Injectable fillers are used to plump out wrinkles; fill defects such as tear trough hollows beneath the eyes, nasolabial folds from the nose to the mouth or marionette lines coming down from the corner of the mouth, or to fill lips and other areas requiring extra volume. Fillers are frequently combined with botox or dysport as the two are complimentary. Fillers may be temporary or permanent. Although I do a lot of filler procedures, I usually recommend fat grafting for its permanence and greater effect.
Permanent fillers such as injectable silicone and others are no longer regarded as safe. They can cause granulomas, permanent deformity and other problems which are exceedingly difficult to correct. Today most plastic surgeons will only consider using temporary fillers.
Collagen, although a temporary filler, is not commonly used anymore either. It was derived from cattle products (bovine collagen) and, as such, allergic reactions were common. Also, collagen was not very long lasting and required frequent toping up.
Modern fillers are made from a long chain, naturally-occurring body sugar called hyaluronic acid (HA). Previously derived from animals (rooster combs), modern HA based fillers are synthetically made and are called NASHA – non animal derived stabalised hyaluronic acid. HA based fillers are hydrophilic and work by attracting water into the treated area to give a soft, gentle fullness. Most fillers will last 9-18 months although this will depend on the type of filler used and the site into which it is injected. The two commonest types of filler which I use in my practice are Juvederm and Restylane.
Within the Juvederm and Restylane range of products are fillers suitable for fine lines, course wrinkles, deep creases and volume replacement. I will choose the best filler product for the purpose or combination of purposes required to deal with whatever problem you have.
Fillers can usually be done at the time of consultation. Usually the procedure is done under topical anaesthetic cream. The cream is applied and takes about 30-40 minutes to make the skin numb. This will not take away all the pain of injection – you will still feel the product going in – but it will deaden some of the pain of the needle. Sometimes I give local anaesthesia similar to that which a dentist might use. The modern fillers also contain lignocaine to further help lessen the pain of injection.
Injection takes a few minutes and you can see the result immediately. There may however be some post injection redness, swelling and bruising. Bruising may take a week to settle, but does not always occur. Swelling and redness is common, but is usually much reduced within a day or two. Lumpiness can occur with fillers, but with the modern fillers this can usually be managed with pressure and massage to dissipate the filler in the tissue. If this does not work, then hyalase can be injected to dissolve the filler. Fillers provide a quick, relatively inexpensive way to rejuvenate and improve the facial appearance.