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Dermal Fillers

There are two types of lines on the face. The first type is the ones that come out when a person animates (dynamic lines), while the second type is lines that are there even at rest (static lines). For dynamic lines like wrinkles, the treatment of choice is Botulinum toxin injections. These injections can relax muscles and prevent the wrinkles from showing whenever muscles of facial expressions are used. They also prevent wrinkles from etching on the skin eventually making them static lines. The most common static lines that bother patients are the frown lines, nasolabial lines and marionette lines. For some patients, their frown lines have etched so deeply that even when they are not expressing, they give the impression that they are angry all the time. On the other hand, although nasolabial lines are normal, having them looking deeper and longer, coupled with marionette lines makes people feel old and unattractive. The treatment option for static lines is dermal filler injections.

Not all dermal fillers are the same. There are temporary and permanent dermal fillers. Years back, permanent fillers presented as a better, cheaper alternative compared to temporary fillers. Permanent fillers used polyacrylamide, and were labeled as permanent since the body did not degrade it. However, it was viscous and painful to inject due to its thickness thus it needed a separate anesthetic injection during the procedure. After several years of study, it was noted that as people aged and their skin became thinner, previously injected polyacrylamide started to become visible. Hence the use of polyacrylamide as a dermal filler fell out of favor.

Temporary fillers, on the other hand, use hyaluronic acid. Because it is a synthetic version of a protein in the body, it is easily degraded. Research has been done to address this soft filler’s short lifespan and its ability to provide more lift. By addressing its cross-linking and the size of its globules, hyaluronic acid fillers have now become more versatile and longer lasting. The need for these changes arose not just because they were used for static lines but because they were needed to address other defects that came with aging-volume loss. Fillers could now also be used to address sagging and sunken cheeks, temples and nasojugal lines, and thinned out lips. Unlike permanent fillers, hyaluronic acid fillers are easy to inject and have their own anesthetic admixed in their gel. Due to the versatility of fillers, they are now also used to address visage and contour issues such as weak chins and jawlines, and forehead feminization.

Injecting fillers on wrinkles and volume defects may sound easy but care must be taken in choosing the doctor to do it. They must be very familiar with the blood supply of the regions to be injected. Not only is there a risk of bleeding in case robust blood vessels are inadvertently hit but filler finding its way into a blood vessel or crowding out smaller blood vessels have very serious consequences (blindness, skin necrosis). They must also know which type of filler to use for the appropriate area. Using the wrong type of filler for a particular area can have in suboptimal results or can cause them to use too much. It must be remembered that subtlety is the best result. Looking too “done” typically means others can tell that a patient has had fillers.

At the clinic, after explaining possible risks and complications, the patient’s face is cleansed, skin markings and topical anesthetics are applied. After a 20 to 30 minute wait, the patient is positioned appropriately and fillers are placed. Before and after pictures are typically taken so that the patient can appreciate the changes the filler gives them. Only a certain amount of filler can be used in one session. If it has been agreed by the patient and the doctor that more fillers need to be injected to achieve the best result, injections may be divided in several sessions after waiting one to two weeks between injections. After the treatment, the patient is advised that there may be some swelling and/or bruising and that these are temporary and will resolve without any additional interventions. They are also instructed to follow up in one to two weeks to see if there is a need to add (or dissolve) some filler.

Due to the filler’s temporary nature, if the results are well appreciated by the patient, they may return to do the treatment again once the filler has been completely degraded by the body.

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