What are dermal fillers?
Dermal fillers help to diminish facial lines and restore volume and fullness in the face.
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.
Dermal fillers can be used to:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
- Improve the appearance of recessed scars
Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.
What dermal fillers won’t do
For some patients, surgery such as a facelift, brow lift, or eye lift may be the best approach. Non-surgical 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.
If you want to reduce facial wrinkles and lines, hyaluronic acid may be a good choice as a dermal filler because of its compatibility with the human body.
In fact, this substance is found in almost every single living thing. In humans, it acts as a network that transfers essential nutrients from the bloodstream to skin cells.
Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in 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. Brand names include Captique, Esthélis, Elevess, Hylaform, Juvéderm, Perlane, Prevelle, Puragen and Restylane. Hyaluronic acid is not derived from animal sources.
When this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to normal aging. It also brings water to the surface of the skin to keep it looking fresh and supple.
In the last few decades, various synthetic forms of hyaluronic acid have been eloped and used to correct disorders in the fields of rheumatology, ophthalmology, and wound repair. More recently, synthetic forms of hyaluronic acid are being manufactured for use in face augmentation.
Types of dermal fillers
There are several different types of dermal fillers.
Dermal fillers differ in chemical makeup, longevity, and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones.
Your surgeon will determine with you the best type and volume of filler needed for your particular areas of concern.
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 the surgeon’s clinic.
Candidates for dermal fillers
You may be a good candidate for dermal fillers if you:
- Are physically healthy
- Don’t smoke
- Have a positive outlook and realistic goals in mind for the improvement of your appearance
For some patients, surgery such as a facelift, brow lift, or eye lift may be the best approach.
Non-surgical 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.
During your dermal fillers consultation be prepared to discuss:
- Your goals
- Medical conditions, drug allergies, and medical treatments
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
- Any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other non-surgical facial procedures, as well as any prior facial surgery
Your surgeon may also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Discuss your available options
- Examine and measure your face
- Take photographs
- Recommend a course of treatment
- Discuss likely outcomes of using soft tissue fillers and any risks or potential complications
Your plastic surgeon will carefully explain:
- Your course of treatment
- The type of filler recommended in your case and why
- Expected results
- The longevity of the result
What happens during hyaluronic acid injections?
Tiny amounts of hyaluronic acid are injected into your face through very fine needles. The treatments typically take less than 30 minutes, depending how many lines are treated. You can expect very little discomfort.
First, your surgeon will listen to your desired results and then evaluate your facial appearance and skin tone, examining the areas of your face to be augmented with hyaluronic acid as a filler.
Map a strategy.
Next, the surgeon will mark strategic points on your face as guides to the appropriate injection sites for the filler as part of your wrinkle removal treatment.
Clean the area
Your injection sites will be cleansed with an antibacterial agent. Then a topical anesthetic will be used to numb the area, particularly if you are sensitive to injections. But in some cases, the hyaluronic acid includes an anesthetic in the mixture.
The actual injections will take just a few minutes total, and just seconds per site.
Clean up and ice
The marks will be washed away and you will be offered an ice pack to reduce any minor and temporary discomfort. At this point you may apply makeup, but be careful not to apply pressure to the treated areas, as doing so may result in movement of the hyaluronic acid.
A special note about scars and deep lines. These areas will often require multiple injections to achieve your desired results. If a deeper injection is required, you’ll be offered a local anesthetic to remain comfortable. Common sites for deeper tissue fillers are the nasolabial folds and marionette lines, or to enhance fullness in the cheeks.
Dermal fillers recovery
There is no downtime with dermal fillers. You can resume most activities right away.
Your initial appearance after treatment with any dermal filler may include:
- An “over-filled” appearance to treated areas
- Mild swelling or bruising
- Temporary numbness or redness
These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days.
Dermal fillers before and after results
The results of soft tissue augmentation using dermal fillers are apparent immediately.
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 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 including 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
Special considerations, risks and recovery
You can resume most activities immediately following injection with hyaluronic acid wrinkle treatment. Just be careful not to rub the area.
Most people tolerate injectable hyaluronic acid therapy without irritation or complications. Right after your treatment, the area may be red, swollen and bruised. This tenderness should go away within a few days.
Almost everyone is a good candidate for hyaluronic therapy. It is almost always suggested as an alternative treatment to people who have a skin test for bovine collagen and develop an allergy. Some people, however, may experience:
- An allergic reaction
- Red and/or thickened nodules that arise in the injected sites. They can persist for several weeks or months.
In the long term
Before you consider having hyaluronic acid treatment, be aware that you might not achieve the results you want with just one treatment. Depending on how your body reacts to the injections, you might need additional injections. Most people need at least three visits before they are completely satisfied with the results.
It’s key to know that the injections last between three to five months, depending on your lifestyle, body chemistry and the rate at which you are naturally aging. To maintain their youthful appearance, most people have new hyaluronic injections two to three times a year.
If you decide not to retreat, your appearance will return to its original condition. Wrinkles and scars will return, and plumped lips will lose volume.
Dermal fillers risks and safety information
The decision to use fillers is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of dermal fillers are acceptable.
Your plastic surgeon and/ or staff will explain, in detail, any risks.
You will be asked to sign consent forms to ensure that you fully understand the procedure, as well as the risks and potential complications.
Complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:
- Acne-like skin eruptions
- Bruising, bleeding from the injection site, swelling
- Damage to the skin that results in a wound and possible scarring
- Infection at the injection site
- Palpability of the filler under the surface of the skin
- Skin rash with itching
- Skin redness
- Under- or over-correction of wrinkles
These risks and others will be fully discussed prior to your consent.
Although good results are expected from your procedure, there is no guarantee.
In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers do dissipate over time. To maintain your correction, you will need to consider repeating the injection process at intervals.
Caution: In the wrong or inexperienced hands, hyaluronic acid injections can be dangerous. In addition to seeking a doctor who is trained and qualified in facial plastic surgery, make sure the physician has specific experience with these types of injections. Even though the injections may ultimately be delivered by another healthcare professional in the surgeon’s office, it will be with the surgeon’s close supervision.
Before & After Photos