Dermal Filler

What fillers are and which product is used

For dermal filler treatments we use hyaluronic acid (HA) based products. Hyaluronic acid occurs naturally in your own tissue and holds a great deal of water; the form used in fillers is cross-linked so that it stays in the tissue for longer.

Not all HA fillers are the same. They differ in gel firmness: firmer products are chosen for deep structural support against bone, softer ones for constantly mobile areas such as the lips. Placing the right product in the right anatomical plane is the basic condition for a result that looks natural rather than done.

Where it is considered

• Lip volume and lip border
• Cheekbones, temples and the hollows beneath the cheek
• Chin and jawline
• The under-eye hollow (tear trough)
• Nasolabial folds

How the treatment is carried out

Depending on the area we use either a needle or a blunt-tipped microcannula; a cannula reduces the risk of vessel injury and bruising in delicate regions. Aspirating before injecting, and delivering the product slowly and at low pressure, are inseparable from doing this safely. Most products contain lidocaine, and topical anaesthetic can be applied as well.

How long it lasts depends on the product, the area and your own metabolism, commonly falling between six and eighteen months. In highly mobile areas it is shorter.

Why reversibility matters so much

The most important safety property of HA fillers is that they can be dissolved with the enzyme hyaluronidase. Over-correction can be corrected, and if a vascular complication is suspected, immediate intervention is possible. For that reason hyaluronidase must be kept on hand wherever filler is being injected.

Risks, and when it is not appropriate

Expected temporary effects are swelling, bruising and tenderness, usually settling within a few days. The serious complication is occlusion caused by product entering a vessel, which can lead to tissue damage and, very rarely, visual loss. Command of facial arterial anatomy is the factor that governs this risk.

Filler is not used during pregnancy or breastfeeding, where there is active infection at the site, or with known hypersensitivity to the product. Active phases of autoimmune disease and the use of blood thinners require separate assessment.