Dermal fillers can be used to reverse the signs of aging, via correction of volume loss over the cheeks/mid face area, over the nasolabial folds, over the jowls and jugal area.
Dermal fillers can also be used to augment areas of facial deficiencies, like a short chin, a flat nose bridge, a button nose tip, prominent eye bags and thin shapeless lips, ear lobes or lower eyelids.
Most dermal fillers contain cross-linked hyaluronic acid (HA). HA is found in all mammalian species including mankind, and is present in virtually all cells, acting as a “glue” keeps cells together.
It is present in higher quantities in younger individuals, helps to retain water and keep the skin hydrated and is lost as we age. The skin laxity and sagginess that occur with aging is typically due to a combination of fat, collagen and volume loss.
Cross-linked HA is 99% biocompatible and acts as “synthetic fat”, filling the areas where volume loss is an issue. As it is firmer than fats, it can also be used to create a taller sharper nose and a longer chin.
The results from dermal fillers are immediately visible after treatment. Over the next few days there may be slight swelling as the HA fillers absorb water, and the most natural results appear after a week or two.
On the average, HA fillers are commonly quoted to last between 6 to 12 months. However the variability between individuals is great. On rare occasions, we have seen cases resorb HA filler within weeks, or last longer than 5 years. HA is a naturally occurring substance in the human body, hence body is both able to synthesize and degrade the HA.
Individual differences in the ability to degrade the HA may account for the wide variation in durability.
At YVL Medical Aesthetics, we inject dermal fillers using blunt cannulae. These are blunt tipped long needles (38mm to 50mm length) incapable of penetrating the skin, hence diluted local anaesthetic is injected near (but not at) the site of treatment to create a small needle puncture.
Discomfort or pain arises from the manipulation of the cannula and the pressure effects of the HA fillers as it is being injected. Despite the fact that all our HA fillers contain local anaesthetic, there will be some sensation of pressure when the HA filler is first injected as the local anaesthetic hasn’t had time to work. Therefore we are extremely meticulous and gentle and slow with the procedure, ensuring as painless a process as possible.
On the overall, earlobe, temple and simple under-eye fillers are generally well tolerated with minimal pain. Nose, chin, jowl and jugal fillers are generally well tolerated also but with slightly more discomfort and pressure sensation.
Lip and nasolabial and simple cheek fillers tend to be associated with more discomfort, whereas complex cheek/ under eye and forehead fillers are generally quite painful due to the need to cannulate through specific ligaments and fibrous planes. Patients who have severe anxiety or very low thresholds of pain may opt to have the entire procedure under sedation by a qualified anaesthetist in our centre.
Initial redness is observed after the injection of dermal fillers. This typically resolves within several hours, including any white discoloration from the use of local anaesthetic injections (containing adrenaline).
Swelling occurs as a result of the HA filler absorbing water (most HA fillers are manufactured in an anhydrous state) as well as a localized immune reaction to the filler. This typically resolves within 2 to 3 days spontaneously and persistent swelling can be treated with oral medications.
Bruising may occur at the sites of injection, these tend to be small focal spots of bruising that is amenable to concealment with make-up. Less commonly, bruising may involve a wider area (i.e. like bruising from a punch) which will then take 2 weeks to resolve fully, and quite hard to conceal.
Individuals with a previous proven reaction to dermal HA fillers should not receive dermal HA fillers, and may have to opt for other types of dermal fillers.
Patients who have underlying medical conditions or have had recent cosmetic surgery may or may not be suitable to receive HA fillers, depending on our doctor’s assessment. Whilst HA fillers are considered safe during pregnancy, cosmetic or aesthetic procedures are not justifiable during pregnancy out of ethical and safety concerns.
Individuals who are acutely ill should hold off elective aesthetic or cosmetic procedures, especially if running a fever.
Little aftercare is required after HA filler injections. One needs to keep all the injection sites clean and free from significant bacterial contamination. This means avoiding swimming or water sports (aquatic bacteria), avoiding contamination by soil/faceal matter, animal saliva (your little poodle can lick you another time), or human saliva for that matter, as well contact with raw meats or fish (e.g. scratching the injection site after handing raw foods).
It is best to avoid alcohol for 3 days after HA filler injection as alcohol has been noted to cause inflammation of the fillers in a small percentage of individuals. Massage is ok once the injection sites have started healing, so is the application of light makeup.
Contrary to popular belief, sauna does not accelerate the absorption of dermal HA fillers, as the body has its own mechanism to maintain its own internal temperature. After all, beauty and the dermal HA filler are not just skin deep (it’s in the lower dermis) and your skin will burn before the fillers get melted by a sauna.