What is a dermal filler?
Dermal fillers are substances injected into or just under the skin and lips to restore volume and contours to the face.
Are dermal fillers safe?
In the UK there are nearly 200 dermal fillers available. In our opinion only a very small number of these have a good safety profile – the hyaluronic acid fillers. There has been considerable media attention to the regulation of dermal fillers in recent months, but to date the best tool patients have is to use a reputable practitioner using a reputable product.
What is Hyaluronic Acid (HA)?
HA occurs naturally in the body, and forms part of the matrix supporting the function of our skin and joints. It can also be considered our skin’s internal moisturizer, absorbing a lot of water and hence being responsible for our skin’s hydration.
Which HA fillers do you use?
There are several brands available – Juvederm, Restylane and Teosyal are some common names. The area to be treated will largely dictate the filler we will use. Juvederm is an excellent range and we have choices of the Ultra range as well as Voluma, Volift and Volbella which provide a longer duration of result as well as a greater lifting effect. For very superficial lines and wrinkles we recommend Belotero as it has been shown to have a more even distribution under the skin, minimizing the risk of irregularities. For the under-eye area we suggest Teosyal Redensity II which works in a very different way to other HA fillers and is specifically designed for use in this area. Teosyal Redensity I is an excellent skin booster which can aid in skin rejuvenation. Whenever possible we use fillers containing a local anaesthetic agent, making the treatment more comfortable.
Which areas can be treated with HA fillers?
HA fillers can be used in many different parts of the face and body. The picture below shows some of the common areas we may inject HA fillers.
- Frown lines
- Droopy brow tails
- Hollow temples
- Hollowness under the eyes
- Refining the nasal shape and tip
- Volumising the cheeks
- Droopy mouth corners
- Lipstick Lines
- Lipstick Lines
- Nasolabial folds & smile lines
- Marionette lines
- Defining the jaw line
- Defining the chin & filling a deep chin crease
- Pre-jowl sulcus
- Rejuvenating the hands
- Hydrating the skin of the neck and decolletage
What does HA filler treatment involve?
Prior to treatment you will have a thorough consultation to discover your main concerns and priorities. We will also take a medical history to make sure fillers are a safe and appropriate treatment for you. Photographs will also be taken as a record. We may also mark our target areas and treatment plan on your face and take a further photograph as a personalised treatment record.
For some areas we may apply a local anaesthetic cream to numb the area whilst we talk. Treatment itself takes around 15-30 minutes. It involves injection of small amounts of a clear gel into or just below the skin. This may be done with fine needles or with a blunt-tipped cannula, which is generally more comfortable, requires less insertion sites and causes less bruising. The technique used will depend on the area to treated, and this will be explained to you during the consultation. We may administer small injections of local anaesthetic if required, or apply some ice to numb the area further. After injection we may massage the area quite firmly with some arnica gel to ensure even and smooth distribution of the product. The arnica gel helps to minimise bruising.
Who should avoid having HA fillers?
- HA fillers should not be administered to pregnant women, or to breast-feeding mothers.
- Any patients who have had a previous reaction to an HA filler should avoid having treatment again. Also please mention if you have a specific allergy to local anaesthetic agents.
- Patients taking blood-thinning medications such as Warfarin and Clopidogrel are at significant risk of bleeding and bruising with HA filler treatments, and would be wise to avoid this. Aspirin also thins the blood but to a less significant degree – patients should be aware that they may bruise, but this is not an absolute contra-indication.
- Patients taking steroid medications have thinned skin and are therefore more at risk from HA filler injections.
- Patients with a tendency to form lumpy scars (known as hypertrophic or keloid scars) should avoid HA filler treatments.
Can patients who get cold sores still have lip filler treatments?
There is no reason why a patient prone to cold sores should not have lip filler treatments, provided they understand that they may develop cold sores post-treatment. If a patient is particularly susceptible then we recommend discussing this with us as we may recommend a short course of anti-viral medication prior to treatment.
Is there any advice I should follow after having HA fillers?
- Avoid touching the injection sites for an hour after treatment to minimise the risk of introducing infections.
- Unless you have been specifically asked to, avoid massaging the treated area as you may move the product from where it was intentionally placed. This also means avoiding other facial treatments such as facials and microdermabrasion for 2 weeks after treatment.
- You may start to feel tender when the local anaesthetic in the product has worn off. Take Paracetamol as required but avoid non-steroidal anti-inflammatory drugs such as Ibuprofen and Aspirin as they can increase the risk of bruising.
- Avoiding alcohol on the day of treatment can also minimise your risk of bruising.
- Avoid anything that will make you very hot until all the redness and swelling has resolved. This includes intense exercise, saunas, steam rooms and sunbathing.
- If you have had filler treatment to the cheeks we will ask you to try to sleep on your back for the first week. Whilst we understand it is difficult to control the position you sleep in, we advise this to minimise the risk of moving or re-moulding the product.
- Light make-up can be applied 6 hours after treatment.
- Drinking plenty of water in the first 2 weeks after treatment will help the HA filler to plump up.
- Following lip filler treatments your lips may feel very dry due to the water absorption by the filler. We will provide you with a nourishing lip balm, and recommend you use this regularly.
What are the side effects of HA fillers?
In professional hands HA fillers are safe drugs and complications are rare.
- The most common side effects are redness, swelling, mild itching and bruising in the treated area.
- Under- and over-correction are possible. Under-correction can be managed with further HA filler treatment. Over-correction is usually treated with firm massage to distribute the product more evenly.
- Very rarely the filler may cause a greyish discolouration of the skin. This is an extremely rare complication with the brands of HA filler we use at Illuminate Skin Clinics.
- Allergic reactions, whilst possible, are extremely rare.
- Inflammatory reactions to the HA filler are also rare but can happen, and very rarely this can lead to the formation of granulomas (inflammatory nodules) within the tissue.
- If the HA filler is inadvertently injected into a blood vessel it can cause lack of blood supply to the area that blood vessel supplies. Usually the practitioner can spot this during treatment and will take measures to manage it instantly. This can result in the formation of an ulcer on the skin, which would require further management. This is an extremely rare complication.
Are the results instant?
HA fillers instantly add volume to a treated area, however the final effect should not be judged for 2 weeks after treatment. Immediately after treatment you may have redness and some swelling in the area. Furthermore most HA fillers absorb large amounts of water over the following 1 to 2 weeks, and so the effect can be further enhanced during this time.
How long do HA fillers last?
Most HA fillers will last between 9 and 12 months in most areas of the face. You should expect a lip treatment to last a little less – between 5 and 6 months – since we use our mouth so much causing the filler to degrade faster.
Using Juvederm Voluma, Volift and Volbella gives a significant advantage in longevity. Voluma and Volift last between 15 and 24 months. Volbella is used for the lips and lasts upto 12 months.
Will I look “over-done” if I have HA filler treatment?
Many celebrities have given fillers a bad name by opting for an extreme look – over-plumped lips and pillow cheeks are common sights in the media. Most reputable practitioners aim for a subtle look rather than an obvious one. Be further reassured by the fact that these excessive results require really quite large quantities of filler to achieve, and not the sort of volumes we routinely use in our treatments.