Dermal Fillers, the liquid facelift
The term Dermal Filler refers to a group of injectable gels and liquids designed to firm and plump skin. In the mind of the general public they are often negatively associated with exaggerated celebrity lips and fears of looking obviously enhanced. Yet when skilfully used the results are subtle and will not look over done. They are ideal for correcting the hollow cheeks and thinning lips that occur with facial ageing. In addition to redefining lips and cheeks they can smooth facial lines and wrinkles as well as improving skin structure and hydration. They are highly effective in treating deeper facial lines, particularly naso-labial lines; these are the deep furrows that extend from the nostrils to the corners of the mouth and marionette lines that extend from the corners of the mouth to the jaw line. They are also a useful alternative to Botox when treating forehead frown lines.
Whilst there are many different substances used as dermal fillers probably the most common is based on hyaluronic acid. Hyaluronic acid occurs naturally in many body tissues including the skin where it has important functions maintaining structure and hydration. Hyaluronic acid binds to water in the skin, locking in moisture. As we get older the amount of hyaluronic acid in skin gradually diminishes which in part is responsible for many of the appearances of skin ageing. It has been used safely in medical applications for many years including eye surgery and in arthritic joints.
Unlike the original collagen fillers, produced from animal material, the latest hyaluronic acid fillers are manufactured by bio-synthesis and are entirely non-animal in origin. This means that they are highly bio-compatible with a very low chance of allergic reactions. A widely used hyaluronic acid filler is Restylane® manufactured by the Swedish company Q-Med. Restylane® is the most well researched filler in the world and has been used in more than 12 million treatments worldwide spanning over 12 years. It has a proven record of efficacy and importantly safety.
An interesting development has been the recent introduction of Restylane Vital®. This is a hyaluronic filler product designed to be injected over larger areas of the face, neck and backs of hands. Restylane Vital® instantly boosts the skin's hydration and restores lost volume from within, in a way that creams and moisturisers simply cannot do. It improves skin elasticity leaving it looking smoother and firmer, helping to correct the signs of ageing and photo-damage. Using fillers to rejuvenate the hands appears to be a particularly exciting development. They can correct the volume loss and crêpey skin on the backs of hands that are tell-tale signs of ageing.
Injected hyaluronic acid is slowly broken down in the body. The beneficial effects of a treatment can be expected to last for up to 12 months. However, this will depend on a number of factors including age, area treated, quantity of filler injected, skin quality, general health and lifestyle including smoking. It was thought that once all the hyaluronic acid had been broken down it would have no further benefit. However a recent scientific study has show than Restylane® may not only inhibit the breakdown of the skin's own collagen but actually stimulate the formation of new collagen. The study will have a big impact on our usage and understanding of hyaluronic acid fillers. This boost to the body's own collagen may help to explain why smaller volumes of filler are often required during top up treatments and why some people seem to derive benefit for 18 months or longer.
Restylane now contains a local anaesthetic, lignocaine that is widely used by doctors and dentists. You may also prefer additional anaesthetic cream or numbing injection. You should experience nothing more than mild discomfort during your treatment. Your treatment will usually take around 30mins with additional time allowed for consultation beforehand and if used, for the additional anaesthetic to take effect.
Immediately after your treatment it is normal for the area to be a little swollen. This may mean that the result appears to be bigger than you were expecting. Do not worry; in a few days you will see the final result once the swelling has gone down. Most side effects are mild or moderate in nature, and their duration is short lasting, usually less than 7 days. The most common side effects are localised bruising and minor swelling.
No special treatment is needed afterwards; you may resume normal activity and return straight back to work. However, for the first 24 hours, you should avoid strenuous exercise, extensive sun or heat exposure and alcoholic beverages. Exposure to any of these may cause or increase temporary redness, swelling, and/or itching at the injection sites. In order to reduce localised swelling and bruising it is recommended that you avoid taking aspirin and anti-inflammatory painkillers such as ibuprofen and diclofenac for a week before your treatment. For similar reasons you should avoid alcohol for 12 hours beforehand.