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All You Need To Know About Dermal Fillers

Friday 12 December 2014

What are dermal fillers?

Dermal Fillers – rejuvenate and enhance facial features with natural looking and feeling results. It is injected below the skins surface to fill-in wrinkles, plump-up small areas such as the lips, and re-volumes large areas like the cheeks.

How do dermal fillers work?

They fill in the area under the skin. Some filler are natural and some are synthetic, but they all work to improve the appearance of aging skin in the following ways:

  • Filling in wrinkles, fine lines and deep creases
  • Improving scars
  • Filling out thin or wrinkled lips
  • Plumping up cheeks
  • Contouring the jaw line

How Dermal Fillers Work

How many treatments do I need?

A single treatment every 9-12 months is needed.

Types Of Hypaluronic Acid Fillers

How long till you see results

You should see an immediate improvement in the treatment areas. Most patients need one treatment to achieve optimal wrinkle smoothing. And one treatment could smooth your lines and wrinkles for up to 1 year! However, results may vary and correction is temporary.  Touch up treatments may be required to achieve and maintain optimal results. The injection process takes only about 15 minutes. You’ll also need to allow time to consult with your doctor prior to treatment.

 Dermal Fillers Solve Wrinkles

How much does it cost?

Fillers are reasonably priced, but the total cost will depend on the area to be enhanced. The average cost is R3000 – R5000 per treatment. We will assess your needs and recommend the optimal treatment to fit within your budget.

Materials

Most injectable dermal fillers have a temporary effect, because over time they are absorbed by the body. FDA has approved only one product made from a material that remains in the body and is not absorbed. The materials used in injectable dermal fillers include:

Absorbable (temporary) materials

  • Collagen: Collagen is a type of protein that is a major part of skin and other tissues in the body. Sources of purified collagen used in wrinkle fillers can be from cow (bovine) or human cells. The effects of collagen fillers generally last for 3-4 months. They are the shortest lasting of injectable filler materials.
Collagen
  • Hyaluronic acid: Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers can be from bacteria or rooster combs (avian). In some cases, hyaluronic acid used in dermal fillers is chemically modified to make it last longer in the body. The effects of this material last approximately 8 – 12 months.

Hyaluronic Acid

  • Calcium hydroxylapatite: Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones. For wrinkle filling, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle. The effects of this material last approximately 18 months.
  • Poly-L-lactic acid (PLLA): PLLA is a biodegradable, biocompatible man-made polymer. This material has wide uses in absorbable stitches and bone screws. PLLA is a long lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.

 Non-absorbable (permanent) materials

  • Polymethylmethacrylate beads (PMMA microspheres): PMMA is a non-biodegradable, biocompatible, man-made polymer. This material is used in other medical devices, such as bone cement and intraocular lenses. PMMA beads are tiny, round, smooth particles that are not absorbed by the body. For dermal filling, PMMA beads are suspended in a gel-like solution that contains cow (bovine) collagen and injected into the face.

PMMA before and after

Uses

The injectable dermal fillers made from absorbable (temporary) material are FDA approved for the correction of moderate to severe facial wrinkles and skin folds, such as nasolabial folds. Nasolabial folds are the wrinkles on the sides of your mouth that extend towards the nose. They are commonly referred to as “smile lines” or “marionette lines

The injectable wrinkle filler made from non-absorbable (permanent) material is FDA approved ONLY for the correction of nasolabial folds

Uses Of Dermal Fillers

Risks

As in any medical procedure, there are risks involved with the use of injectable dermal fillers. That is why it is important for you to understand their limits and possible risks.

Most side effects associated with dermal fillers happen shortly after injection and most go away in less than two weeks.

In some cases the side effects may appear weeks, months or years after injection.

Any injectable dermal filler could cause long-term side effects, permanent side effects, or both.

Common side effects include:

  • Bruising
  • Redness
  • Swelling
  • Pain
  • Tenderness

Less common side effects include:

  • Raised bumps in or under the skin (nodules or granulomas) that may need to be surgically removed
  • Infection
  • Open or draining wounds
  • A sore at the injection site
  • Allergic reaction
  • Necrosis (tissue death)

FDA has approved injectable dermal fillers for treatment of moderate to severe wrinkles and localized fat loss (lipoatrophy), as well as lip and cheek augmentation in the face. The FDA has approved two absorbable injectable dermal fillers for lip augmentation, and one for cheek augmentation, in patients over the age of 21.

Dermal Fillers Wrinkle Effect

FDA has NOT approved injectable wrinkle fillers to:

  • Increase breast size (breast augmentation)
  • Increase size of the buttocks
  • Rejuvenate the hands or feet
  • Implant into bone, tendon, ligament, or muscle

FDA has NOT approved liquid silicone or silicone gel for injection to fill wrinkles or augment tissues anywhere in the body.

What if you don’t like the results of the Dermal Fillers?

 HYALURONIDASE is useful for dissolving HA filler in the following instances:

  1. The filler was overdone/”over filled” and it is not aesthetically pleasing
  2. There is prolonged swelling, particularly around the eye and most often with Juvederm
  3. An infection has occurred in the area of prior filler
  4. The filler is lumpy or has nodules and doesn’t respond to massage and time (especially lips)
  5. Rare possible allergic reaction to the HA filler
  6. When there is vascular compromise secondary to the HA filler injection which can be caused by external compression on a vessel or intraluminal (within the vessel) injection

Hyaluronidase

When injecting hyaluronidase, it is mixed with lidocaine by the physician, so it is a fairly comfortable procedure.  There are a couple limiting factors with the injection.  It is not as precise as the filler injection, so it can remove some of the filler that you wanted to stay along with the unwanted filler.  Also, dosing/how much to use, is not an exact science.  It may take more than one treatment to dissolve the HA filler.  The results can occur within minutes, but usually take about a day to fully appreciate.  Also, Juvederm tends to be the hardest to dissolve, and it thought that this is related to the way it is cross linked (manufacturing process).  I imagine that Voluma would be similar to Juvederm or maybe even harder to dissolve, but I don’t have any experience with it yet.

The bottom line is that you don’t have to live with HA filler that you are not happy with.  You can easily reverse lips that are lumpy or too big, swelling around the eye from filler, or dissolve an over correction or asymmetry with hyaluronidase.  An injection with hyaluronidase can get you back to where you used to be in about 24 hours.  Also, it’s nice to have a little piece of mind when getting injected with an HA filler that the process can be completely reversed with a small procedure.

Before deciding to have a procedure using injectable dermal fillers, the below need to be taken into consideration:

  • You seek a specialist in the fields of dermatology or plastic surgery.
  • Select a doctor who is trained to perform the dermal filler injection procedure. Having filler injected should be considered a medical procedure, not a cosmetic treatment.
  • You know the type of product being used and all possible side effects.
  • You ask for the patient labeling for the product your doctor plans to use. Patient labeling should be available for all FDA approved injectable dermal fillers.
  • You have realistic expectations about the benefits you want to achieve. Discuss the amount of smoothing/filling effect that you expect and the amount of smoothing/filling effect that your doctor expects to be able to achieve based on your situation.

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