| Filling of lines and wrinkles |
DERMAL FILLERS Dermal fillers are substances designed to be compatible with the body, for use in filling in areas that have lost volume with time, or are volume deficient for any reason, or simply need augmentation. They have a low incidence of side effects, are very easy to administer for someone with the right training, are very safe, and usually have an immediate effect. With best management they can be relatively pain free and easy to maintain. They are generally cost effective and produce effects that often cannot be achieved using any other modality. LIMITATIONS OF DERMAL FILLING. Results can vary from person to person. This can depend on the part of the face which is treated, how much movement there is in the treated area, the condition of the skin, and the experience and skill of the person performing the treatment. Some defects can be difficult to improve with the first treatment and although you may notice some improvement, more treatments may be needed to get best results. Treatment with dermal fillers is not going to be successful for every person, and results and duration are variable. In some people wanting treatment of deep facial lines or significant tissue sag a combination approach may be necessary. WHO CAN USE DERMAL FILLERS TO TREAT PATIENTS. Dermal fillers must be administered only by medical personnel. It is a simple procedure, done in the doctor’s office, and not usually requiring time off work. A medical practitioner must at least consult with the patient and authorize the treatment that is appropriate but some medical practitioners delegate the actual injections to a nurse. The Cosmetic Physicians Society has created guidelines for this arrangement, which have been reviewed by the Health Department and other authorities. WHAT CAN DERMAL FILLERS ACHIEVE? Dermal filling can be used to improve acne scars, depressions or pockmarks in the skin due to injury or disease, for example, chickenpox marks and unevenness in the skin after surgery or skin grafting. Other areas suitable for dermal fillers are deep “smile lines” which run from the side of the nose to the corners of the mouth, ”crow’s feet” at the corner of the eyes, ”frown lines” between the eyebrows, “smoker’s lines” which are vertical lines on the top lip, “marionette lines” at the corner of the mouth, “worry lines” which run across the forehead, the definition of the lip border, and other facial lines. HOW IS IT DONE? The technique for dermal filling is straightforward but tailored to each patient’s lines. A very fine disposable sterile needle is used to inject the fillers. There are various techniques used to deposit the fillers under the skin, but all of them aim to create a smooth surface through placing columns or droplets of filler next to each other under the line or hollow. Treatment is usually quick and is not particularly painful. A couple of the fillers contain a local anesthetic but topical and injected anaesthetics are also available for sensitive areas, as well as the option to take oral analgaesics before the appoinment. SIDE EFFECTS OF DERMAL FILLING. Straight after treatment the skin over the treatment area may look slightly raised, puffy and a little reddened, depending on the individual’s response to the needles, anaesthetic, wiping and alcohol used to sterilize the area. The amount of swelling and how long it takes to settle will vary from person to person. Treatment with dermal fillers will not stretch your skin out of its natural shape. With resorbable fillers any side effects generally resolve without permanent damage, as the filler disappears. HOW LONG WILL THE RESULT LAST? Depending on the location of the implant and due to differences among people, the results from treatment typically last from less than six months to two years or more. Especially after the first treatment, a review may be required in two to three weeks to assess results and adjust as appropriate. To maintain the improvement from your first treatments, extra top-up treatments will be needed. How often the top-up treatments are needed will vary from person to person. When you notice a line or defect coming back, you can arrange for another treatment. Or, you can choose to stop having treatment, and your skin will go back to its previous position. The will be some lasting benefit because of the natural collagen that is generated in response to the presence of the filler and to the needle pricks given to put it there. Most of the implants are not permanent because they are natural materials and slowly breaks down into natural components which are then taken up by the body, but there is one that lasts up to 5 years and one that is classed as permanent. Background of dermal filling. Physicians have been developing ways to restore volume and structure to aging skin using a variety of approaches for over 100 years. Past fillers included paraffin, silicone and collagen injections. In the 1930s, researchers discovered a natural substance in the body that they named hyaluronic acid, and they found that it plays a key role in numerous areas of the body including the maintenance of skin volume and hydration, eye volume and shape and joint lubrication and cushioning. In the decades since, numerous therapeutic and aesthetic uses have been developed for this versatile natural substance. Other simple molecules are also currently modified to make modern dermal fillers, allowing cosmetic physicians a broad palette from which to choose to meet the needs of their patients. Long Term Wrinkle Correction. There is a reliable transparent, injectable gel for correction of soft tissue deficiencies and tissue augmentation. The sterile gel consists of sterile water bound to 2.5 % of the active substance and does not contain microparticles, hence the use of the word Aqua in its name. This unique gel has been specially designed for correction of facial contour deformities due to aging, acne, trauma, surgery and infection or due to congenital deformities, and can be used for: Cheekbones, Smile lines, Lip augmentation, Frown lines, Depressed corners of the mouth and marionette lines, Chin, Tissue reconstruction following lipodystrophy or surgery, Other soft tissue deficiencies of the face such as scars etc. This gel is not indicated for treatment of fine wrinkles. Treatment should not be administered if there is infection of any type on the skin, in patients with autoimmune disorders or people who are acutely unwell. This gel is unique due to its stability and long lasting cosmetic results. After injection a thin layer of the body's own connective tissue surrounds the gel, enabling it to become a stable part in the connective tissue. It remains soft after injection and has a very natural feel and look. WATERBINDING FILLERS. Dermal fillers based on the water binding hyaluronic molecule have become very popular because of their safety and ease of use, and excellent ability to produce a smooth fill for lines and wrinkles. These are malleable smooth gels that flow easily into the skin, creating a smooth, natural look and feel. Water binding fillers are an excellent treatment option for Lip enhancement, Deep folds, Facial lines, Wrinkle correction, Volume augmentation of the lips, shaping facial contours (such as cheeks and chin correcting) and smile lines (correcting thin, superficial lines around the eyes), and the fine lines of the mouth and forehead. What is hyaluronic acid? Hyaluronic acid is a natural complex sugar found throughout all living organisms that retains water -- absorbing more than 1,000 times its weight -- and adds volume to the skin’s surface. In addition, hyaluronic acid binds with collagen and elastin and transports essential nutrients to these fibers. The triple combination of collagen, elastin and hyaluronic acid provides structure, elasticity and volume to the skin and contributes to its overall appearance. As the skin ages and is exposed to environmental pollutants and ultraviolet rays, the cells lose the ability to produce hyaluronic acid. As a result, the skin begins to lose volume, often resulting in the formation of facial wrinkles and folds. Dermal fillers comprised of crossed-linked hyaluronic acid are used by physicians to help temporarily replace lost hyaluronic acid and to restore skin volume and a smooth, natural appearance. In its natural form, unbound hyaluronic acid forms a liquid made of highly-hydrated individual polymers (chains) that are metabolized in the body in just 12 hours. Cross-linking refers to a process in which the individual chains of hyaluronic acid are chemically bound (or “cross-linked”) together, transforming the liquid hyaluronic acid into a soft solid, or “gel.” The firmness of the gel depends on the degree of cross-linking of the individual hyaluronic acid chains. The body metabolizes cross-linked hyaluronic acid more slowly, resulting in a longer duration of effect when hyaluronic acid is used therapeutically.
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