Scarring, wrinkle, and skin depression treatment (Dermal Fillers)

What are dermal fillers?

Dermal fillers are substances injected into the skin or lips in order to increase volume in specific areas. They can be used to treat individual creases and wrinkles, or used to increase volume more generally in a wider area. There are several different types of filler with different properties and different uses. There are also many varieties of each type, and the market changes very rapidly with new products becoming available all the time.

Which types are available at the moment?

There are four main types in current use, along with a few that are still in the very early stages of evaluation. They can be generally grouped into either ‘resorbable’ fillers (non-permanent), and ‘non-resorbable’ fillers (permanent). The four main ones are:

1) Hyaluronic acid (HA) based fillers (non-permanent)

The most common by far are the HA derivatives, which include all the Restylane™ varieties, Perlane™ , the Juvederm™ range, Teosyal™ , Belotero™ , Cristal™ , CRMTM, Emervel™ and several others.

2) Poly-L-lactic acid (non-permanent)

The poly-L-lactic acid filler is more widely known as Sculptra (and was previously called NewFill). It is not strictly speaking a filler, but instead induces collagen production, and its effects last considerably longer than the HA fillers

3) Calcium hydroxylapatite (CaHA - non-permanent)

Calcium hydroxylapatite has been used for many years in bone-grafting and dental reconstruction work, and was introduced into the filler market in 2004 under the brand name Radiesse. It is also non-permanent, but long lasting.

4) Polymethylmethacrylate (PMMA - permanent)

PMMA has been used in various fields of medicine since the 1940s for such things as dental prostheses, bone cement and hip implants, and has a proven safety profile. Unlike the other fillers mentioned, PMMA should be considered as permanent. It is not currently very popular when compared to the others.

Which types do you offer?

I use HA fillers and Sculptra. The HA fillers I use most commonly are from the Restylane and Teosyal ranges, and will always (unless there’s a specific reason not to, such as an allergy) use the varieties that contain local anaesthetic too. As well as increased comfort during the treatment, the local anaesthetic offers additional benefits which possibly include reduced risk of bruising. If you have had previous experiences with a certain brand of filler, and would either much prefer to use a certain brand, or specifically do not want to use a particular variety, then we can accommodate that – just let us know during your consultation.

I currently do not offer either calcium hydroxylapatite fillers (although I am looking at these, and may offer them in the future), or PMMA (as there is very little demand for it).

Can fillers be used to deal with sagging and loose skin?

Not really, no. As you age and skin loses its elasticity, wrinkles may appear that are as a result of this loose skin. Fillers are not the ideal solution here. They may help with correction of a few of the lines, but it may be that a surgical approach offers a better outcome. If I feel this is the case, I can if you wish refer you to a Plastic Surgeon colleague to discuss this further.

How long do they last?

HA fillers are all broken down and removed by the body eventually. Most of the manufacturers suggest that they last 9 – 12 months. In my experience, I think that’s slightly optimistic – I think it’s reasonable to expect them to last 6 – 9 months, and if you’re lucky, they may last a full 12 months.

What if I’m unhappy with the result of my filler injection?

In the unlikely situation that an undesirable outcome occurs with a HA filler, it is possible to correct it using an enzyme known as hyaluronidase, which breaks down the unwanted hyaluronic acid. In most, 10-30 units of hyaluronidase is enough to correct the problem. Local site reactions may occur in up to 25% of persons, although they are usually transient and mild. Initial treatment with as little as 5-10 units is commonly recommended and is often effective, although some treat with as much as 75 units with few adverse effects. Additional corrections can be performed, although full correction may take up to 4 weeks to fully appreciate.

How do you decide which areas to treat?

In order for you to be happy with your treatment, the single most important thing is that we both understand exactly what you are looking for. At your initial consultation we will discuss in depth the areas that cause you most concern, your requirements and expectations, followed by an honest appraisal of the best options, and a treatment plan tailored to your needs. The areas of the face that are most commonly treated are the lips, glabellar ‘frown’ lines between the eyebrows, the nasolabial folds or ‘smile’ lines which run from each side of the nose to the corner of the mouth, tear troughs, and the so-called ‘marionette’ lines which run vertically down from the corner of the mouth. However, there are many other areas that can also be treated and we can talk about those options at your consultation.

Will I see the results immediately?

You will notice a change immediately, but the final effect usually takes 2 weeks. After your treatment, you may experience some bruising and swelling which takes a little while to settle down, so the appearance for the first few days should not be taken as the final result.

Can I combine fillers with other treatments?

Yes, and I may well recommend this at your consultation. All of the various aesthetic treatments are excellent at what they do, but none of them offer a complete solution to all problems. Some wrinkles may just need a filler, some may respond much better to botox, and some may require a combination of them both for the best result. Don’t worry – we will discuss this in full, and we’ll make a plan that we both agree on BEFORE we start treatment. If we schedule botox and fillers at the same session, then we’ll do the fillers first and botox afterwards, so that the fillers do not interfere with the placement of the botox injections.

What will happen at my initial consultation?

The first thing that I want to know about is your general medical history, including any medication you are taking (whether that is prescribed, or over-the-counter). If you have not had an aesthetic treatment before then we’ll talk about and agree on exactly which treatments are most appropriate to your long-term aims and objectives. We can discuss any alternatives, any risks and complications associated with treatments, and I’ll answer any questions you may have. I would encourage you to bring a friend or relative with you, as they are often likely to remember parts of the consultation that may have slipped your mind. I will take notes as we talk and possibly some photographs too. If you have specific ideas in mind, then feel free to bring pictures with you.

And what about when I come for my treatment?

Firstly, we will look again at the discussion we had at the consultation, and be sure that you are still happy with it. If you’ve changed your mind about ANY aspect of treatment, that’s no problem at all, and if you feel you need longer to decide, then there’s absolutely no rush and no pressure. Only once you are entirely comfortable with our plan and have decided to proceed will I ask you to sign a consent form for treatment.

I’ll ask you to remove any makeup if you are wearing it. I will then take photographs (and possibly very short video clips too, depending on what we are planning to do) of the areas we are going to treat.

Photographs are a vital part of the process – without reference to these images at a later date, it is extremely difficult to assess how effective the treatment has been. I will apply some local anaesthetic cream to the injection sites and allow some time for that to work. I’ll then place tiny dots with a make-up pencil on your face where the injections will go, and record that with another photograph (I use this to ensure I know exactly how much filler goes into exactly which area – this information allows me to make very accurate and informed adjustments to your treatment in the future). You can then relax on the couch, whilst I perform a series of tiny injections to the marked areas. The treatment is very much a 2-way process – I’ll regularly ask you to look at what we’ve done so far, and get your feedback. No matter how experienced or talented your practitioner, no-one knows your face better than you.

Why do fillers sometimes need massaging once they’ve been injected?

To ensure that it has spread evenly through the area we are treating. It can be a bit disconcerting the first time! For instance, if I have injected your nasolabial folds then in order to spread it effectively, I’ll put one finger inside your mouth and my thumb outside, and massage the area firmly. This may be a little uncomfortable, but the fillers containing local anaesthetic do seem to help here. I may ask you to continue massaging the area for a few more days. If this is the case, you’ll first be shown how to do it, and then given detailed instructions how often you should do it.

How long does it take for a treatment?

Depending on the volume of filler we’re using, around 30 – 45 minutes.

What happens afterwards?

Immediately after the injections and massage, I’ll rub some arnica gel into the area we’ve treated. I’ll then give you some more arnica gel to take home which I find helps with any bruising or swelling. We will then arrange your follow-up appointment, give you your aftercare information and you are free to go! You can go straight back to work if you wish - by the time you leave, you will be able to see a change and there may be some redness at the injection sites. If it’s possible, I’d advise you to avoid makeup for the rest of the day, but if not, try and leave at least a few hours before reapplying.

Can anything be done to prolong the effects?

No – the ingredients in the fillers are slowly cleared by your body at a certain rate, and there’s no way to slow that process down.

Can I have a filler treatment if I’m pregnant or breast-feeding?

No. Whilst they almost certainly are safe in these circumstances, they have not been tested and conclusively PROVEN to be safe. Until that happens then the manufacturers do not permit the use of their products in pregnant or breast-feeding patients.

Are there any situations when having fillers is either not recommended, or must be avoided?

There are very few. If you have had a previous adverse or allergic reaction to a filler, then you should not have it again. If you have any infection at the site of injection, then we will delay treatment until the infection has been treated or clears up. If you have an active cold sore, or the feeling that one is about to break out, then I’d advise you to use Zovirax until it has settled.

I'm sure there are many questions that you have regarding dermal fillers, of which we hope some will be answered on this page. We've included a few common questions that we're asked below but please don't hesitate to contact me for a free consultation where I will be happy to answer any questions in person.

How long have fillers been used?
Is there an age limit to receive fillers?
How do Hyaluronic acid fillers work?
Is Hyaluronic acid safe? Is there a maximum does?
Are dermal filler injections painful?
What are the side effects of dermal fillers?
Can other medications interfere with fillers?
Should I be concerned about herbal supplements I'm currently taking?