What are Dermal Fillers?
If you’d like to restore youthful fullness to your face, enjoy plump lips, enhance shallow contours or soften those facial creases and wrinkles, dermal fillers may be the answer. Dermal fillers have been called “liquid facelifts” because they offer many of the benefits of a surgical facelift without the downtime.
Although they can’t help with excess sagging skin, these soft tissue fillers can add more volume and provide immediate results at a lower cost compared to surgery. But these treatment aren’t permanent; they must be repeated and maintained.
Some dermal fillers are used in conjunction with other skin rejuvenation treatments such as injections of botulinum toxin. Your plastic surgeon will assess your needs and recommend one or a combination of treatments to achieve your desired results.
How the Treatment Works
Wrinkle fillers can be divided into two categories: temporary and semi-permanent.
Human fat, also known as autologous fat, is harvested from your own body. Using your own fat requires a more extensive procedure than other injectable fillers because you first must undergo liposuction to extract the fat prior to injection. By using your own fat, you eliminate the risk of allergic reaction or rejection by the body. You should know that not all of the live fat cells survive when transplanted into a new site. You can expect a fairly high rate of re-absorption. Because of this, your doctor will likely overfill the area being treated. At first you might look abnormal, but it will soon settle and you’ll enjoy a new look. When your doctor extracts this fat via liposuction, it’s possible that there will be more than is needed for one application. Most natural fat can be stored for touch-ups.
Collagen is a natural substance known as a protein, and the main component in cartilage, teeth and bones. It is derived either from human skin or cows (known as bovine collagen). Brand names include: CosmoDerm, Cosmoplast, Zyderm, Zyplast.
Human cadaveric dermis is skin that’s cultivated from a cadaver, then injected into your face. This substance results in particularly impressive filling of facial hollows. Brand names include: Cymetra, Dermalogen, Fascian.
Hyaluronic acid is also a natural substance found in your body. High concentrations are found in soft connective tissue and in the fluid surrounding your eyes. It’s also in some cartilage and joint fluids, as well as skin tissue. If the name sounds familiar, it’s because the same substance is often injected into the aching joints of people with arthritis to ease pain by providing extra cushioning. Hyaluronic acid is not derived from animal sources. Brand names include: Captique, Esthélis, Elevess, Hylaform, Juvéderm, Perlane, Prevelle, Puragen and Restylane.
Calcium hydroxylapatite, the heaviest of facial fillers, is found naturally in human bones. This mineral-like compound is reserved to fill the deepest creases such as nasolabial folds, marionette lines and frown lines. It’s also used to enhance fullness of the cheeks and other facial contours. Calcium-based microspheres are suspended in a water-based gel. Brand names include: Radiesse, Radiance.
Polylactic acid is a synthetic material. When it is injected, it stimulates the body’s own production of collagen. This substance is known to work particularly well in the lower half of your face, to fill the lines caused by laughing, to augment thin lips and fill out deep nasolabial folds. This substance is unlike other dermal fillers because it doesn’t produce immediate results. Instead, it stimulates collagen production, so results appear gradually over a period of a few months. Brand names include: Sculptra, New-Fill.
PMMA (polymethylmethacrylate) fillers contain about 20 percent of tiny PMMA microspheres that are suspended in 80 percent purified collagen gel. This substance, considered semi-permanent, can be removed. PMMA is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips. PMMA has been used for many years in permanent surgical implants. Because of this, your surgeon will likely under-fill on the first treatment, adding more later if needed. Brand names include: Articol, Artefill, Metacrill.
Special Considerations, Risks and Recovery
There is no downtime with dermal fillers. You can resume most activities right away. Just take care not to rub the treated area so that the filler material remains undisturbed. You’ll likely experience swelling or a bit of bruising, which should fade within a few days.
If you opt for human fat as a filler, you’ll notice an “over-filled” appearance at first. It should resolve within a few hours or, in some cases, a few days. But for some people, this over-filled appearance could last for a few weeks.
Fillers that are derived from non-human sources require a pre-treatment allergy test.
Complications from fillers are uncommon. The risks include:
- Antibodies, or rejection of filler material, may reduce the effectiveness of future injections.
- Fillers that contain microscopic granular substances, particularly, calcium hydroxylapatite, may clump as a result of facial movement or your natural aging process. As time progress, these clumps can turn into lumps or nodules. Surgery can remove the lumps.
- Infection at the injection site
- Migration of filler material away from the original site.
- Necrosis (skin death)
- Skin rash
- Skin sensitivity
- Temporary numbness
- Temporary paralysis of facial muscles
- Under- or over-correction of wrinkles
In the long term
It’s important to realize that dermal fillers are not permanent. Even the semi-permanent variety require re-treatments eventually. The way your face continues to age and how your body absorbs fillers will determine the timing of repeat treatments.
If you decide not to re-treat, your appearance will return to its original condition. Wrinkles and scars will return, and plumped lips will lose volume.
Cost is always a consideration in an elective procedure or treatment. The cost of polyalkyimide fillers vary due to the expertise and qualifications of the practitioner, the type of procedure used, time and effort the procedure or treatment requires, as well as geographic office location. Patient financing plans may be available. Additional fees may include:
- Surgical facility costs
- Anesthesia fees
- Prescriptions for medication
Be sure to ask your surgeon about all costs involved in your procedure. Most health insurance does not cover cosmetic surgery or its complications.
Questions to Ask
Be sure to ask questions, and don’t be shy about discussing any concerns.
- Am I a good candidate for a dermal filler?
- What will be expected of me to get the best results?
- Who will perform the dermal filler injections?
- Have they been specifiaclly trained in this procedure?
- Where and how will you perform my procedure or treatment?
- How long of a recovery period can I expect?
- What are the risks and possible complications associated with my procedure?
- How can I expect to look over time?
- Do you have before-and-after photos I can look at for this procedure?
- What results are reasonable for me?