What is a dermal filler?
Dermal filler is a general term used to describe a variety of facial injectable substances designed to smooth out wrinkles, replace facial volume loss and enhance facial features.
They can be made from a variety of materials, including hyaluronic acid (HA), calcium hydroxyapatite, poly-L-lactic acid, autologous fat (fat from your own body) and collagen.
Types of Dermal Fillers:
- Hyaluronic acid (HA) fillers
Most common type of dermal filler at present due to its safety, high tissue compatibility and reversibility.
- Calcium Hydroxyapatite (CaHA) fillers
Synthetic fillers that help stimulate collagen production, providing long-term improvements in skin texture and appearance.
- Poly-L-lactic Acid (PLLA) fillers
Biodegradable synthetic substance that helps stimulate collagen production over time. Often used for overall facial volume restoration and is considered a long-lasting option for addressing facial volume loss.
- Fat Grafting (Autologous fat injection)
An invasive procedure. Fat is harvested from one part of your body (such as the abdomen or thighs) and injected into another area of the face to restore volume.
- Collagen fillers (less common)
Collagen-based fillers are less popular nowadays due to their risk of allergic reactions and longevity issues.
Why is Hyaluronic Acid (HA) the most common type of dermal filler?
Hyaluronic acid (HA) is commonly used as a filler in aesthetic treatments for several key reasons:
- Naturally occurring in the body
Hyaluronic acid is a naturally occurring substance in the body, commonly found in the skin and connective tissues. It plays a crucial role in maintaining hydration, providing structure and volume to tissues.
- Excellent hydration properties
- HA is highly effective at attracting and retaining water molecules, which provides for excellent hydration to the skin.
- When injected, it draws moisture into the skin, helping to restore volume and improve the skin's texture and elasticity. This hydrating property gives the skin a plump, youthful, and renewed appearance.
- Biocompatibility and safety
The risk of allergic reactions is extremely low due to its tissue biocompatibility. This makes it one of the safest options for dermal fillers.
- Non-permanent and reversible
The body naturally breaks down HA over time, typically within 6–18 months depending on the type of HA fillers. Additionally, if any complications arise, the effects can be reversed with an enzyme called hyaluronidase, which helps to break down and reverse the effects of the filler.
Hyaluronic acid cross-linking technology and its significance:
Cross-linking refers to the process by which individual HA molecules are chemically bonded, creating a more stable and longer-lasting gel, as natural hyaluronic acid has a relatively short lifespan, with a half-life of about 24 hours.
When to consider HA dermal fillers?
You can consider HA filler if you experience the following aesthetic concerns:
a) Fine lines and deep facial wrinkles
HA fillers can help to smoothen fine lines and deep facial wrinkles.
b) Facial volume loss
As we age, we naturally lose fat, collagen, and bone density in the face, which can lead to sagging, hollow cheeks, sunken eyes, and a general loss of facial volume. HA fillers can restore lost volume, helping to rejuvenate the face and create a more youthful, refreshed look.
c) Non-surgical facial contouring
HA filler offers a non-invasive way to balance, enhance or define facial features such as the cheekbones, temples, jawline and chin without the need for surgery.
d) Lip rejuvenation or enhancement
HA fillers can be used to add or restore volume, enhance the shape of the lips, and smooth out fine lines around the mouth.
e) Facial asymmetry
HA fillers can help balance facial features by adding volume to specific areas, providing symmetry and harmony to the face.
f) Abnormal skin texture and dehydrated skin
HA fillers are known for their excellent ability to attract and retain water, making them particularly useful for improving the hydration and texture of the skin.
How long can HA filler effect last?
The effects of HA fillers typically last between 6 to 18 months, depending on the type of filler used, the site of filler injections, and the individual’s metabolism. Areas with more movement such as the lips tend to have a shorter duration of effect, while areas with less movement (such as the cheeks, chin or jawline) may retain results longer.
Risks and complications:
While HA fillers are generally safe, some risks and complications may arise.
Mild temporary side effects:
Very common, does not require medical attention:
- Bruising: common and usually resolves within 1–2 weeks, can be prevented by avoiding strenuous activities/alcoholic drinks/foods that increase blood circulation post-injection.
- Swelling/redness: caused by local inflammatory response, common during the first 24–48 hours after the procedure, will resolve gradually with or without cold compress.
Moderate complications:
- Tyndall effect (blue tint): Occurs when the filler is placed too superficially under the skin causing a bluish discoloration, can be addressed by removal of filler products.
- Lumps or bumps: Small, palpable lumps under the skin may form if the filler settles unevenly, generally temporary and can be addressed by gentle massage (if recommended by your doctor) or hyaluronidase injections to dissolve the HA filler product.
- Asymmetry: Caused by uneven filler placement, can be corrected with a touch-up treatment.
- Allergic reactions: Rare and symptoms include redness, itching or swelling at the injection site, might require medications to manage the allergic reaction or removal of filler product in severe cases.
- Migration of filler: Filler may shift or migrate from the original injection site causing uneven facial contours.
Serious complications:
Uncommon but requires immediate medical attention:
- Vascular occlusion: A rare but serious complication where the filler was injected into an artery causing vascular occlusion. This can lead to a lack of blood flow to the tissue resulting in tissue damage (necrosis). Symptoms include severe pain, skin color changes or extreme swelling in the treated area. Immediate action is needed involving hyaluronidase to dissolve the HA filler to prevent further tissue damage.
- Blindness: This can occur if the filler is accidentally injected into an artery leading to the eyes. This is a medical emergency and requires immediate intervention.
- Infection: Infection can occur at the injection site following the HA filler injection. Symptoms include severe pain and swelling at the injection site, fever and pus discharge.
Contraindications:
- Pregnant or breastfeeding
- Active infection or inflammation at the injection site
- History of allergy to filler ingredients
- Presence of wounds near the injection site
Pre-procedure:
- Photo documentation
- Detailed consultation with doctor to determine the filler injection plan
- Face is cleaned and topical numbing cream applied for 30 mins
- Obtain written consent
Post-procedure:
- Apply topical healing cream on the treated area, followed by moisturizer and SPF50 sunscreen
- Post-procedure advice:
- Avoid alcohol for 24 hrs
- Avoid strenuous activities for 24 hrs
- Avoid hot sauna/extreme heat exposure for 24 hrs
- Avoid massage/rubbing the injection site for 24 hrs
- Avoid makeup on the same day and the following day
- Stay upright for at least 4 hrs post-injection
- Apply topical medication to the injection site as instructed by doctor
- Consider applying cold compress over the injection site to reduce swelling, if present
- Inform the clinic immediately if there is any unusual post-injection side effect such as intense pain/swelling or extensive bruising at the injection site
Price: $1,200 to 1,600 (face)
