Dermal Fillers

Dermal fillers are products that are injected under the skin to fill spaces between cells. The most widely used fillers are made from hyaluronic acid (Juvederm®, Restylane®, Stylage®) which is a naturally occurring sugar molecule found in the skin. Over time the body’s production of hyaluronic acid declines resulting in visible signs of aging. They are the most used fillers for aesthetics because of the availability of a reversing agent and wide selection of products available. Hyaluronic acid dermal filler has been shown to stimulate collagen production, but this is minimal.

Other dermal fillers are calcium hydroxylapatite (Radiesse®) and poly-L-lactic acid (Scupltra™). Calcium hydroxylapatite is identical to components of teeth and bone making it biocompatible with minimal risk of allergic reaction. Poly-L-lactic acid is a polymer that has been used safely in medicine for dissolvable stitches. Both products are considered stimulatory agents due to the moderate degree of collagen that is generated. They provide natural volumization and are often used for improving skin quality.

Dermal fillers can be used on patients looking for rejuvenation, beautification, or restoration. Rejuvenation aims to restore age related changes by restoring volume and contour to achieve facial harmony. Beautification procedures can change proportions and ratios to reach desired aesthetic goals. Restoration aims to improve the quality of the skin.

Dermal fillers should not be injected if you are pregnant or breastfeeding, have a bleeding disorder or have an allergy to one of their components including lidocaine. Dermal filler treatment should not be undergone if you have an active infection or if you are undergoing any kind of surgical or dental procedure (including cleaning) in the next 2 weeks. It is preferable to postpone filler treatments until after you have undergone your procedure. Some patients with active autoimmune diseases are not good candidates for dermal filler due to their increased risk of developing complications. Patients with uncontrolled diabetes, are immunocompromised, or have had previous complications with dermal fillers are also not good candidates. Dermal fillers should not be injected in areas that have implants or have been previously injected with silicone fillers.

Dermal fillers can be used to rejuvenate all aspects of the face and neck. Radiesse® and Sculptra™ can also be used on body areas including hands, inner arms, abdomen, knees, and buttocks.

The effects of hyaluronic acid dermal fillers and undiluted Radiesse® are immediate, but there may be some post injection bruising and swelling. You may experience some firmness in the area injected that will resolve over 1-2 weeks. Final results may take 2-4 weeks before the dermal filler is integrated into the skin.

Diluted Radiesse® and Sculptra™ are biostimulatory fillers and results begin at 4 weeks and continue to improve over 12-18 months.

The most used dermal fillers are hyaluronic acid, calcium hydroxylapatite (Radiesse®) and poly-L-lactic acid (Sculptra™). These fillers are not permanent but are broken down by the body over time.

Hyaluronic acid fillers last between 6-18 months depending on the product used, the patient’s metabolism, and area injected before they are broken down like our natural hyaluronic acid. They can also be dissolved with hyaluronidase if need be. Radiesse® and Sculptra™ lasts for 1 to 2 years and have the added benefit of being biostimulatory agents for collagen.

There is mild pain with injection of dermal filler. Most filler have a numbing agent mixed into them which makes the injection process more comfortable. Numbing cream and ice packs can also be used in areas that are more sensitive to pain like the lips.

Common side effects of dermal fillers include pain, redness, swelling, and bruising which resolve over a few days. Rarely lumps can occur when filler is not placed smoothly, or an infection may occur. A very rare complication (0.001%) is tissue necrosis. This is caused when dermal filler is inadvertently injected directly into a blood vessel. Although rare, tissue necrosis, scarring, blindness, and pulmonary embolism have occurred in the most severe cases. There are often early visible signs of intravascular injection which can be addressed by dissolving hyaluronic acid filler with hyaluronidase to prevent serious complications. Choosing an experienced injector with a thorough knowledge of anatomy will also help to reduce this risk.

If hyaluronic acid filler is injected too superficially it may cause a bluish discoloration in the skin. This is called the Tyndall effect and can be resolved with injection of hyaluronidase to dissolve the filler.

In some cases, patients may experience nodules. These can occur if too much filler is placed, not using the correct product, muscle action around the area of injection or impurities in the filler. These generally resolve with no intervention.

It is normal to experience some pain or firmness after dermal filler injections. If you experience increasing pain, unusual bruising, or blisters in the area in the days after the procedure please contact Dr. Fisher. Concerning symptoms such as double vision, eye pain, vision loss, shortness of breath and chest pain must be reported immediately. These may occur up to 72 hours after filler injection.

Hyaluronic acid dermal fillers can be dissolved with hyaluronidase. This can be done to correct asymmetry or over injection of dermal filler. It is also an important step in managing inadvertent intravascular injection. There is some effect on the body’s hyaluronic acid, but this is quickly regenerated with no long-term effects.

Dermal fillers can migrate into surrounding areas. This can be related to both the location and volume of filler injected. It is important to see a qualified injector with an excellent understanding of anatomy and filler properties to avoid migration of filler to unwanted areas.

It is recommended that you do not take any non-essential blood thinning medications (ASA, aspirin, ibuprofen), supplements (fish oil, Vitamin E) or herbal remedies (garlic, ginkgo, dong quai, ginger, turmeric) for 1 week before dermal filler treatment. If you are required to be on any blood thinners for medical reasons you can still undergo treatment but will be at an increased risk of bruising.

Alcohol should be avoided for 48 hours before dermal filler treatment to reduce the chance of bruising.

Patients that suffer from cold sores should take an antiviral medication to prevent an outbreak if they are undergoing lip injections.

Avoid high impact exercise and excessive heat (hot tubs, saunas) for 48 hours to minimize swelling and bruising. You may use cold compresses, take arnica, or use Vitamin K cream to if you experience swelling and bruising. Avoid massaging or rubbing the area or sleeping face down for 1 week. Make up may be used on the area after 24 hours. You should not undergo any dental or surgical procedures or vaccinations for at least 2 weeks after treatment. You should avoid facials or facial massages for 3-4 weeks. Some rare complications such as tissue necrosis may not present for up to 3 days afterwards so travel should be avoided during this time to ensure access to proper treatment. Alcohol may affect healing and exacerbate swelling and bruising so should be avoided for 48 hours after treatment.

Dr. Fisher generally recommends waiting 2-4 weeks between hyaluronic acid dermal filler treatments to allow for filler to fully integrate and for all swelling to be resolved. Radiesse® and Sculptra™ treatments should be spaced at least 8 weeks apart to allow time for collagen production.