Cosmetic Injectables

Face and lip fillers (dermal fillers)

Dermal fillers are substances injected into your face. They fill lines and wrinkles and add volume to areas such as your lips or cheeks.

WHAT ARE DERMAL FILLERS MADE OF?

The most popular dermal fillers used contain a naturally occurring gel like substance, classified as a glycosaminoglycan, which is found within our skin and connective tissues.

The skin consists of an abundance of this substance making it the perfect dermal filler due to its biocompatibility. These fillers are temporary and are broken down by the body over time.

Treatments can range from restoring lost volume softening lines and folds, contouring and sculpting to replicate bone, augment the lips and hydrate the skin. For lip enhancements, the product used are also dermal fillers but can be referred to commonly as lip fillers.

CAN I HAVE DERMAL FILLERS IF I AM PREGNANT, BREASTFEEDING OR PLANNING PREGNANCY?

It is not recommended to have dermal fillers if you are pregnant or breastfeeding. Although the substance that dermal fillers are made of is found naturally within the body these products have not been studied in pregnant of breastfeeding women.

However, if you are planning pregnancy then there is no reason why you cannot get your regular dermal filler treatments.

WHO CAN’T HAVE DERMAL FILLERS?

Patients with multiple allergies or allergies to any of the components in the product (such as the local anaesthetic lignocaine) need to avoid having treatment.

It is best to avoid dermal fillers if you have a history of active autoimmune disease or are on immunosuppressant medication due to the risk of reacting to the filler. However it is not an absolute contraindication and many patients with lupus, rheumatoid arthritis and other autoimmune disease can safely have treatment without any adverse events. It is important to always liaise with your treating physician and cosmetic dentist about your medical history.

Patients who are on high dose of prescription acne medication may need to wait 6 months before they can have dermal fillers due to an increased risk of poor healing.

WHAT IS THE DOWN TIME WITH DERMAL FILLERS?

Dermal fillers have very minimal down time. It is important to remember that the treatment is a medical procedure so there are expected ‘side effects’. In general dermal fillers are relatively pain free (this is helped by the use of local anaesthetic with in the filler and the use of topical anaesthetics and nerve blocks). Pain should be temporary but many have some tenderness and discomfort in the area of treatment for a few days. This can be treated with simple pain relief such as paracetamol.

Swelling and redness is expected. Swelling often peaks at 24-48 hours but can persist on a lesser scale for a few weeks. It can take a few weeks (generally 4) for the filler to fully settle into the skin which is why doctors will not do a ‘top up’ treatment before this has occurred. Swelling can also result in some asymmetry which will settle with time. Swelling can be managed by cool compress, avoidance of heavy exercise and antihistamines and occasionally steroids in severe cases.

The main factor causing down time is bruising. This is expected with any treatment using a needle into the skin. The skin has a vast supply of arteries, veins and capillaries and even the most skilled injector can cause a bruise.

WHAT ARE THE RISKS OF DERMAL FILLERS?

Dermal fillers are considered low risk, however there are some very important risks that every patient needs to be aware of.

The most serious risk with dermal fillers is the risk of injecting into a blood vessel such as an artery or vein. As dermal fillers are a viscous gel they can act to occlude the vessel and prevent the flow of blood. This can result in decreased perfusion to target tissues such as the skin and result in skin death or necrosis due to a lack of blood supply, There have also been cases of blindness resulting from dermal fillers due to the gel traveling to smaller arteries like the retinal artery which supplies the eye.

High risk areas for this complication are the glabellar (frown area), nose, nasolabial folds and tear troughs. Even the most experienced cosmetic doctors would have had intravascular injection as a complication before. However in the right hands this is managed immediately with dissolving the filler and appropriate treatment. Another reason why it is essential to go to a dental clinic for your treatment.

Other risks include infection such as cold sores in those who have the HPV virus and rarely bacterial infection. There is a small risk of nodule formation and granuloma formation which is a delayed inflammatory reaction to the dermal filler. In cases like this it often occurs many months after treatment, but can be treated with antibiotics, steroids and occasionally removal of the product.

WHAT AREAS CAN BE TREATED WITH DERMAL FILLERS?

Dermal fillers can be used to treat almost all areas of the face. Their use depends on the type of gel and ranges from soft products to smooth and refine the skin, volumizing products to replace lost volume and plump the lips and firmer products which are used to add structure and support. Dermal fillers can add volume and sculpt the lips and rejuvenate the mouth area, contour the cheekbones and restore lost volume in the cheeks, fill in lines and folds in the face (eg marionette lines, nasolabial folds), add support to the tear trough area and rehydrate the skin. More advanced techniques for dermal fillers include adding volume to the temple region, supporting the forehead, shaping the nose, sculpting the jawline and chin, rejuvenating the neck and hands as well as intimate procedures.

The use of dermal fillers is unlimited, however having treatment in higher risk areas (as explained above) needs to be performed by an experienced and skilled injector. In the right hands dermal fillers can completely rejuvenate the face, freeze the clock and improve the quality of the skin.

HOW MUCH DERMAL FILLER WILL I NEED?

This is a difficult one as no two people are the same in regards to the amount of product required nor their individual concerns or expectations. The lips for example will need at least 1ml for a noticeable result, whereas the nose and tear troughs may need slightly less.

When we consider cheekbone enhancement, jawline sculpting and chin enhancement, 2-3 ml may be needed initially.

WHY CAN’T THE NAMES OF DERMAL FILLERS BE MENTIONED IN ADVERTISING?

Unfortunately we are unable to name dermal fillers in advertising. In Australia, strict laws prevent the advertising of prescription medications. As dermal fillers and wrinkle relaxers are prescription medications we cannot advertise them. This even extends to the ingredients of the dermal fillers which is why navigating the available options can be very confusing for the consumer.

We are only able to advertise dermal fillers as ‘dermal fillers’. The two main companies that produce dermal fillers in Australia are Allergan and Galderma, they are the industry leaders and produce two of the world’s most popular brands of filler. Simply Google them and the names will come up. Within each of these ranges of filler are numerous fillers of difference characteristics and names. Again it is extremely frustrating and confusing that we cannot use these names in any form. Any clinic that uses brand names of these products is essentially breaking the law in Australia.

The best thing for any potential patient to do is simply contact their preferred doctor or clinic and arrange a consultation. Here the different fillers will be explained and the correct treatment recommended.

DOES BRUISING AFFECT THE END RESULT?

Bruising is one of the most common effects from dermal fillers and can vary from person to person. It is sometimes impossible to avoid bruising, especially with lip injections as this area is extremely vascular and well supplied by a network of tiny blood vessels. Injecting a needle into the skin in any area of the face can result in a bruise despite the good intentions and skill of the injector.

A bruise can be prevented by avoiding alcohol (preferably 7 days prior to treatment and 7 days post treatment) and medications that may thin the blood such as aspirin, ibuprofen and fish oil. Ensuring you follow your aftercare advice provided by the doctor is also essential. Applying cool compress, no exercise and no alcohol is essential to prevent and lessen bruising.

If you do get a bruise this can often look frightening and will get worse before it gets better. Rest assured a bruise will only last 5-7 days, and in the case of a haematoma (collection of blood under the skin) 2 weeks. This can be managed with ice, topical creams such as arnica and hirudoid and LED light therapy treatments in severe cases. A bruise may be unsightly but is no reason to panic. It will NOT affect the final result of treatment and is only a transient side effect. It is a consented risk and one that must be anticipated with any cosmetic treatment. Once the bruise slowly fades naturally the treatment will be settled and not affected in any way.

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