Dr Frances Pitsilis - What are Dermal Fillers?

Dermal fillers can address some of the most common concerns men and women have in relation to their lips and facial contours. The most highly researched are the hyaluronic acid products that has been on the market for over 18 years, and used on over 12 million people. In this article, I will discuss hyaluronic acid dermal fillers.
 
The pre-packaged sterile syringe contains a sterile gel consisting of stabilized hyaluronic acid with the addition of a small amount of local anaesthetic -  Lidocaine Hydrocloride.

It is biodegradable, and safely and completely broken down by the body. These injections are given to correct facial wrinkles and/or for lip augmentation.  

Common Lip concerns include:
• Upper lip too thin
• Lips generally losing volume with age

• Reduced definition of lip borders

• Lines above, below, and around lips

• Desire fuller lips

• Concern of shape of lips.

The most popular filler to use for the lips is hyaluronic acid because it is clear, soft, and is versatile. Hyaluronic acid is also used as a filler anywhere else in the face, including the lines around the mouth, Hyaluronic acid is one of the substances, along with collagen, that is found in the skin of all animals.

Appearing older from volume loss in the face can occur as a result of thinning of skin and muscle, gravity, changes to the skull bones with ageing but also volume loss in the cheeks and mid face. Hyaluronic acid injection helps to improve this problem.

Areas that can be treated include:

• Enhancing the cheek bones and cheek volume
• Improving the appearance of the jowl
• Improving downward turned lips
• Improving the sunken area under the eyes

Hyaluronic acid products that can be used in certain situations:

• Very light product - attracts more water. Mainly for skin hydration for face, neck, backs of hands.
• Standard product - can be used anywhere for volume, lips and lines. We do not recommend it for under the eyes.
• Thicker product - and useful for more lift as well as under the eyes.
• Very thick product - thickest, with most lift. Used for deeper lifting.

How long does swelling normally last after a lip or face enhancement?
Normally the swelling resolves within two days of injection. The swelling is not an immunological reaction and is part of the normal course of events. However results can vary.


How long does a treatment last?
In general, follow-up treatment is needed after about 6-12 months. This depends on many factors, such as the structure of the skin, lifestyle, age, and the degree of perfection required by the patient. A follow-up treatment 6-9 months later may add to the duration of the effect.


Alternatives to Hyaluronic acid treatment.
No treatment, other facial soft tissue augmentation, cosmetics, Botulinum Toxin ( wrinkle relaxing injections) , laser skin resurfacing, light based therapies, chemical peels, or plastic surgery for wrinkle reduction.


Side effects and complications include but are not limited to:
There is commonly general swelling, bruising, and mild discomfort that settles in most people over 48 hours.

Below are unusual reactions:

• Potential allergic reaction. Rate of 1/2000 treatments. As with any product, this can develop during or after injection.
• Injection site reactions.  Rate of 1/10,000 – 1/20,000. Lumpy or “thick” feeling at or just under the skin, bruising, redness, itching, pain, tenderness, or slight swelling.
 Injections into the lip area could trigger a recurrence of facial cold sores (herpes simplex infections) for patients with a history of prior cold sores.
• Less common reactions. Rate 1/50,000. Infection, inflammation, skin discolouration, nodules (lumps) and papules (blotches).
• Rare cases of the following: infection progressing to an abscess, itchiness, hypersensitivity reactions (a type of allergic response), reactivation of herpes infection (cold sore virus) of the face, acne-like lesions, granuloma (an invasion of the tissues by immune cells), blisters, redness and thickening of skin, swelling of face, urticaria (hives), dermatitis, scarring, skin atrophy (thinning), short duration of effect, skin death at injection site, telangiectasias (small red veins). Some of these can occur up to 4 weeks after the treatment.
• Isolated rare cases of vascular occlusion (blockage of a blood vessel). The product may block a blood vessel. If this happens, there is potential for the tissues supplied by this blood vessel to suffer oxygen deprivation and possibly die.
• Isolated rare cases of transient visual disturbance. This has been documented after inadvertent injection into an artery when the upper half of the face was injected.
• Lignocaine anaesthetic injection reaction. Usually with high doses, symptoms affecting the central nervous system or heart can occur. The adrenaline in the injection may cause palpitations and rarely, an allergic reaction. We take caution in those with epilepsy, impaired cardiac conduction, severely impaired liver function, or severe kidney failure.
• Local anaesthetic cream. Contains Procaine, Lignocaine and Tetracaine. Allergy or reaction to any of these ingredients can occur.

Absolute Contraindications - Who should not have Hyaluronic acid dermal filler injections:

• Allergy or anaphylactic shock to hyaluronic acid, or lignocaine anaesthetic.
• Pregnant or breast feeding women.
• Infection or inflammation in the area.

Relative Contraindications - Who should discuss carefully whether to have hyaluronic acid dermal filler with the doctor or nurse:

• Recent skin disorders.
• Autoimmune disorders eg. Multiple Sclerosis, Lupus, Rheumatoid Arthritis, Scleroderma.
• On immunosuppressant drugs eg. Methotrexate, Prednisone, Humira, Azathioprine, Cyclophosphamide.
• Diabetics.
• Bleeding disorders or who are on anticoagulant drugs.
• Generally unwell in any way.

Can Hyaluronic acid dermal filler be used after laser treatment or chemical peels?
Yes, but we recommend waiting until the treated area is totally healed and the skin is back to normal.


What pretreatment guidance should be given to patients before a treatment?
Patients should be advised to discontinue aspirin, nonsteroidal anti-inflammatory medications, St. John’s Wort, and high doses of vitamin E before treatment, as these can increase bruising or bleeding at the injection site. Previous eruptions of herpes simplex can be triggered by needle insertion, but appropriate prescription drugs can minimise the risk.


Are there any known drug interactions?
No commonly used drug interactions.


Is pain relief recommended?
The lips are a highly sensitive part of the body and anesthesia may be needed before treatment. With the canula techniques we now use, we often don’t need more than some local anaesthetic cream. If needed, a dental type anaesthetic injection can make the lips completely numb, especially if it’s your first treatment.

Having read all of this, you may be worried. Relax, most serious complications are extremely rare, as already mentioned. Please also read the article “questions to ask when considering a dermal filler”.