Treatment
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.
What are the different types of Dermal fillers used?
Dermal fillers tend to be broadly classified as being either non-permanent or permanent in their effect by both manufacturers and practitioners using these products.
Non-permanent or resorbable dermal fillers
In 1981, Collagen was the first filler approved in the U.S. for soft-tissue filling by injection. It is made from bovine (derived from cows’ skin) collagen and is currently known in the U.K. as Collagen Instant Therapy.
The collagen is taken from the cow and then purified to such a degree that it resembles the collagen which occurs naturally in our own skin. It is necessary to have a skin test before this treatment, however, as some patients may be allergic to bovine collagen.
Collagen instant therapy comes in different thicknesses, depending on the depth of your wrinkles or loss of firmness in your skin. You will sometimes hear Collagen Instant Therapy called by the brand names Zyderm® and Zyplast® by your clinic.
Your practitioner may discuss some other collagen only based fillers which are available in the U.K. which include:
Cymetra – Collagen derived from human skin.
The leading dermal filler used by most UK practitioners is a hyaluronic acid based product. This particular brand is manufactured using bacteria. Again, this product comes in different thicknesses and is called Restylane® or Restylane Perlane®.
Hyaluronic acid is a naturally occurring substance found in the spaces between the cells of body tissues in all animals. It has already been used widely in general medicine to help eye surgeons perform cataract operations, and for injection into arthritic joints to aid movement. It is estimated that 30 million patients around the world have been treated with some form of hyaluronic acid. Hyaluronic acid has now largely replaced collagen as the favourite filler of U.K. cosmetic experts. This is because it is more likely to be compatible with our bodies than collagen, and so people are less likely to be allergic to it and do not require a test prior to use.
Other hyaluronic acid only based products include:
Hylaform® and Hylaform Plus® – Manufactured from cockerel combs.
Juvederm® ULTRA, Matridur® and Hydrafill are examples of other Hyaluronic acid based brands derived from non-animal sources.
A newer filler using polylactic acid is promoted under the brand name Sculptra ®.
According to the manufacturer, Sculptra ®, as the name suggests, is used more as a sculpting agent rather than just a wrinkle filler and larger areas can be treated with a longer lasting result.
Another product new to the UK market in 2004 is calcium hydroxylapatite, the key component of Radiesse . Calcium hydroxylapatite has been safely used in the body for many reasons including dental applications where bone build-up is needed for reconstruction and also in block form for cosmetic applications such as cheek, jaw, cranial and chin implants.
Radiesse is marketed as a long lasting dermal filler and facial sculpting agent where results can last for 2 years or longer.
Most of the ingredients of available non-permanent or temporary fillers have been widely used and clinically tested for safety and effectiveness.
Permanent or non-resorbable dermal fillers
These are newer fillers that can give a longer lasting effect, or even a permanent effect, and may be recommended in some cases by a practitioner.
These products are currently not widely used, but include the following brands:
Artecoll® – Rounded PMMA beads in bovine collagen.
Aquamid™ – Polyacrylamide.
Bio-Alcamid™ – Alkyl-imide.
Matridex® – Hyaluronic acid with Dextran microspheres.
What skin problems can dermal fillers treat?
Collagen treatment has been widely used to increase the size and volume of lips in women for a number of years, and this is still the most popular use for most dermal fillers.
However, these products are also very effective in both men and women in helping to fill out lines around the lips, the lines from the nose to the corners of the mouth (nasolabial lines), smile lines on the cheeks, as well as crow’s feet and forehead wrinkles.
Thicker fillers can also be used to add volume to sunken cheeks and weak chins, reshape the tip of the nose, as well as filling out deeper acne or other scars. In addition, fillers can be used to help reduce the appearance of veins and bones in aged hands with thin skin.
Usually, if you need to have fillers in the upper part of your face for movement lines associated with expression i.e., crow’s feet, forehead and general wrinkle lines, it is usually recommended that the fillers are used alongside injections of botulinum toxin (or Botox®).
Some fillers can be used to treat larger skin defects in other areas of the body.
Depending on the area treated, and the depth of wrinkles or scars or sagginess of the skin, your practitioner may recommend that different combinations of types of fillers are used in order to achieve the best results.
What happens during Dermal Filler treatment and how long does it take to recovery?
During your first visit to a clinic, you should explain what you expect from a dermal filler treatment and how you would like to look afterwards. Your practitioner should discuss any potential problems connected with the treatment, such as allergies. You must discuss which filler is best for you and how much it will cost.
For instance, if bovine collagen is recommended, you will be advised to have a skin test where a small amount of collagen is injected into your forearm to see if you have an allergic response. This skin test is only currently recommended for products containing bovine collagen. Other dermal fillers can be used without a skin test. The area injected will be checked after 2 – 3 days and again after 4 weeks to see if there is any swelling or tenderness. Around 3% of people will have a positive skin test preventing them from having treatment with bovine collagen.
The practitioner should take a medical history to make sure that there are no reasons why you shouldn’t have the treatment. Then you will usually be asked to read detailed information and sign a consent form which means that you have understood what the treatment may do, along with any potential side effects from the filler(s) being used.
Photographs may also be taken by the practitioner for a “before and after” comparison of the treatment.
The consultation, skin test (if appropriate), or maybe even an initial treatment might happen in your first visit, if your skin suits the filler recommended and you are comfortable in going ahead with the treatment. If not, you will simply be given a second appointment to begin your procedure.
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 (an anaesthetic like the ones used by dentists) is injected into the lip area to help to numb them prior to treatment.
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.
Recovery time for Dermal Fillers
Depending on the area treated, and which filler is used, treatment times can vary from around 30 minutes to an hour, and recovery time can be from a few hours to a few days. However, most people find that they can return straight back to work after treatment with dermal fillers.
