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.

What dermal fillers can do

• Plump thin lips

• Enhance shallow contours

• Soften facial creases and wrinkles

• Improve the appearance of recessed scars

• Reconstruct contour deformities in the face

• Decrease or remove the shadow of the lower lids

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

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What dermal fillers can't do

For some patients, surgery such as a facelift, brow lift or eye lift 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 aging and that ongoing treatments will be needed for long-term results.

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Who is a good candidate 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

• Are committed to maintaining good skin health

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach.

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How much do dermal fillers cost?

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Cost is always a consideration in elective procedure or treatment. The cost of dermal filler injections may vary based on the expertise and qualifications of the person performing the treatment, the type of procedure used, time and effort the procedure or treatment requires, as well as the geographic location of the office.

Your satisfaction involves more than a fee.

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What types of dermal fillers are available?

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

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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.

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Hyaluronic acid

Common Brand names include:  Juvederm, Revanesse, 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 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

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.

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Polylactic acid

Brand names include: Sculptra

Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body's own 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 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.

You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your own 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.

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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.

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, your surgeon will likely under-fill on the first treatment, adding more later if needed.

One of the downsides of PMMA is that a number of 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. To avoid any unwanted results, it's key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.

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Summary

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 office or medical spa.

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What are the risks of dermal fillers?

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 provider 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.

Severe 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

• Asymmetry

• Bleeding from the injection site

• Bruising

• Damage to the skin that results in a wound and possible scarring

• Infection at the injection site

• Lumps

• Palpability of the filler under the surface of the skin

• Skin necrosis (ulceration or loss of skin from disruption of blood flow)

• Skin rash with itching

• Skin redness

• Swelling

• Under- or over-correction of wrinkles

In very rare cases, the filler may accidentally be injected into your blood vessels instead of under your skin. This can block blood flow. What happens if your blood flow is blocked will vary depending on where the block is. If your skin is affected, you might have skin loss or wounds. If your eye is affected, you might lose your eyesight or go blind.

These risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your provider, including those complications requiring urgent care. Although good results are expected from your procedure, there is no guarantee that you will be satisfied with your results. Because significant complications can occur from dermal filler injections, it is important to be in the care of a board certified plastic surgeon who understands the risks and is trained and prepared to deal with any complications that may occur.

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.