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Filler Treatment
Dermal fillers, also known as injectable implants, soft tissue fillers, lip and facial fillers, or wrinkle fillers are medical device implants for use in helping to create a smoother and/or fuller appearance in the face, including nasolabial folds (the lines extending from the sides of the nose to the edges of the mouth), cheeks, chin, lips, and back of the hands.
Since some dermal fillers are naturally absorbed over time, patients may need to repeat the procedure after some time to maintain the desired effect. Successful results will depend on the underlying tissue structure and the volume and type of filler used. The time that the effect lasts depends on the filler material and the area where it is injected.
There are several different types of dermal fillers. The most common types are:
Calcium hydroxylapatite:
Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. It’s often used to:
- Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
- Enhance fullness of the cheeks and other facial contours
- Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications
Hyaluronic acid:
Hyaluronic acid injections can be used to improve the skin’s contour and reduce depressions in the skin due to scars, injury or lines. It’s often used to:
- Acne scars
- Cheek depressions
- Crow’s feet at the corner of your eyes
- Deep smile lines that run from the side of the nose to corners of the mouth (also known as nasolabial furrows)
- Frown lines between the eyebrows
- Marionette lines at the corners of the mouth
- Redefining lip border
- Scars including burns, acne and those caused by wounds
- Smoker’s lines; vertical lines on the mouth
- Some facial scars
- Worry lines that run across your forehead
Polyalkylimide:
Polyalkylimide is a semi-permanent dermal filler and is often used by plastic surgeons to:
- Treat deeper wrinkles such as nasolabial folds or depressed scars
- Plump thin lips
- Enhance cheekbones and the jawline, and to replace facial volume lost due to age
- Treat facial wasting from HIV medications
Polylactic acid:
Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body’s own production of collagen. This type of dermal filler is known as a stimulator.
Polylactic acid is known to work particularly well in the lower half of your face, and is used to:
- Fill the lines caused by laughing
- Plump thin lips
- Treat deep nasolabial folds
Polymethyl-methacrylate microspheres (PMMA):
PMMA is considered a semi-permanent filler and 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.
When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. 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.
Approved Uses of Dermal Fillers
- Absorbable (temporary) fillers are approved for moderate to severe facial wrinkles and skin folds, such as nasolabial folds (lines extending from the sides of the nose to the edges of the mouth) and perioral lines (small wrinkles in the skin around the mouth and lips).
- Augmentation (increased volume) of lips, cheeks, chin, and back of the hand.
- Non-absorbable (permanent) fillers are approved for only nasolabial folds and cheek acne scars.
- The restoration and correction of signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (HIV).
- Correction of contour deficiencies, such as wrinkles and acne scars.
Unapproved Uses of Dermal Fillers
- Increase breast size (breast augmentation)
- Increase size of the buttocks
- Increase fullness of the feet
- Implant into bone, tendon, ligament, or muscle
- Inject the glabella (area between eyebrows), nose, periorbital area (around the eyes), forehead, or neck
Risks of Using Dermal Fillers
As with any medical procedure, there are risks involved with the use of dermal fillers. It is important to understand their limits and probable risks.
Any dermal filler can cause temporary side effects, permanent side effects, or both. Most side effects associated with dermal fillers occur shortly after injection and many resolve in a few weeks. Swelling and pain after hand treatment may last a month or longer. In some cases, side effects from a dermal filler injection may appear weeks, months, or years after injection.
Common risks include:
- Bruising
- Redness
- Swelling
- Pain
- Tenderness
- Itching
- Rash
- Difficulty in performing activities (only observed when injected into the back of the hand)
Less common risks include:
- Raised bumps in or under the skin (nodules or granulomas) that may need to be treated with injections, oral antibiotics, or surgically removed
- Infection
- Open or draining wounds
- A sore at the injection site
- Allergic reaction
- Necrosis (tissue death)
Post-Treatment Instructions:
- Avoid significant movement or massage of the treated area. Unless instructed by the provider.
- Avoid strenuous exercise for 24 hours.
- Avoid extensive sun or heat for 72 hours.
- Avoid consuming excess amounts of alcohol or salts to avoid excess swelling.
- If you have swelling you may apply a cool compress for 15 minutes each hour.
- Use Tylenol for discomfort.
- Try to sleep face up and slightly elevated if you experience swelling.
- Take Arnica to help the bruising and swelling, start at least 2 days prior to injections.