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DERMAL FILLERS

Dermal fillers are a type of minimally invasive aesthetic medicine used to add volume, alter the contours of the face, and fill in wrinkles. Common areas to inject fillers are in the face, neck, and hands, resulting in a fuller, smoother, and more youthful appearance. Dermal fillers can be very helpful in those with early signs of ageing, or as a value-added part of facial rejuvenation surgery and are among the most popular aesthetic procedures because they carry immediate results, very few risks, and little recovery time.

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As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow's feet become more apparent. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle.

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In general, you may be a good candidate for dermal fillers if you want plump thin lips, enhance shallow contours, soften facial creases and wrinkles and change the contours of the jaw, improve the appearance of recessed scars, reconstruct contour deformities in the face and decrease or remove the shadow of the lower lids.

“Dermal filler injection is a highly individualized procedure. You should do it for yourself, not to fulfil someone else's desires or to try to fit any sort of ideal image, especially those coming from social media. Choosing a procedure based on “what’s new” is never a medically sound decision. Hearing about a brand name procedure on television, through an advertisement or online does not necessarily mean it is the best procedure for you.”

What dermal fillers can't do?

For some patients, surgical treatment such as a facelift, brow lift, or eyelid surgery may be the best approach. Minimally invasive rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results but may help delay the time when consideration of a facelift becomes appropriate. It is important to remember that dermal fillers are temporary treatments for facial ageing and that ongoing treatments will be needed for long-term results.

What should I expect during a consultation for dermal fillers?

During your initial consultation, you will have the opportunity to discuss your cosmetic goals.  Dr Ricardo will evaluate you as a candidate for dermal fillers and clarify what approach is best for you. Alternative and additional treatments may be considered, once he understands your goals and medical condition. It is important to be completely honest during the consultation and be prepared to discuss your medical conditions, drug allergies and medical treatments, current medications, vitamins, herbal supplements, alcohol, tobacco and drug use, and any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other minimally invasive facial procedures, as well as any prior facial surgery.

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Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, evaluate the elasticity of your skin, take photographs, discuss the type of procedure or combination of procedures and tell you whether your expectations are in line with typical results, discuss any risks or potential complications and share before-and-after photos of cases similar to yours.

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For many people, the use of "off-the-shelf" fillers can be a simple office-based procedure that can nicely enhance their appearance. These dermal fillers are very predictable and have relatively minimal risks and side effects. These fillers are often injected in Dr Ricardo's office and usually be completed on the same day as the initial evaluation.

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The success and safety of your dermal fillers procedure depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. Dr Ricardo will determine with you the best type and volume of filler needed for your particular areas of concern. His assisting staff will fully attend to your comfort and safety.

There are several different types of dermal fillers. The most common types are:

Calcium hydroxylapatite

Brand names include: Radiesse

Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. It's often used to:

  • Moderate-to-severe creases such as nasolabial folds, marionette lines, and frown lines.

  • Enhance fullness of the cheeks and other facial contours.

  • Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications.

Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required. This type of dermal filler is known to produce a very natural result, doesn't migrate and side effects are rare. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.

Hyaluronic acid

Brand names include: Captique, Esthélis, Elevess, Hylaform, Juvederm, Perlane, Prevelle, Puragen, Restylane

Hyaluronic acid injections can be used to improve the skin's contour and reduce depressions in the skin due to scars, injury, or lines. You can see potentially dramatic improvements for:

  • Acne scars.

  • Cheek depressions.

  • Crow's feet at the corner of your eyes.

  • Deep smile lines that run from the side of the nose to the corners of the mouth (also known as nasolabial furrows).

  • Frown lines between the eyebrows.

  • Marionette lines at the corners of the mouth.

  • Redefining lip border.

  • Scars of burns, acne, and those caused by wounds.

  • Smoker's lines; vertical lines on the mouth.

  • Some facial scars.

  • Worry lines that run across your forehead.

Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. If the term sounds familiar, it's because the same substance is often injected into the aching joints of people with arthritis to ease pain and provide extra cushioning.

Polyalkylimide

Brand names include: Aquamid

Polyalkylimide is a semi-permanent dermal filler and is often used by plastic surgeons to:

  • Treat deeper wrinkles such as nasolabial folds or depressed scars.

  • Plump thin lips.

  • Enhance cheekbones and the jawline, and replace facial volume lost due to age.

  • Treat facial wasting from HIV medications.

Polyalkylimide has very little reaction with human tissue, meaning it's biocompatible, and no allergy test is required. It is radio transparent, meaning it won't interfere with x-rays.

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After the injection, a thin layer of collagen slowly forms around it over the course of about a month. The gel is eventually surrounded. A single procedure can inject a large volume. This product, which is thought to be quite stable over time, can even be removed if necessary.

Polylactic acid

Brand names include: Sculptra

Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body's production of collagen. This type of dermal filler is known as a stimulator. This non-toxic, biodegradable substance has been used for more than 40 years as a suture material. Polylactic acid is known to work particularly well in the lower half of your face, and is used to:

  • Fill the lines caused by laughing.

  • Plump thin lips.

  • Treat deep nasolabial folds.

This substance is unlike other dermal fillers because it doesn't produce immediate results. Instead, it stimulates your own body's collagen production, so results appear gradually over a period of a few months.

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You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your collagen. Then it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.

Polymethyl-methacrylate microspheres (PMMA)

Brand names include: Bellafill

PMMA is considered a semi-permanent filler and is most often used to treat medium-to-deep wrinkles, folds, and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.

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When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, will likely under-fill on the first treatment, adding more later if needed.

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One of the downsides of PMMA is that several injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. 

Body Injections - Patient Safety Warning

The FDA (Food and Drug Administration federal agency in the United States) does not approve any type of injections for body contouring and augmentation purposes. These include hydrogel and silicone injections. These injections attempted for these types of procedures can lead to serious complications, including infection, scarring, disfigurement, stroke, and death. Usually, these procedures are offered by unlicensed individuals and should be avoided.

What are the steps of a dermal fillers procedure?

Step 1 – Facial assessment & mapping

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If you choose to utilize packaged soft tissue fillers, Dr Ricardo will evaluate your facial appearance and skin tone and examine the areas of your face to be augmented. Strategic points on your face may be marked as the appropriate injection sites for the filler.

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Step 2 – Cleansing & anaesthetizing​​

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The injection sites will be cleansed with an antibacterial agent. Pain at the injection site may be ameliorated by the use of a very cold instrument to chill the skin, anaesthetic ointment to numb the skin or injection of local anaesthesia. Some fillers contain a local anaesthetic like lidocaine to enhance comfort during injection. While not painless, the injections are usually easily tolerated.

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Step 3 – The injection

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Injection usually takes only a few moments per site. The process of injecting, massaging, and evaluating the result is performed, and additional filler is added as needed. Depending on the number of areas to be treated, the whole process may be as short as 15 minutes, or as long as an hour.

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Step 4 – Recovery

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You may be offered an ice pack to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.

How can fat injections be used as dermal fillers?

Some patients may want to consider fat injections, which use fat harvested from the patient's own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

How fat injections are administered?

Fat injection requires a more extensive procedure than "off-the-shelf" soft tissue fillers. A "donor area" must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft. The grafted fat then has to redevelop a blood supply to survive. About 50% of the fat injected will survive, and the surviving fat will last forever.

What results should I expect after fat injections?

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. Typically, multiple fat transfer procedures will be needed to achieve the desired results. The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in an operating room.

What should I expect during my dermal fillers recovery?

Recovery time varies for each patient and each type of filler injected. You can resume most activities right away, but it is generally recommended that you avoid intense physical activity for the first 24-48 hours to minimize swelling and bruising. Be sure to discuss your specific recovery plan with Dr Ricardo before scheduling your injections.

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Your initial appearance after treatment with any dermal filler may include an "overfilled" appearance to treated areas, swelling or bruising ranging from mild to severe, temporary numbness or redness, palpable lumps or hard areas at the injection sites, and hypersensitivity reaction that can seem like an allergic reaction with hives and swelling.

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Most conditions can be alleviated with topical icing and massage and will improve within a matter of hours or just a few days. Some reactions may require more aggressive treatment with medications or injections. When your fat is the injected filler, the healing process is longer and may take a few weeks. Be sure to discuss your recovery and treatment plan with your Dr Ricardo.

What results should I expect after dermal fillers?

The results of soft tissue augmentation using dermal fillers are apparent immediately and will last from several months to several years depending on the filler used and the patient injected. Maintaining good overall health and maintaining healthy and strong skin with appropriate products and skin treatments will improve the results and longevity.

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