Dermal fillers are injectable substances to restore lost volume, smooth out wrinkles, and enhance facial contours.
The types of dermal fillers are Hyaluronic Acid Fillers, Calcium Hydroxylapatite Fillers, Polylactic Acid Fillers, Polymethyl Methacrylate (PMMA) Fillers, and Fat Injections.
The procedure for dermal fillers involves facial assessment and mapping, cleansing and anesthetizing, injection, and clean up and recovery. The procedure takes 30 minutes to an hour, depending on the areas treated.
The benefits of dermal fillers are immediate results, minimally invasive, versatile applications, and customization.
While generally safe, dermal fillers have side effects, including redness, swelling, bruising at the injection site, temporary discomfort or pain, allergic reactions (rare), asymmetry or lumps if not injected properly, and infection (rare).
The considerations for dermal fillers comprise qualified providers, medical history, expectations, and post-treatment care.
What Are Dermal Fillers?
Dermal fillers are a popular cosmetic treatment option for enhancing facial volume and lessening signs of aging. They also enhance facial features, such as lips and cheeks, and bolster symmetry among facial structures.
A new study by Wang et al., titled Implications for cumulative and prolonged clinical improvement induced by cross‐linked hyaluronic acid: An in vivo biochemical/microscopic study in humans, investigates the effects of dermal injections on skin aging. Chronic exposure to ultraviolet light causes premature aging, or photoaging, of human skin. During photoaging, type I collagen bundles in the dermis, which provide strength and support, become fragmented, leading to wrinkles, fragility, and loss of elasticity.
Frank Wang, MD, the William B. Taylor Endowed Professor of Clinical Dermatology at U-M Medical School, emphasizes the importance of wearing sunscreen daily to prevent type I collagen damage from sunlight.
The study found that injecting cross-linked hyaluronic acid, the most popular type of dermal filler, into photoaged skin reverses the dermal changes associated with photoaging. These fillers that slow down lines and wrinkles by adding volume, further stimulate the production of new type I collagen in the dermis.
Cross-linked hyaluronic acid rapidly prompts collagen production within weeks of injection and continues to promote collagen accumulation over a year. This dual action ameliorates the skin’s appearance in the short term by filling spaces and boosting collagen, while also providing long-term benefits as the new collagen lasts for years. This insight suggests that repeated injections lower the need for future treatments by continuously adding collagen.
“A single injection of cross-linked hyaluronic acid dermal filler can lead to rapid and long-lasting improvement of skin by stimulating collagen deposition, and furthermore, repeat injections may add more collagen, eventually reducing the need for re-treatment,” Wang said.
What Are the Types of Dermal Fillers?
The types of dermal fillers are Hyaluronic Acid Fillers, Calcium Hydroxylapatite Fillers, Poly-L-Lactic Acid Fillers, Autologous Fat Injections, and Polymethylmethacrylate (PMMA) Fillers as enumerated by the American Society of Plastic Surgeons:
- Hyaluronic Acid Fillers
Hyaluronic acid (HA) fillers are the most frequent type. They attract and retain water, adding volume and hydration to the skin. Popular HA fillers include Juvederm and Restylane.
- Calcium Hydroxylapatite Fillers
Calcium hydroxylapatite (CaHA) fillers contain microspheres of calcium embedded in a gel. These fillers stimulate collagen production and are used for deeper lines and volume loss. Examples include Radiesse.
- Poly-L-Lactic Acid Fillers
Poly-L-lactic acid (PLLA) fillers stimulate collagen production over time. These fillers are used for deep wrinkles and volume loss. Sculptra is a well-known PLLA filler.
- Autologous Fat Injections
Autologous fat injections involve harvesting fat from one part of the body and injecting it into the face. This method provides natural and long-lasting results.
- Polymethylmethacrylate (PMMA) Fillers
Polymethylmethacrylate (PMMA) fillers are composed of tiny beads suspended in a gel as noted by Carpintero et al. (2010) in Dermal Fillers: Types, Indications, and Complications. PMMA fillers provide long-term results and are used for deeper wrinkles and facial volume. Bellafill is a notable PMMA filler.
What Is the Dermal Filler Procedure?
The procedure for dermal fillers involves facial assessment and mapping, cleansing and anesthetizing, injection, clean up and recovery as explained by Carpintero et al. (2010) in Dermal Fillers: Types, Indications, and Complications.
Facial Assessment and Mapping:
- The healthcare provider evaluates the patient’s facial appearance and skin tone.
- Strategic points on the face are marked as appropriate injection sites, and photographs are taken for reference as illuminated by Guo et al. (2023) in Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives.
Cleansing and Anesthetizing:
- The injection sites are cleansed with an antibacterial agent to prevent infection.
- To minimize discomfort, a cold instrument, anesthetic ointment, or local anesthesia is applied to numb the skin.
The Injection:
- The actual injection process is quick, taking only a few moments per site.
- The provider injects the filler into the targeted areas, massages the area to ensure even distribution, and evaluates the results. Additional filler is deployed as necessary.
- The entire procedure usually lasts between 15 minutes to an hour, depending on the number of areas treated.
Clean-up and Recovery:
- Once the desired results are achieved, any markings are cleaned off.
- Patients are offered an ice pack to reduce swelling and discomfort. While tenderness takes a day or two, substantial pain is uncommon and does not require medication.
What Are the Benefits of Dermal Fillers?
The benefits of dermal fillers include volume restoration, wrinkle reduction, enhanced contours, Minimal Downtime, and customizable results as espoused by Michon & Hassan (2022) in Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions.
Volume Restoration
Dermal fillers restore lost volume in areas such as the cheeks and under the eyes. This enhancement leads to a fuller, more youthful appearance as explained by Kristina Liu (2020) in her Havard Health Publishing article- Dermal fillers: The good, the bad and the dangerous.
Wrinkle Reduction
Fillers smooth out wrinkles and fine lines, providing immediate improvement in skin texture and reducing signs of aging.
Augmented Contours
Dermal fillers enhance facial contours by defining features such as the jawline and lips, creating a balanced and harmonious look.
Minimal Downtime
The process consists of minimal downtime, with most patients resuming normal activities within a day. Swelling and bruising, if present, resolve quickly.
Customizable Results
Fillers offer customizable results based on individual needs and goals. Practitioners adjust the type and amount of filler to achieve the desired outcome.
What Are the Side Effects of Dermal Fillers?
The side effects of dermal fillers are swelling, bruising, redness, lumps or bumps, and infection as given by the United States Food and Drug Administration (2023):
- Swelling
Swelling occurs at the injection sites and lasts a few hours to several days as elaborated by Colon et al. (20203) in Adverse Events Reported From Hyaluronic Acid Dermal Filler Injections to the Facial Region: A Systematic Review and Meta-Analysis. It is a common reaction as the body responds to the filler.
- Bruising
Bruising develops at the injection sites. This side effect is minor and fades within a week.
- Redness
Redness at the injection sites is standard and resolves within a few hours to days.
- Lumps or Bumps
In some cases, lumps or bumps form under the skin. These are addressed by massage or additional treatments if necessary.
- Infection
Infection is a rare but serious side effect. Proper hygiene and aftercare cut this risk. Symptoms of infection encompass prolonged redness, swelling, or discharge.
- Allergic Reactions
Allergic reactions to the filler material or anesthetic happen. Symptoms cover rashes, itching, or swelling beyond the treatment area.
What Are the Considerations for Dermal Fillers?
The considerations for dermal fillers are qualified practitioners, realistic expectations, pre-existing conditions, maintenance treatments, costs, the potential for overuse, pregnancy and breastfeeding, allergies and sensitivities.
Qualified Practitioner
Choosing a qualified and experienced practitioner is crucial. Verify the practitioner’s credentials and expertise to ensure safe and effective treatment.
Realistic Expectations
Understanding the limitations of dermal fillers helps set realistic expectations. While fillers improve appearance, they do not provide permanent results and require maintenance.
Pre-Existing Conditions
Inform the practitioner of any medical conditions or medications. Certain conditions affect treatment outcomes or increase the risk of complications.
Maintenance Treatments
Dermal fillers provide temporary results. Regular maintenance treatments are necessary to sustain the desired appearance and address natural aging processes as considered by Colon et al. (20203) in Adverse Events Reported From Hyaluronic Acid Dermal Filler Injections to the Facial Region: A Systematic Review and Meta-Analysis.
Costs
The cost of dermal fillers varies based on the type of filler, the amount used, and the practitioner’s fees. Discussing costs and payment options in advance helps manage expectations and budgets.
Potential for Overuse
Overuse of dermal fillers precipitates an unnatural appearance or complications. Ensure that treatments are performed by experienced practitioners who focus on achieving balanced, natural results.
Pregnancy and Breastfeeding
While not all dermal fillers pose risks during pregnancy or breastfeeding, it is prudent to avoid elective procedures during these periods unless necessary.
Allergies and Sensitivities
Discuss any known allergies or sensitivities with the practitioner before treatment. This information supports the selection of an appropriate filler and avoiding adverse reactions.
What is the difference between dermal fillers and facial implants?
Dermal fillers are injectable substances that temporarily enhance facial volume and smooth wrinkles, while facial implants are permanent devices surgically inserted to provide long-term structural changes. Dermal fillers offer flexibility with less downtime, whereas implants are more invasive procedures with extended recovery times.
What are the signs of a poorly administered dermal filler?
Signs of a poorly administered dermal filler are uneven results, excessive swelling, prolonged redness, or lumps and bumps under the skin. If you notice any of these issues, consult your practitioner to address and correct the problems promptly.
Are dermal fillers used in combination with other cosmetic treatments?
Yes, dermal fillers are combined with other cosmetic treatments, such as Botox or laser therapy, to power overall results. Nonetheless, consult with a qualified practitioner to create a comprehensive treatment plan that addresses your specific needs and goals.
How do I choose the right type of dermal filler for my needs?
Choosing the right dermal filler involves a consultation with a qualified practitioner who will assess your facial anatomy, discuss your goals, and recommend the most suitable filler type based on your needs. Consider factors such as the filler’s longevity, composition, and the specific areas you wish to treat.
