Non-Surgical Treatments
Dermal Fillers

Dermal fillers have become increasingly popular to reduce the visibility of facial lines and wrinkles since the introduction of “Collagen” in the late 1970’s. Hyaluronic acid based fillers are now the most widely used and least problematic in clinical practice.  Hyaluronic acid is a naturally occurring substance found in many parts of the body but it is manufactured synthetically for use as a dermal filler. A range of commercial products are available and most are produced in different viscosities (thickness) – in general less viscous products are used superficially and thicker preparations deeper in the facial tissues. We only use fillers in the practice which are approved by the FDA in the United States.

HA fillers are injected into or beneath the skin.  Some preparations contain local anaesthetic, but topical local anaesthetic creams can make the injection more comfortable. In some very sensitive areas, particularly around the mouth, a regional local anaesthetic block (such as a dentist might use), is very helpful.  They are used to fill fine lines and wrinkles in the face and hands and to add volume to some areas such as the cheeks, chin and lips.  Over-enthusiastic injection of large quantities should be avoided since this tends to produce an unnatural appearance. After injection there may be a little redness and, occasionally, bruising but this will usually resolve in 24 hours or so. It is impossible to eradicate wrinkles with fillers but they can be made significantly shallower.

A recent innovation known as Micro-filling has proven to be very helpful in the reduction of fine, vertical furrows in the upper and lower lips.  This involves multiple injections of tiny amounts of Restylane through a very narrow (32 gauge) needle. This can be accomplished comfortably using local anaesthetic cream and because the needle is so fine, causes little or no discomfort.  It causes no bleeding and its most significant advantage is to make wrinkles around the lips less noticeable without creating any fullness in the lip itself when this is not wanted. 

HA fillers will last for 3-6 months in most people.  Complications are extremely rare though infection is known. There may be a little unevenness at the injection site for a short time. Allergy is virtually unknown and “test” injections are unnecessary.

Although permanent or semi permanent fillers may seem attractive their complication rate is very much higher.  Unfortunately it is impossible to resolve some of the problems that may arise, particularly chronic granuloma formation (a low grade but long lasting infection).  For this reason I advise against their use.

In general HA based dermal fillers can be very helpful in addressing some of the superficial signs of ageing and improving facial contour so long as they are used sensitively.  They are not designed as a substitute for surgery, their aims are different and they will not address underlying structural change.  As with all aesthetic treatments it is important that expectations are pitched at a realistic level.

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