Cosmetic Facial Injections (Dermal Fillers)
Dermal fillers are injectable products made from a very wide range of materials which are used to treat facial wrinkles and conceal the effects of aging on the face. The most commonly complained lines are those seen on the forehead, on the cheeks (naso-labial folds), around the mouth (“marionette lines”), lips, side of the eyes (“crow feet”) etc. They can of course be used for the filling of any other contour irregularities -dimples, scars and so on. Fillers are commonly used as an adjunct to other procedures, like laser treatment and/or botulinum toxin and are comfortably administered in an outpatients setting.
The choice of exact filler is determined by results required and exact anatomical area treated (deep furrow vs. delicate lines). My patients are most likely to be offered treatment with hyaluronic acid based products which I found to have the safe record after administration and excellent clinical result. Treated patch of skin is gently massaged after injection. The procedure is minimally invasive causing only mild discomfort and will not leave scars. A topical anaesthetic cream (eg. EMLA or AMETOP) may be applied to reduce discomfort half an hour prior to the treatment, especially if more areas need to be addressed. Even a local anaesthetic injection (dental block) can be used although this is rarely required. Modern fillers also contain local anaesthetic reducing discomfort further.
The effects are not permanent but should last for around 6-12 months, possibly even longer. Procedure can be repeated several times at adequate time interval, but sensible clinical decisions should be made and common sense applied.
Following the procedure, there may be some redness in the treated areas, though this is usually minimal. Your face may be a little swollen and tender for a short period. The treatment starts to work immediately but the greatest effect is seen after about 1-2 weeks. The filler gives firmness to the treated skin. Lines and wrinkles should appear smoother and softer within few days.
Patients are usually happy to leave the clinic few minutes after the procedure. You can return to work the same day and resume most activities within few hours. Make-up may be applied immediately afterwards.
Types of Fillers
Dermal fillers may be biocompatible or synthetic and are marketed alone or in combination.
Biocompatible fillers have a perceived safety record and are resorbable. However the period of benefit is of limited duration normally lasting about 12 months. This allows reasonable benefit from the injections yet accommodation of natural changes of the face with continued ageing.
Synthetic fillers are permanent, but associated with rejection, migration and granuloma (scar lumps) formation and are unable to change with time. In the case of an adverse reaction complete removal is almost impossible to achieve even with surgery. I do not use such fillers in my practice and true indications for their use are only very few anyway.
Most commonly used fillers are produced from synthetically-produced hyaluronic acid (HA). Hyaluronic acid preparations (hyaluronan) are obtained by bacterial synthesis or from an avian source and are cross linked to varying degrees to maximise viscoelasticity and persistence. They last between 6 and 12 months and although well tolerated there is a 1% incidence of adverse reactions including granulomatous inflammation and sterile abscesses.
Collagen implants are prepared from three sources: bovine, human or autologous. Collagen synthesis may also be increased by fibroblast stimulation or injection of cultured cells.
Bovine Preparations – this comes in a highly purified or monomolecular form in different concentrations and mixed with local anaesthetic. A test dose is required as approximately 3% of patients demonstrate sensitivity and another 1% will develop sensitivity with treatment. In most patients it will be completely resorbed within 3 to 6 months.
Human Preparations – these are a preparation of human collagen, elastic fibres and other dermal components from screened donors. No pre-treatment skin testing is necessary and the effects last from 3 to 12 months.
Injectable Fibroblasts can be cultured from a small skin biopsy and following a test dose at one month a series of 3 injections is given at 2 week intervals. Gradual improvement occurs over 6 months and repeat injections can be prepared as required from the original biopsy.
Polylactic Acid stimulates fibroblast production. The effect takes 4 to 6 weeks to achieve but can last for years. This should not be injected superficially as obvious fibrous nodules can result which may be difficult to treat.
Synthetic Permanent Dermal Fillers
As mentioned above, these fillers have a very limited application and are hereby mentioned as a reference rather than recommendation.
Methylmethacrylate has been used for many years as bone cement for joint replacement surgery. However in the skin redness, inflammation and infection may occur. One preparation utilises Methylmethacrylate microspheres suspended in bovine collagen whilst an alternative suspends them in hyaluronic acid. These are intended to permit even distribution of the microspheres prior to absorption of the collagen or hyaluronic acid. A series of injections are required to achieve the final result and allergic reactions to collagen may occur.
Polyacrylamide Gel is used alone or in combination with polyvinyl microspheres. The injected volume is reported to diminish by one third post injection and the build up again over the next months. The augmentation is supposed to be permanent but additional injections may be required. This augmentation tends to stay soft but Polyacrylamide gel can act as a reservoir for bacteria and has been associated with a significant delayed infection rate.
Silicone Injections are banned in most countries but are still used in some. Although giving apparently excellent initial results, migration and inflammation are almost inevitable and the surgery then required.
- Allergic reaction to the filler
- Contour irregularities
- Under correction and over correction
- Line reappearance (repated treatment required)
- Sterile abscesses
If you have any concerns following your surgery please contact:
- Hospital where you were operated:
Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
- Your GP practice
- My secretary on 0845 026 7776 (Monday – Friday, 9:30 – 18:00)