— REJUVENATION OF SKIN USING YOUR OWN AUTOLOGOUS FACTORS —

While dermal fillers are sometimes referred to as “wrinkle fillers” they can do much more than treat wrinkles. They can restore volume, give your facial features more definition and give the illusion of lifting. Indeed it has been shown by 3D facial mapping that replacing for example cheek volume or jaw angle projection can lift nasolabial folds (the lines between the nose and the mouth) topographically by a measurable amount without any filler actually being put into the nasolabial fold.

Dermal fillers can be used for many applications:

• Smoothing lines around the nose and mouth (perioral lines)

• Reducing volume loss and deflation in cheeks and temples

• Softening vertical lip lines

• Increasing lip plumpness, definition and projection

• Smoothing out a chin crease or secondary smile lines

• Correcting facial asymmetry

As we age, our skin loses volume and elasticity. Natural collagen declines by 2% every year, with 30% of our collagen being gone by the time we’re in our 30’s. How quickly we age depends on a number of factors. Our collagen decline is mainly influenced by genetics, lifestyle and our amount of cumulative sun exposure throughout our lives. If you feel that you are ageing prematurely or you’re bothered by skin laxity and wrinkles, dermal fillers can reduce the visible signs of volume loss and collagen breakdown. They work even better when used in combination with other reparative treatments such as skin thickening or tightening (link).

Dermal fillers work by replacing lost volume with a natural gel. They can be placed on top of bone to elevate facial features and give support to areas such as cheeks and jawline. Fillers can also be done to improve nasolabial folds and to contour the cheekbones. Superficial placement of filler in soft tissue is a common technique for softening lines and augmenting the lips. A good knowledge of facial anatomy is vital for practitioners performing cosmetic injections as there are many important structures under the skin of the face that can be injured if the injection site, speed or volume is not correct.

There is a huge range of different dermal fillers available in Australia. They may vary in their molecular size, density, product longevity and the type of chemical processing used to create them. For instance, to enhance the volume of the red part of your lips, your doctor may choose a softer more spreading filler while more dense, stiff filler may be better suited for sharpening the border of the lips or flipping them outwards. Contouring cheekbones or adding structure to replace bone requires a filler that will be stiff and strong, whereas filling the front part of the cheeks needs a soft and very flexible filler that moves normally with the skin when you smile.

Most of the temporary fillers are made from a natural complex sugar molecule which we all have in our bodies. It’s found in high concentrations in our skin, joints, and eyes. This molecule has a unique property of being able to hold 1000 times its own weight in water and to attract and bind water molecules. This makes it extremely useful in skincare for keeping the skin hydrated and giving it volume.

The advantage of this type of filler in particular is that it is highly biocompatible and allergic reactions are extremely rare. The body will gradually break down these molecules and the skin will return to its previous condition. On average this takes six to twenty four months but sometimes dermal fillers can last much longer. If you are happy with the results of your treatments then you will require maintenance injections every 6-24 months, depending on the type of product chosen for you. Natural fillers can be layered and the same area can be retreated with no adverse effects.

In the semi-permanent category is another type of filler made from calcium based microspheres suspended in an aqueous gel carrier. These fillers work by stimulating your body to produce collagen around the microspheres, gradually improving facial volume and definition over several months. They tend to last upwards of 18 months and require maintenance injections, just like the resorbable fillers. Because some of their effect is related to tissue growth stimulated in your body by the filler, the result is influenced by how well your body responds to tissue growth stimulation, and often this is less well when you are older or not in good health.

The longevity of your dermal filler will depend on a number of factors: the quantity and type of filler used and how quickly your body breaks it down. Sometimes individuals with good biological tolerance for dermal fillers may have longer results and other patients eliminate the filler faster than expected. There has been much debate about what influences the rate of breakdown of dermal fillers but there is no good evidence to enable doctors to predict how fast you will break down your dermal filler other than watching how your body processes it. On average you can expect your injections of resorbable dermal fillers to last 6-24 months.

The placement of the filler can affect how long it will last. Areas with more movement, such as the mouth, nasolabial folds and marionette lines, will generally result in filler breakdown much faster than cheeks or temples. Also the denser the filler and the deeper the injection, the longer it is likely to last.

If you love the results of resorbable dermal filler but would like something that lasts a little longer, then consider tissue stimulating injections. Instead of using water-binding molecules, this treatment involves injecting tiny biocompatible microspheres in a gel base into the skin to promote the formation of collagen. As collagen builds around the microspheres, so does the volume in the treatment area. This type of filler is ideal for jawline and lateral face, and can be used in a dilute form to wash over the dermis to treat crepiness and fine lines as well. Repeat treatment may be necessary especially when this product is used on the neck and hands.

Dermal fillers are dispensed by prescription and only a registered medical practitioner may prescribe them according to Australian law. In Australia, it is mandatory that the doctor prescribe dermal fillers personally for each patient so a consultation between doctor and patient needs to occur before these medications can be used. Sometimes doctors delegate the actual injecting to nurses who are trained in cosmetic injectables, but nevertheless the consultation must occur, and the authority to delegate injections is valid for 12 months only. Even though intended for cosmetic reasons, filler injections are still considered a medical procedure that calls for training and expertise. Of course a keen aesthetic eye is important as well, which is where art meets science.

As with any cosmetic procedure the possibility of side-effects does exist. You may experience some redness, swelling or bruising at the injection site. The severity of bruising and swelling can depend on injection technique and areas being treated, as well as your tendency to bruise and anything you have eaten or taken that affects clotting time. There are many foods and supplements that will increase the risk of bruising as well as prescribed medications. Other possible side-effects include: lumpiness, inflammation and infection. Although major allergic reactions to dermal filler are not generally observed there are late inflammatory responses that have occurred that have responded to dissolving of the filler, so the body may object to the presence of the filler and treat it as a foreign substance in some people. Should the dermal filler be injected into an artery the area of tissue normally supplied by this artery may be compromised and the filler could be carried distant from the site of injection, affecting tissues further afield. Although this is rare, if it happens, a dissolving agent should be administered immediately to reverse the filler. Sometimes this complication is not noted for a while and can result in a “bruise” or infective appearance that fails to resolve quickly. If you see any appearance after having dermal filers that doesn’t seem normal you should return to your doctor promptly as the earlier treatment is given for these kinds of side effects the better the outcome. Although an excellent knowledge of anatomy makes it much easier to avoid injecting filler into arteries, knowledge of the variations on standard anatomy, and the ability to recognise when there has been vascular compromise is important for any practitioner performing cosmetic injectables. Just as we all learn how to do CPR but hope never to need to use that knowledge, cosmetic medical practices should all have emergency protocols in place and have on hand the dissolving agent and the knowledge of how to use it, as well as the drugs required to treat an allergic reaction and the ability to prescribe the other medications that would be supportive for any side effects that might occur. At Restoration Clinic our side effect rate is low, but the outcomes of any side effects will always be better than they would be if not given the correct attention.

We recommend booking your dermal filler injections on a day when you are not planning any heavy activity or strong sun exposure. If you do get any swelling or bruising ice may be helpful, as will rest. If you usually take non steroidal anti-inflammatory medications or other blood thinners, vitamin E, Fish Oil or St John’s Wort, you should discuss this with your doctor prior to treatment. It is recommended to stop taking these medications for up to two weeks prior to your dermal filler injections as these medications have been associated with an increased possibility of bruising and bleeding.

The first step of your procedure is the pre-treatment consultation where you will have the opportunity to ask questions and discuss your aesthetic goals.

During your consultation, your doctor will assess the area of the face you wish to enhance, as well as review your health history. It is important to disclose your clinical background fully before treatment. Health conditions such as allergies, skin and neurological disease or medications that you are taking can influence your results, and your past medical history can be extremely useful to your doctor in knowing what steps to take to minimise problems.

The second step is the injection procedure. Your skin will be cleansed and disinfected, and you may be offered a topical or injected anaesthetic to numb the location before the injections. The anaesthetic will ensure that the procedure is as comfortable as possible but some people prefer just to use ice to numb the area before treatment. The ice minimizes the risk of bruising as well.

Depending on the products being used and the treatment area, you’ll probably see results right away. Some patients may experience bruising and swelling immediately or after several hours. Some areas swell more than others, such as lips and eyes. All swelling is short-lived and should resolve quickly. You can return to work right after your treatment; however, you should skip the gym or other high energy activity for the rest of the day. You should be sure to keep the injected area clean for the following few days as the body needs time to heal the injection holes.

Before considering having dermal filler injections you should ensure your skin and you are in good health. It is not wise to pass a needle through infected skin or where there is a coldsore, and of course if your body is busy dealing with some other infection you may not have the immune defenses spare to deal with injections.

If you have eczema or psoriasis or any other dermatological problem in the area you wish to have treated with dermal fillers this should be taken care of first, or your doctor may devise a workaround so as not to interfere with the damaged skin.

Have a good night’s sleep and come to your appointment well hydrated. If you have any fear of needles or tendency to faint be sure to advise your doctor, and if you are prone to coldsores please use oral or topical coldsore treatment before and after having dermal fillers. If you are prone to bacterial infections your doctor may choose to give you antibiotics to avoid this, and if you are planning any dental work or energy based cosmetic treatment such as laser be sure to advise your doctor in case the timing of any treatment needs to be shuffled around this.

Your doctor may have more suggestions for how best to prepare for dermal fillers after you have had your consultation.