothening out wrinkles.
Because of this “filling” effect the results of dermal fillers can be instantaneous. Results last for over four months to 2 years, depending on the type of dermal fillers used. Designed for subtlety, fillers help to rejuvenate the face naturally, and thus has enjoyed a surge in popularity to reverse the effects of aging.

There are various types of fillers available, and the current two (2) major classes are HA (Hyaluronic Acid) and non-HA. Non -Hyaluronic Acid are the bio-stimulators such as Calcium Hydroxylapatite (CaHA), Poly-L-lactic acid (PLLA) and PolyCaproLactone (PCL).
To date, hyaluronic acid is the most commonly known filler.

Why hyaluronic acid you ask?
Hyaluronic acid are naturally found in the skin, but diminishes as you age causing the skin to sag and subsequent wrinkles. Thus the injection of HA fillers essentially replenishes your body’s natural production of hyaluronic acid.
As it exist in the body, you do not need to worry about welcoming alien substances into your body.

In the rest of this article, we’ll be discussing all the aspects of dermal fillers, and why they might be the right choice for you.

What are dermal fillers made of?

Dermal fillers are made out of FDA approved products that are commonly used by cosmetic surgeons. Most fillers are categorised by the materials that they were made with, such as acid fillers which we will be focusing on. It is important to know the general types as well as the most widely used acids in dermal fillers to ensure that you’re getting the right treatment for your condition.

Types of Acids used in Dermal Fillers

Hyaluronic Acid (HA) is the first type of acid that we’ll discuss. It is a substance that is naturally occurring and it resides in your skin. The body uses many types of acid to function optimally, and HA is to keep the skin plump and hydrated. HA fillers are typically soft and gel-like. Although the results are temporary, they generally last from 6 to 12 months before the body begins to naturally absorb the particles. Currently most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment.
Examples of HA fillers are Belotero (Balance, Intense, Volume, Hydro, Soft), Restylane, Teosyal and Juvederm.

Calcium Hydroxylapatite (CaHA)
Also a naturally occurring substance (fully biodegradable), Calcium Hydroxylapatite is located mainly in our bones. The calcium particles are nearly microscopic when used in fillers and have the appearance of a smooth gel. Calcium Hydroxylapatite’s filler is usually thicker than that of hyaluronic acid fillers and tend to last longer as well, usually for about 12 months for most patients. Calcium hydroxylapatite has also been reported to help with the stimulation of natural collagen production, and it is often used for deeper lines and wrinkles.
An example of Calcium Hydroxylapatite (CaHA) is Radiesse.

Poly-L-lactic acid is biocompatible (meaning it is safe to use in the body) and is classified as a biodegradable synthetic substance. Its application as a filler is quite recent, though it has been used in medicine for a number of years including in devices such as dissolvable stitches. Classified as “collagen stimulators” due to the acid’s capability to smoothen out fine lines by helping your skin rebuild natural collagen—the filler gel, it self -dissipates a few days after treatment.
Poly-L-lactic acid is also used to treat deeper facial wrinkles, and results can last for more than 2 years.
FDA approved Poly-L-lactic acid fillers include Sculptra® Aesthetic.

** CaHA and PLLA both possess biostimulatory properties. However, CaHA lacks long-lasting results and for PLLA, immediate effect.

Enter PolyCaproLactone (PCL), another collagen biostimulator. It revitalise collagen production and combines durability with immediate outcome, making it superior to CaHa and PLLA.
Ellanse is a PCL biostimulator and it had been well-documented to be safe and efficacious.

Which fillers do you need?

The filler to use depends on the visibility of your existing wrinkles. As fillers work by filling in hollows and smoothing lines, it is essential to select a filler that will only remove the lines and wrinkles but able to improve, enhance & restore volume. For example, someone with less apparent wrinkles could use a filler containing Hyaluronic Acid. On the other hand, a patient who is of a more advanced age or  desires a longer-lasting effect on deep wrinkles might be more suitable for biostimulators instead.

Working and effects of dermal fillers

Enhancing appearance

Dermal fillers enhances appearance by:
1. Smoothening out lines around nose and mouth
2. Restoring volume to sunken cheeks or temples
3. Diminishing vertical lip lines
4. Plumping up the lips for fuller mouth
5. Smoothening a chin crease
6. Improving skin texture which also helps acne and traumatic scars
7. Boosting overall symmetry among facial features

How do dermal fillers work?

What happens when we age?
To understand how dermal fillers work to help you look younger, let us first understand how we age. As we grow older, our skin lose elasticity. This is because our body’s natural production of hyaluronic acid, which diminishes over time, causes the creases, hollows and sagging of the skin.
On the face, we see wrinkles appearing as well as hollowed cheeks and deeper lines between the cheeks and mouth. Lack of moisture, daily life, sun exposure and environment stressors create cracks in our skin’s surface, giving the appearance of dullness.
Now what fillers can do is restore those lost volume and rejuvenate our skin.

Dermal fillers such as hyaluronic acid fillers and biostimulators are injected under the skin at predetermined areas. The fillers work by revitalising and adding volume to the affected areas. This lifts the facial skin, plumps out hollowed areas and smoothen out wrinkles and fine lines almost instantly.

Which dermal fillers do I need?

While extensive research will help you understand about dermal fillers and its benefits, only a certified and experienced doctor trained in medical aesthetics are qualified to ascertain the type of dermal fillers suitable for your desired outcome. As each dermal filler available in the market is uniquely formulated to achieve different results, seek a trusted and reliable medical aesthetic doctor who is experienced in various dermal injections. Ask to view Before and After images of past patients. Check to see if his/her style resonated with you.

Rheology of fillers; which means different brand of filler and different range within a brand, will have their own unique characteristics. Thus every single dermal filler possesses a certain texture, density and elasticity, as well as different injection depth for different parts of the face/neck, and thus certain fillers work better for certain areas of concern.
For example “volume fillers” are great for the cheekbones to restore fullness, which lifts the face and reduces the look of smile lines in the process. Softer, more malleable fillers, on the other hand works better for addressing fine lines and delicate areas such as for plumping up lips.

During and after treatment

Congratulations!
So you have done your homework and after a proper consultation with a qualified doctor, you have determined the dermal filler for your concerns.

A typical dermal filler session begins with cleansing of the area to be injected. You may be given a topical anaesthetic to numb the area prior to injection. However, current filler products also contain lidocaine, a mild anaesthetic which will help to minimise discomfort during and after your treatment.

Once the skin is sufficiently numb, your doctor will mark and map out the areas for treatment. The doctor would then proceed to inject precise amounts of filler at pre-determined areas.

Depending on the product and the areas treated, results are visible immediately. Some patients may experience mild bruising and swelling, but these are temporary and should subside over the days following the session. You should be able resume normal daily activities right after your treatment, though it is advisable to hold off exercising or other strenuous activity until your doctor gives the green light.

Last but not least, if you’re dissatisfied with your after- filler look, it is possible to have it adjusted or erased. Your doctor might suggest a second procedure to improve the outcome, or inject different fillers to achieve the desired results, or you may opt to dissolve it altogether. Yes, you have the choice to “undo” your procedure, though that may incur additional expense.

Major Application Areas

Key areas of application:

-Eyes
Fillers are typically used around the eyes to diminish crow lines and it is also a superb option for lightening dark circles, under eyes bags and to fix sunken eyes, also known as tear troughs (grooves that sit between the lower eyelid and the cheeks).

-Nose
Also known as non-surgical nose shaping, fillers are injected to re-contour the shape of the nose. For example, fillers can be applied around the tip of the nose to reduce nose size or to obtain a more refined nose shape. Another popular use of fillers for the nose is to straighten out any humps or bumps on the nose.

– Forehead
Forehead lines, forehead wrinkles or frown lines are creases/horizontal lines on the forehead which unfortunately is a totally front-and-center sign of aging. Fillers can be placed into the wrinkles to replenish volume and give a smoother appearance.

-Chin
The commonly desired chin is slightly V-shaped or heart-shaped chin that is beautifully proportioned. While fillers may not change a chin completely, with skills and the right fillers, it is possible to modestly enhance the chin and jawline contours. 

Side Effects and Risks

How long do the results last?

One of the benefits of dermal fillers is that the substance used closely resembles what we have exists in our body so the risk of allergic reaction is minimal. That said, since dermal filler products are biodegradable, they will naturally dissipate in the body over time. The longevity of your filler can range from 6-12 months (or longer) depending on the brand, thickness, parts treated and the amount injected. In short, depending on brands and techniques, the effects are long lasting but not permanent.

Hence top-up treatments are necessary 6-12 months or even 2 years (depending on fillers used) after your initial treatment. The duration also depends on many factors, such as skin type, skin condition lifestyle and age. Meanwhile, to ensure an optimal and long lasting result, your doctor might recommend medical grade skincare, dietary changes and stress management techniques. Dehydration from alcohol and smoking can also affect the skin and cause wrinkles so staying hydrated and maintaining good lifestyle habits are key to long term skin health.

Safety

Current dermal fillers in the market has been scientifically documented and backed up with comprehensive studies that support its safety and efficacy. Dermal fillers, in particular HA fillers contains substances that occur naturally in the body, and thus the risk of allergic reaction is minimal.
As long as you seek qualified medical advice, and had thoroughly discussed your condition and medical history with your doctor, there is little to worry about adverse effects that could result from dermal filler injections.

Side effects

As dermal fillers involves injections, related side effects which can occur includes tenderness, swelling, bruising and in worse cases, infections. However these are mild reactions and will resolve in days. In the hands of an experienced and skilful doctor, there is little chance of adverse occurrences, and remember, such pains could be avoided if you select the right doctor to handle your case.

Dermal Fillers vs Botox

Both dermal fillers and Botox are injectables and they are not permanent. Thus, repeated treatments are necessary for continued wrinkle-reducing effects.

Those less informed may still mistaken dermal fillers to be the same as Botox, no thanks to the latter’s notoriety for “frozen faces“. BUT Botox and dermal fillers aren’t one and the same.
Neurotoxins like Botox and Dysport are muscle relaxers. When injected, it relaxes the muscles near these wrinkles by not allowing the muscles to move much and the affected muscle is temporarily paralyzed or frozen. That softened, reduced, or even removed the appearance of ‘dynamic wrinkles’, which are wrinkles that are caused by muscle movement.

On the other hand, dermal fillers contain ingredients that add fullness to areas that have sagged or hollowed due to aging. Areas commonly affected are in the cheeks, lips, and around the mouth.

As for efficacy, bear in mind that Botox and dermal fillers treat different problems and works for different parts of the face. As a matter of fact, a combination of both may be used as complimentary treatments to achieve the best results. Consult your doctor and consider your options before making a decision.

Choosing a Reliable Provider

Certifications

Consultation is key.
It is imperative to find a medical practitioner that understands and possesses experience in injectables. Take your time to discuss your concerns with the doctor. Evaluate the way he explained the process and his recommendations. Request to view Before and After images of past patients.
At the end of the day, an injector is like an artist and your face, his canvas. Seek an injector who possess similar concept of beauty with you. That way, he would be able to identify with you on your desired look as well as expectations.

A professional and caring doctor will take time to explain the ideal treatment plan for you, and is honest about what is possible based on your expectations. Beware of those who eagerly promises great claims but have nothing to show for it.

Cost

If you see a deal for inexpensive filler, be skeptical. Research and compare prices among clinics. If a particular clinic is offering much less than the average quote, be wary. Counterfeit and diluted filler are common. Avoid fillers that are unheard of. Check for FDA approved ones. You should only allow a trained medical doctor to handle your injectables.

Conclusion/Final Thoughts

Although injection of dermal filler into the face may seem simple, it is not. Without training and experience, a doctor may cause permanent serious damage to your face. Only trained, qualified doctors can ensure that your procedure is done safely and properly
Do not be swayed by low prices. You have one face for the rest of your life, and is it not worth risking of disfigurement for the sake of some savings.
Injectables are best handled by certified doctors, not beauticians or beauty therapists.