Fillers

In this month’s journal, we’re taking a good look at one of the most popular tools that aesthetic dermatologists can use to help rejuvenate and harmonize your face: fillers.

If you hear fillers and think duck lips, trout pout, and pillow face, then think again. While we’ve all seen social media feeds ‘filled’ with those who may have overdone the filler and no longer look like themselves, in the right hands, fillers can work wonders. Judiciously placed filler can have amazingly natural and undetectable results that can be hard to achieve with other treatments.

What are fillers used for?

Fillers are used to add or restore volume, refine contours, smooth wrinkles and lines, and fill in scars, especially those caused by acne and chickenpox. Fillers may also be used to improve necklines and add volume to the hands. Some of the most common uses for fillers are to:

• Volumize lips
• Plump cheeks
• Fill in forehead lines
• Reshape the chin or nose
• Eliminate marionette lines and smile lines (nasolabial folds)
• Reduce the appearance of scars

What is the difference between the different types of fillers?

Dermal fillers differ in chemical makeup, and longevity, and have varying degrees of softness. They are typically injected into the dermis or subdermal tissue. There are several different types of filler and a range of different brands.

Hyaluronic Acid

The most commonly used fillers are comprised of hyaluronic acid (HA). HA is a sugar molecule that occurs naturally within our skin. Common hyaluronic acid filler brands include Juvederm, Belotero, Teoxane, and Restylane. HA has a wide range of uses, including improving cheek contours, redefining lip borders, and reducing smile lines, marionette lines, and frown lines between the eyebrows. Post-treatment results are immediate and typically last 6-18 months. Unlike other fillers, hyaluronic acid fillers are reversible using an enzyme called hyaluronidase.

You may have read recent coverage about hyaluronic acid fillers staying in the body for longer than 18 months. There is no evidence that residual filler causes any harm to our overall health. So, while this is an area that should be investigated further, there is no cause for concern based on the decades of evidence available regarding hyaluronic acid fillers.

Calcium Hydroxyapatite

Calcium hydroxyapatite is found naturally in our bones and teeth. Radiesse is the most well-known brand. Calcium hydroxyapatite is effective in reducing the appearance of moderate-to-severe creases such as nasolabial folds, marionette lines, and frown lines. It can also be used to enhance the fullness of the cheeks and contour the jawline. Effects are usually seen within one week and last up to 12 months. There are also combined HA and calcium hydroxyapatite products now available. Calcium hydroxyapatite is not reversible.

Polylactic Acid

Sculptra is the most widely known brand of polylactic acid filler. Polylactic acid works particularly well in the cheeks and lower half of the face. Unlike other dermal fillers, polylactic acid doesn’t produce immediate results. Instead, it stimulates your own body’s collagen production, so results appear gradually over a period of a few months and last up to 24 months. The best results come from a series of treatments. Polylactic acid is not reversible.

Polycaprolactone

Polycaprolactone, brand name Ellansé, gives instant volume and long-lasting results to deliver brighter skin with improved density, firmness, and elasticity. It is used to improve the appearance of lines, wrinkles, folds, sunken cheeks, jowl laxity, aged hands, and scarring. It is unique among fillers in that it also stimulates natural collagen production over time, with results lasting up to three years. Polycaprolactone is not reversible.

What can I expect at my filler appointment?

Numbing cream is typically applied 15-30 minutes prior to your treatment. Your face is then thoroughly cleansed and marked to indicate treatment areas.

Fillers may be injected with a needle or a cannula, a blunt-ended thin tube that is inserted through a tiny hole in the skin. Needles offer precision, and cannulas allow for filler to be placed over a larger area, reducing the risk of bruising. Certain areas lend themselves better to a needle versus a cannula. When treating the full face, both techniques will often be used.

After an initial prick, discomfort is minimal. Ice helps to reduce any pain and minimize the risk of bruising. Depending on the type of filler used, results can be seen immediately and will continue to settle over 2-4 weeks. Most patients return for a follow-up to assess if any tweaks are needed.

The future of fillers

Aesthetics is a fast-paced field with incredible innovation, and your practitioner will keep a firm eye on filler safety and longevity.

If you are considering fillers, speak to your practitioner about developing a treatment plan tailored specifically to your needs and what you would like to achieve.