Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours. More than 1 million men and women annually choose this popular facial rejuvenation treatment, which can be a cost-effective way to look younger without surgery or downtime.
Face fillers, otherwise known as dermal fillers, are small injections of gel, typically made up of hylauronic acid, that fill in wrinkles and add volume to soft tissue. You can have dermal fillers in different parts of your face: around the eye, cheeks, nose, mouth and jawline, as well as lip fillers administered directly into the lip tissue.
Fillers basically restore lost volume to your face and plump areas, so that deep-set lines are smoothed. Why is this needed? As we get older our bodies stop producing collagen and elastin, both of which contribute to the youthful look.
Experts argue over when we start losing collagen, but the generally agreed age is 25. Pretty young, right? Your collagen and elastin levels then decline at a rate of about 2% per year. Your body will have stopped producing it altogether by your late twenties.
Here at The Pimlico Clinic we specialise in facial contouring and lips filler.
Augmenting lips is taken to the next level at our clinic, with different styles to choose from including the Russian or Italian technique.
The most common types of dermal fillers are made from hyaluronic acid.
Hyaluronic acid is often favoured over other filler substances because it can be dissolved (with an enzyme called hyaluronidase) if anything goes wrong with the treatment or if the client doesn’t like the results.
Another plus of hyaluronic acid is that it's a naturally-occurring molecule found in the skin, which means it’s a safe material that’s well-received by the body.
Dermal fillers are used to treat static lines (which remain on the face even when it’s relaxed) and for facial contouring. Treatment areas include:
When filler is injected into the skin, it smooths out fine lines and wrinkles and plumps out areas which have lost volume. Essentially, dermal fillers work in place of diminished fat, collagen and elastin.
Hyaluronic acid (the most common filler substance) makes a great injectable as it attracts and holds onto lots of water - this water then helps create the plumping effect underneath the skin.
The dermal filler side effects are pretty minimal and usually disappear soon after the treatment - they typically last a few days. They include things like swelling, redness and minor bleeding near the injection points. You might also experience some bruising, but applying an arnica cream to the area can help keep this at bay.
If any of these symptoms persist, contact your practitioner for advice.
There’s no downtime following a filler treatment, so you’ll be able to resume your plans as usual. And any side effects you encounter should clear up within a few days of your treatment.
But, you might want to clear your calendar of important events until any signs of redness, swelling and bruising have disappeared.
Your practitioner will likely apply a topical numbing cream to the target area to help reduce pain as much as possible. Lots of modern fillers also contain lidocaine, which will continue to numb the area with each injection.
Some areas of the face will be more sensitive than others - like the lips and nose - but, talk to your practitioner about pain management options if you’re concerned.
When hyaluronic acid-based dermal fillers are used, results typically last for 6-18 months. But, their exact longevity will vary from person to person as it depends on how quickly each individual metabolises the filler.
Also it varies depending the area of the face being injected.
The ‘Russian technique’ can look a bit dramatic, with very sharp and pointy Cupid’s Bows.
For someone who has never used dermal fillers before, or just wants that natural look, the result could be a little too drastic.
I have noticed that most of clients booking the ‘Russian Technique’ comes to the appointment wanting a more subtle enhancement and not as sharp Cupid’s Bows, but still flatness to the face.
I figured that this SOFTER Russian style lip enhancement needed a new name;
Enter ‘ITALIAN LIPS’
Firstly, Italians are generally delicate, moderate, simple, and traditional people with focus on the details and quality rather than quantity.
Secondly, because it’s my native country
You can now select the Italian or Russian technique online depending on your preference.
No one wants to emerge from their practitioner sporting a pair of duck lips or a serious case of trout pout.
This type of noticeable, over exaggerated difference in a patient’s appearance is an easy tell that some type of face altering procedure has taken place.
Fortunately, when administered by a professional, fillers can look completely natural or more noticeable depending on your goal.
If you desire a natural look, the changes can appear so subtle that most people won’t even realize you underwent a cosmetic procedure.
While they will notice the improvements to your appearance, it won’t be so obvious to cause them to suspect anything other than you looking your best.
Hyaluronic acid dermal fillers can be dissolved by injecting an enzyme called Hyaluronidase in order to rapidly remove unwanted filler.
This is used for elective or emergency dissolving.
When should I dissolve the filler?
•when visible lumps and bumps are present (and they are not shifting with a massage)
•puffy side profile, with visible filler outside the vermillion border
•over filled lips, with too much filler used over the course of years
•in case of an emergency and vascular occlusion
When can you start to see the effects?
Hyaluronidase has immediate effect and even better results are visible in 24 to 48 hours.
Are there any risks?
Just like there are risks or adverse events associated with injecting dermal filler, hyaluronidase itself is not risk free as it can cause temporary discomfort of injection, redness, swelling, bruising and very rarely allergy.
*a skin patch test needs to be carried out 30 minutes before the treatment to verify suitability.
It is good to familiarize yourself with the lip process;
swelling after lip injections is common, but you may also experience redness and bruising from fillers.
On the other hand, with proper lip filler aftercare, the healing process is fast.
Day 0 (lip filler treatment)
Straight after the procedure, considerable swellings can occur.
Most of the time, there is uneven swelling.
It is advisable that you not be concerned about the unevenness in the first few days, as it is impossible to assess until the inflammation has cured or subsided.
Day 1 (One day after the treatment)
Often, inflammation, on the first morning after treatment is when it is most severe and intense. You’re also at the greatest risk of developing cold sores from a lip filler enhancement procedure one to two days after this enhancement.
The upper lip will have considerable projection and might be considerably larger than the lower lip as usually more work and therefore more trauma is involved on the top lip.
Also, during this time, the lips will appear big due to the inflammation.
On day 2, expect inflammation. Inflammation happens after 24 hours, and often, it may begin to reduce and gradually improve over the next couple of days. At this stage, you will start seeing some bruises and might feel lumps on the lips.
By the time an entire week has passed, bumps and bruises will have vanished.
The patients lips will be better and at their best by then.
On the fourth day, patients may begin to notice a development in the inflammation. You will also see that it is more comfortable to eat and talk. Still, there will be softness to hold and touch.
After 1 Week
After seven days the swelling disappears. Your lips size will also lessen a bit.
But, this is the period when you begin seeing the actual outcome.
The lip filler swelling can lasts for a total of fourteen days.
4 Weeks Later
At four weeks after the lips have settled we can assess a patient for symmetry and size.
If the patient wishes more, then it can be performed at this phase.
If there is a need for correction, you need to wait for this period.
You will be advised the best filler suitable for your skin and desired result on the day.
As a general rule the main difference between fillers is a follows:
Nexfill- medium thickness filler.
Very versatile filler, suitable for reshaping the lips and add definition.
Revolax- thick filler.
Suitable for major reshaping of the lips, very defined look. More suitable for Russian lips. Lasts the longest due to its thickness.
Stylage- medium thickness filler.
Very versatile, good for reshaping. Added bonus of antioxidants that work agains skin aging.
Juvederm- soft filler.
Attracts water and gives a plump look. Great for hydration but not for reshaping. Ideal for who wants plumpness without definition and change in shape.
This is a common question asked by patients, and a good question because so many patients have a misunderstanding of the true amount in a syringe of filler, or have been improperly informed.
Most filler syringes contain 1.0 ml (milliliters or cc) of product.
Some fillers do come in larger or smaller sizes but let’s discuss the vastly more commonly used 1.0 ml syringes.
Much of the confusion and misunderstanding is caused by the use of the metric system to quantify the volume or amount in the syringes. That is, they’re using milliliters not teaspoons or tablespoons.
The conversion of 1.0 ml to a teaspoon is about 1/5th.
That is, one syringe of filler is equal to 1/5th of a teaspoon—not all that much!
Or if you’re looking for a more real-world example look at a common blueberry.
A typical blueberry is about 1ml of volume or about 1 syringe of filler.
This is why one syringe is typically the perfect amount in the right hands to naturally enhance the lips or fill in a few lines and wrinkles, but not enough to fully augment the cheeks or jaw for example.
How much filler do I need?
0.5ml of filler or 3ml of filler? How much will you need? Well, the quantity used depends on a few different factors. These include:
* How deep your wrinkles are
* How much volume your face has lost
* Your face shape and features
* The type of filler treatment you want - for example, a liquid nose job, cheek filler, lip filler, or tear trough filler. It's worth bearing in mind too that different fillers are used for different facial filler treatments - and the viscosity of these varies.
Ok, let's break it down a bit!
Here's what you'll likely be looking at...
AVERAGE AMOUNT OF FILLER NEEDED
FOR EACH AREA OF THE FACE
A - Temples: 0.5-1ml of filler for each temple
B - Tear troughs: 0.5-1ml of filler for each tear trough
C - Cheeks: 1-3ml of filler for each cheek
D - Nose: Quantities of filler used for liquid rhinoplasty will depend on the changes being made - usually 1ml would be enough.
E- Nasolabial folds: 0.5-2ml of filler for each side of the face.
F- Lips: Quantities depend on the desired lip
plumpness, but can range from roughly
0.5-1ml of filler. You might need several
appointments to reach the desired look
G - Marionette lines: 0.5-1ml of filler
for each side of the face
H- Chin and jawline: 1-5ml of
filler to shape and define the chin and jawline
Hyaluronic acid is a substance that is found in our bodies in the intra-and extracellular matrix. It is form of antigen-free tissue glue, if you will.
Therefore, hyaluronic acid is naturally broken down in the body without adverse effects.
Hyaluronic acid has been used for years in surgery and was FDA approved for cosmetic use in 2004.
To date, there is no information to suggest that long term aesthetic use of hyaluronic acid gels has any detrimental effects.
A 2013 study published in the journal of Clinical, Cosmetic and Investigational Dermatology presented an overview of adverse long terms events associated with dermal fillers in aesthetics.
The study concluded that all dermal fillers have the potential to cause complications, but “serious adverse events are rare” and the “majority of adverse reactions are mild and transient, such as bruising and trauma-related edema.”
The majority of adverse reactions is “related to volume and technique,” and most serious adverse events “are avoidable with proper planning and technique.”
Meaning, the skill and expertise of the person performing the injections is very important and very influential on the long term effects of a dermal filler.
AESTHETIC TREATMENTS & INJECTABLES
Injectables are often recommended in the early stages of facial aging when surgery is not yet necessary.
***Injectables like Botox are used to relax facial muscles that produce crow’s feet and brow furrows giving you a refreshed and well-rested appearance.
Injections are relatively painless and have little to no downtime needed.
The effects typically last 3-6 months before touch-ups are needed.
***Dermal fillers are used to add volume and create more rounded contours in the face. Using fillers to add volume to plump up these areas, instantly improves your face’s appearance, giving you a more youthful look, smoothing lines, wrinkles and folds in the face. The most common areas that fillers are used to correct include:
* Laugh lines or the creases that run from the nose to the mouth
* Hollowness under the eyes
* Cheeks, temples and facial contours
* Lips and vertical lines on the edge of the lips
* Indented acne scars
Dermal fillers are a popular alternative to surgery, but there is a limit to what they can do. What fillers can’t do is remove extra skin, provide significant skin tightening, lift facial muscles or fat pads, which means the results are not permanent.
Typically, the results from fillers last six months, some up to two years and require touch-up treatments once or twice a year.
Plastic surgery comes into play when gravity needs to be reversed and the aging process can no longer be corrected with dermal fillers, injectables or peels.
A face lift is the way to go if you have advanced signs of aging and need more significant facial enhancement. A facelift is ideal for the following trouble areas:
* Sagging of the skin
* Excess fat around the neck or double chin
* Deep fold lines around the nose and mouth
* Cheek or jaw jowls
A face lift involves surgically enhancing the face to achieve to achieve your desired aesthetic goal. The procedure involves removing excess skin from the face or neck area and repositioning tissue using small incisions with minimal visibility, to tighten and smooth the face area.
Surgical rhinoplasty, which is often called a “nose job,” is one of the most common plastic surgical procedures.
However, more and more people are looking for a less invasive way to reshape their nose.
This is where liquid rhinoplasty comes in.
It still smooths out bumps and contours the nose, but it’s temporary and has very little recovery time compared to the actual surgery.
With a surgical rhinoplasty can take up to 1 year to see the desired result, not to mention the bruising, pain, discomfort that comes with it.
Liquid rhinoplasty is the nonsurgical option to traditional rhinoplasty.
It’s used to temporarily address issues like a dorsal hump (small bump), a drooping nasal tip, and asymmetry.
It is easy to say it’s one of my favorite treatment considering the instant amazing outcome it gives.
The best way to prepare for Dermal Fillers is to make sure you are keeping your body healthy.
You should keep your skin, especially the areas which will be treated, in good condition.
This can be done by moisturising and keeping it clean so that pores are not damaged when the treatment occurs.
Patients may reduce the amount of bruising and swelling by:
* Limiting their alcohol consumption (having none the night before your procedure).
* Avoiding strenuous exercise the day of treatment, as this increases the heart rate and speeds up blood flow, meaning it increases your risk of bruising.
* Not using Vitamin E, Aspirin, Herbal Supplements, Non-Steroidal Anti-inflammatory medications such as Ibuprofen 1-2 weeks prior to treatment as these medications are more likely to cause bruising.
* Come in with clean face, no make applied to avoid bacterial infections.
* Avoid dental work for 3 weeks before or after dermal filler injections.
* Covid vaccine should be minimum 2 weeks before or after treatment.
* Cold sores should be treated before coming in for your appointment. If present on the treatment day and on the area treated we will have to reschedule.
* Avoid scheduling an appointment around a special event, give it at 2 weeks for the area to settle.
When a filler is injected, it does stretch the skin slightly, filling out sagging skin and tissues that have been weakened over time.
However, after the filler fades away the skin will recover and revert to the way it looks when you came in.
In some situations, depending on the type of treatment, your skin will look even better!
If at any time you choose to discontinue the use of dermal fillers, your skin will just return to its previous condition.
1ml of filler only takes up 1/5 of a teaspoon, so is a relatively small amount of volume, only significant weight loss can actually leave saggy skin. In the case of dermal filler the amount injected is so small that doesn’t impact the skin elasticity.
The primary difference between the two treatments, is that Botox reduces the activity of muscles in the face that cause wrinkles.
Dermal fillers fill the trouble areas with hyaluronic acid, plumping and lifting the skin to replace collagen loss.
What can dermal fillers correct?
Different types of dermal fillers are designed to treat varying signs of aging. Depending on the filler selected, they may:
* plump up thinning lips
* enhance or fill in shallow areas on the face
* decrease or remove the shadow or wrinkle under the eyes caused by the lower eyelid
* fill in or soften the look of recessed scars
* fill in or soften static wrinkles, especially on the lower face
Static wrinkles include those around the mouth and along the cheeks. These wrinkles are usually a result of a loss of collagen and elasticity in the skin.
What can Botox correct?
Botox only works on wrinkles that are caused by muscle movement. These are known as dynamic wrinkles, and are often called “expression lines.”
The most common dynamic wrinkles that Botox can treat are lines on the upper face, such as the “11” between the brows, horizontal lines on the forehead, and crow’s feet around the eyes. These lines are caused by smiling, frowning, squinting, and other facial expressions.
Botox will NOT work on fine lines and wrinkles caused by sagging or loss of plumpness in the face. These are known as static wrinkles. Static wrinkles include lines in the cheeks, neck, and jowl areas.
* Botox: This freezes muscles to stop creases and wrinkles caused by facial expressions. These are typically found in the upper face, such as the forehead and around the eyes.
* Dermal fillers: These use hyaluronic acid and similar substances to “fill in” or plump areas that have lost volume and smoothness. This includes wrinkles around the mouth, thin lips, and cheeks that have lost fullness.
* Botox results last 3 to 4 months.
* Dermal filler results vary, depending on which filler is used and the area treated. (6 to 18 months or longer).
Traditionally, dermal fillers have been injected using needles.
In fact, most dermal fillers still come packaged with two short (1/2 inch) needles as the recommended means of injecting the product. However, there are several advantages of not using the supplied needle, and instead, using a blunt-tipped cannula for the injection of dermal fillers.
I personally prefer the use of a cannula for safety and less trauma, however I use the needle when doing lips, which requires precision and when wanting to lift areas like cheeks, where depositing dermal filler on the bone with a needle gives more of a lift to older clients.
On the other hand I prefer the use of the cannula on areas like jaw line and cheeks when wanting definition and not much of lift.
Pros of cannula:
•Cannulas are blunt, which mean that they are less likely to pierce through a vein or artery. This results in less swelling, bruising and intravascular injection of filler.
•The practitioner has more feel about what structures are being passed by the tip of the cannula.
•Cannulas are longer than needles, allowing for fewer injections and entry points through the skin.
•Can go in through the same entry point multiple times without hurting the patient.
•You are able to get more definition as the filler is deposited more superficially (like in jaw line and cheeks requiring definitions and not much lift).
* It is hard to get down to the deeper levels of the skin and tissue with a cannula
* Takes an extra step for injectors. Using a cannula means you have to create an entry hole for the cannula to go in to.
* You must find the path of least resistance with a cannula because of it’s blunt tip, therefore it sometimes takes a heavy hand to get the cannula where it needs to be.