Dermal Fillers

a.    Calcium hydroxyapatite

 

is naturally occurring substance, found primarily in our bones. When used in a filler, the calcium particles are nearly microscopic and suspended in a smooth gel. The consistency of a CaHA filler is typically thicker than that of a hyaluronic acid filler and typically last longer as well, about 12 months for most patients. Calcium hydroxyapatite also helps natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved CaHA fillers include Radiesse®. Calcium hydroxyapatite is biosynthetically produced, so no animals or animal products are used than it has low risk of an allergic reaction. This type of dermal filler is known to produce a very natural result, doesn't migrate and side effects are rare.

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b.    Hyaluronic Acid (HA)

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Hyaluronic acid is a naturally occurring substance that is already found in connective tissue also skin, it exists widely in connective tissue. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 to 12 months or longer before the body gradually and naturally absorbs the particles. Most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment. FDA approved HA fillers include: Juvéderm products, Restylane products, Belotero, Revanesse , The RHA collection.

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c.    Poly-L-lactic Acid

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Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has been used for many years in medical devices, such as dissolvable stitches. Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines is by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment. Poly-L-lactic acid is typically used to treat deeper facial wrinkles, and results can last more than 2 years. FDA approved Poly-L-lactic acid fillers include Sculptra® Aesthetic.

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d.    Polymethylmethacrylate (PMMA)

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Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. In dermal fillers, PMMA takes the form of a “microsphere” or tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Bellafill® (formerly known as Artefill).

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e.    Autologous fat injections (facial fat grafting)

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Autologous fat injections are the only injectable filler treatment that requires surgery, but results can last for many years. Your own fat is harvested from another area (autologous means “from the same person”), typically using liposuction. The fat is then purified and injected into the face to help restore volume to the cheeks, temples, lower eyelids, or other areas. Fat injections require specialized training to perform safely and achieve great results, and should only be performed by an experienced, board-certified cosmetic surgeon.

 

During your consultation, your doctor will evaluate your area of concern and review your medical history. While the risks associated with dermal fillers are minimal, you need to fully disclose your medical history prior to treatment, as certain allergies, skin and neurological conditions, or medications can affect results and can cause complications.

The choice of the type of filler depends on your needs, the amount of volume loss. It is best for you with an experienced doctor’s guidance. Each product is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for certain areas.

 

Just before the injection, the area is cleaned and a topical anesthetic cream is applied to numb the area prior to injection. Then, your doctor will inject a certain amount of filler under the skin. Depending on the product and the areas treated, you should see the results immediately after filler injections. Some patients experience mild bruising and swelling, but these are temporary and should subside over the days following treatment. You will be able to go back to your normal activities right after treatment. 

It’s a personal decision to use fillers. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of dermal fillers are acceptable. Severe complications from dermal fillers are rare. The complications include: 

1. a.    Acne-like skin eruptions

2. b.    Asymmetry

3. c.    Bleeding from the injection site

4. d.    Bruising

5. e.    Damage to the skin that results in a wound and possible scarring

6. f.    Infection at the injection site

7. g.    Lumps

8. h.    Palpability of the filler under the surface of the skin

9. i.    Skin necrosis (ulceration or loss of skin from disruption of blood flow)

10. j.    Skin rash with itching

11. k.    Skin redness

12. l.    Swelling

13. m.    Under- or over-correction of wrinkles

 

The filler may accidentally be injected into your blood vessels accidentally in rare cases. This blocks blood flow and you might have skin loss or wounds depending of the amount of block. If your eye is affected, you might lose your eyesight or go blind.

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