WHAT’S IN THIS ARTICLE?
1. What are Dermal Fillers?
2. Dermal Fillers Classified
3. Indications
4. Pre-Treatment Care
5. Post-Injection Management
6. Contraindications
7. Side Effects
8. Combining Dermal Fillers with Other Procedures
9. How to Achieve Successful Outcomes
If you might be struggling with aging issues on your skin, then you might have come across dermal fillers. It is one of the popular treatments among cosmetic patients in Singapore with the surge in requests driven widely by increasing awareness among the public.
To get a better understanding of these products, should you decide to go with the procedure, educating yourself helps a lot. It allows you to be prepared, have realistic expectations, and ultimately successful results. Here’s a beginner’s guide to help you wade through the all important details behind dermal fillers.
1. What are Dermal Fillers?
Also known as soft tissue fillers, wrinkle fillers or injectable implants, these substances are medical device implants that have been approved by the FDA (Food and Drug Administration) for use in creating a smoother and fuller appearance in the face or on the backs of the hands.
Dermal fillers come in several types to address a variety of problems in different areas of the face. They are also made from diverse sources, all with their own strengths and longevity.
2. Dermal Fillers Classified
Based on Origin
Human
Also called autologous wrinkle fillers, fat is the commonly used substance in this category. It is surgically removed from areas like the stomach, buttocks, or thighs which are then treated before it is administered. It is expected that this will require two procedures: one to remove the fat and another to inject it, and it can be done in one visit.
Platelet rich plasma (PRP) is also another type of autologous wrinkle filler. Your own blood is drawn and placed in a centrifuge to separate its components. The plasma which separates is then treated and injected into the face. The effects can last up to 12-18 months.
Animal
Also known as collagen wrinkle fillers, these are derived from a purified form of collagen which is extracted mostly from cows. Most of these injections already start to break down in as early as one month after treatment. They also come with a higher rate of allergic reactions, hence it requires allergy testing beforehand.
Synthetic
This category comprises lab-made substances and is not related to anything that is naturally found in the skin. Generally, synthetic fillers have longer-lasting effects. If not administered correctly, this can cause disfigurement.
Based on Longevity
Temporary
Also referred to as nonpermanent fillers, these products last less than 12 months. They spontaneously disappear, which is an advantage if the patient is not satisfied with results.
Semipermanent
These fillers go through slow degradation over a period of 1-2 years. They last longer than temporary fillers. The products under this classification are made either with Poly-L-Lactic acid, Calcium hydroxylapatite, and Polyvinyl Alcohol. These are used for volume fillers and volume enhancement.
Permanent
These types of fillers remain for longer than two years in the tissue. Usually made of Polyacrylamide, these are indicated for deep folds, wrinkle volume correction, and volume enhancement for large defects.
3. Indications
Facial Areas
- Facial folds
- Frown lines between the eyebrows
- Marionette lines at the corners of the mouth
- Cheek depressions
- Smoker’s lines
- Worry lines across your forehead
- Nasal Depressions
- Enhancement of facial contours
- Lip Augmentation
- Depressed scars (e.g. post acne, chickenpox, postsurgical scars and certain diseases)
- Sunken eyes
- Earring ptosis
- Atrophic earlobes
- Dermatological diseases (e.g. dermal atrophy, angular cheilitis, AIDS lipodystrophy)
Non-Facial Areas
4. Pre-Treatment Care
Although aging is a generalized phenomenon, the process of aging in different areas of the body does not occur uniformly, especially on the face. The subcutaneous fat in the face is not composed of a single uniform layer, but rather it is compartmentalized. Each individual compartment ages at a different pace in a single individual. This is an important consideration for aestheticians so that they can customize their approach for different areas.
Patient Education and Assessment
It is also important during the pre-treatment process that patients are counseled about the nature of the fillers, its longevity, side effects, cost and what to expect. A personal consultation is encouraged because it is through this that the aesthetician can assess both the physical and psychological states of the patient, which is necessary for the doctor to employ a customized approach and eventually achieve success.
Psychological Assessment
In any cosmetic procedure, it is important that a patient comes in with realistic expectations. Before going in for a consultation, check yourself at the door and see if what you expect is not way beyond the bounds of what is safe and necessary.
The doctor will also assess your pain tolerance to ensure that you will not experience significant discomfort during the procedure. For those with a low pain threshold, dermal fillers are administered under topical anesthesia.
Medical Assessment
Although some may see aesthetic treatment to be less invasive, a proper way to do it is to approach it with caution just the same. This will involve checking your history for any medical illnesses and medications. The risk of bruising is higher in patients who have bleeding disorders, uncontrolled hypertension, or those taking anticoagulants (e.g. aspirin, warfarin or clopidogrel).
Aesthetic Assessment
When you come in, you will be asked what your goals are with your dermal filler treatment. Do you want to restore your previous, original look, or do you want a new and different one?
An aesthetic assessment of the area/s to be treated will be done in an upright position; otherwise, gravitational force alters or defects the grooves. It is possible that your face may have some degree of asymmetry, which is why a photograph of your face will be taken before the procedure so that proper judgement can be done. It is also through this step that the doctor is able to determine the exact parts of the face that need to be treated.
Know the Fillers
The reason why you need to know this beforehand is for you to have a wider knowledge of the kind of filler you prefer to use. There are several dermal fillers available in Singapore today, each with its own strengths and uses. A certain clinic has their own set of products they use, and you can ask the doctor more about them or look them up yourself. Primarily, your choice will be based on your goals and preferences, but there are also other factors that must be considered.
Choosing the Right Filler
Since every patient has their own goal in mind, one must choose the right tool for the job. The choice of fillers will depend on these factors:
1. Target area
Different dermal fillers have their approved indications by the FDA. They may not have reviewed the use of dermal fillers on certain areas of the body.
2. Defect to be corrected
Superficial defects require lighter molecules, while volumizing and augmenting effects can be achieved with denser fillers.
3. Longevity desired
Prolonged effects can be achieved with permanent fillers.
4. Material
Collagen-based fillers must be pre-tested before administration.
5. Any existing medical condition of the patient
This is to avoid untoward reactions or complications during and after the treatment.
Know About the Technique
This doesn’t necessarily mean that you must know about the nitty gritty details, but it pays to ask your doctor on how they plan to achieve the look you desire using dermal fillers. This is an opportunity for a patient to assess the doctor’s knowledge and expertise, especially if you are still looking around for one, and whether you agree with their plan of action.
After you have been given a run down of the procedure, you will be asked to sign a written consent if you wish to go with that particular doctor.
5. Post-Injection Management
- Avoid extreme cold or heat for 48 hours
- Avoid massaging the treated area
- Avoid strenuous physical activity for six hours
- Elevate the head while sleeping for one night
- Resume skin care routine after 24 hours
6. Contraindications
Although generally rare, complications remain a possibility even with dermal fillers. They include:
Absolute
- Unrealistic expectations
- Hypersensitivity to products
Relative
- Keloidal tendency
- Patients with autoimmune disease
7. Side Effects
Common Side Effects
- Bruising
- Redness
- Pain
- Swelling
- Tenderness
- Itching, rash
- Difficulty in performing activities (observed in cases where the dermal fillers are injected on the back of the hand)
Less Common Side Effects
- Infection
- Raised bumps under the skin (granulomas or nodules) that may have to be surgically removed
- Allergic reaction
- A sore at the injection site
- Open or draining wounds
Rare Side Effects
- Injury to the blood supply
- Damage to the skin or the lips
- Migration or movement of filler material from the site of injection
- Severe allergic reactions
8. Combining Dermal Fillers with Other Procedures
Dermal fillers can also be used concurrently with other aesthetic treatments. However, it should be done with caution. Not every procedure may provide positive results, while some may take certain considerations for it to be safe and successful.
Dermal Fillers and Chemical Peels
The opinion of different researchers varies as to when dermal fillers and chemical peels can be used appropriately. It was suggested that chemical peels should ideally be carried out 1-2 weeks before or after dermal filler treatments. However, in the absence of more studies, there is no consensus regarding this matter.
Dermal Fillers and Lasers
Studies also vary on this matter. One study claimed that there is no reduction in the clinical outcome when lasers are used over dermal fillers. However, there are also others which suggest that laser resurfacing should be done first then followed by dermal fillers once collagen remodeling is completed.
Dermal Fillers and Botulinum Toxin
The combination of these two injectable treatments is considered a new paradigm in skin rejuvenation. In cases like this, the botulinum toxin is administered first. Once visible improvement is seen in a week or two, the dermal filler injection then follows to enhance results. However, for grooves along the nose and mouth, fillers are injected first and then followed by the botulinum toxin.
Dermal Fillers and Radiofrequency
Radiofrequency (RF) is a non-ablative skin rejuvenation treatment. It has been shown that this treatment doesn’t alter the composition of the dermal filler when the RF energy passes over the areas that are treated with the filler.
Dermal Fillers and Plastic Surgery
Surgical procedures to contour the face, or other indications, can be supplemented by fillers since they have the advantage of creating finer corrections.
9. How to Achieve Successful Outcomes
A comprehensive plan that you and your doctor will discuss
So, the long and short of it is that a successful dermal filler procedure can be done when you openly discuss matters with your doctor. There is a lengthy list of ways that this treatment can be done, but you only need one that suits you. Openly communicating with your doctor allows you to be on the same page. Pretty much just like talking to your hairstylist. You need to be specific with what you want, and should there be anything unclear about the whole situation, always make sure to clarify.
Choosing the right filler for the right indication
The responsibility for this lies in the doctor’s hands, but on the part of the patient, this underlines the importance of why one ought to be careful in choosing their doctor. Skills, knowledge and experience are all critical factors to consider in finding one. Remember that dermal fillers have their own uses. Some are more suitable in contouring while others, like Skinboosters™, are appropriate in adding volume, and you need someone who understands it lock, stock and barrel.
Dermal Fillers is a good non-surgical option for those who are not open to surgery. However, it doesn’t mean less preparation because it is less invasive. If you have read the blog up to this point, then you have gained valuable knowledge to help you in your decision, and to protect you from botched outcomes.
We are one of the clinics in Singapore that offer Skinboosters™ along with an array of other dermal fillers in our treatment arsenal. If have other questions in mind that we have not covered in this blog, send us a message or book a personal consultation with Dr. Anita Soosay now.
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