Dermal Fillers

Dermal fillers are gel-like substances injected under the skin to replace volume lost with age, soften lines and wrinkles or enhance facial contours. The most commonly used filler is hyaluronic acid, a substance also found naturally in the skin; other materials such as calcium hydroxylapatite and poly-L-lactic acid may also be used. Fillers are generally applied to areas such as the nasolabial folds, lips, cheekbones, under-eye hollows, chin and jawline. Fillers can also be used to improve some depressed acne scars and volume loss on the back of the hands. Fillers are a different procedure from botulinum toxin (Botox), which reduces expression lines by temporarily relaxing the muscles.

Hyaluronic acid fillers are often preferred because, if necessary, they can be dissolved with an enzyme called hyaluronidase. Fillers are generally well tolerated; the most common side effects are temporary redness, swelling, tenderness and bruising at the injection site. Rarely, infection, lumps, irregularities in shape or an allergic reaction may develop. A very rare but serious complication is a filler blocking a blood vessel; this can damage the skin and, very rarely, cause loss of vision. For this reason, if symptoms such as severe pain, whitening or dusky discoloration of the skin, or visual disturbance occur during or after the procedure, seek medical attention immediately.

Choosing the right specialists to provide this health service is essential; to have fillers performed without complications, you should consult plastic surgeons or dermatologists. It is important to research specialists' qualifications, competence and experience and to make your choice accordingly.

Who are the best candidates for fillers?

According to most plastic surgeons and dermatologists, ideal candidates for fillers are people aged 18 or older who are in good physical health and are not pregnant or breastfeeding. Fillers are not recommended if the patient has an active skin infection in the treatment area, a known allergy to the filler material, or uses certain medications that would pose a risk. It helps to have moderately realistic expectations about the results of the procedure.

How is the filler procedure performed?

• Preparation before the procedure

The patient's needs and condition should be assessed. The appropriate form of treatment should be discussed with the specialist. The steps to take if anything goes wrong, as well as the risks and possible side effects, should be discussed. Patients should mention if they have previously had any filler or cosmetic injection and, if possible, which product was used. They should also tell the specialist if they use blood thinners. It may be necessary to pause certain medications to reduce the risk of bleeding or bruising; however, whether to stop a blood thinner must always be decided together with the doctor who prescribed it.

Usually, little pain is felt during the procedure. Many hyaluronic acid fillers contain a local anesthetic to improve comfort. In addition, a topical anesthetic cream or ice/cold application may be used to numb the area.

• During the procedure

Fillers come in different densities and properties; the product used is chosen according to the treatment area and the desired result. Filler procedures are generally performed in medical settings and can be completed in a short time. The specialist injects the filler under the skin using a fine needle or a blunt-tipped cannula. The amount of filler needed depends on many factors, such as the size of the treatment area.

• After the procedure

After the procedure, unless your doctor advises otherwise, do not rub or massage the treated areas for 24 hours. Mild swelling, redness and bruising usually resolve within a few days; cold application can help reduce these complaints. Avoid strenuous exercise, sunbathing and saunas for 2 days. You should carefully follow the advice given to you about what to do and what not to do. The effect of fillers is usually visible immediately after the procedure; the final result typically settles within 1–2 weeks, once the swelling has gone down.

How long a filler lasts depends on the material used, the treatment area and the individual; hyaluronic acid fillers generally remain effective for between 6 months and 1–2 years and are gradually absorbed by the body. Remember that repeat treatments at certain intervals may be needed to maintain the effect. The timing of a repeat treatment is decided by your doctor. You can return to daily activities and normal life immediately after the procedure.