Dermal Fillers

Dermal fillers act to improve skin support, volume and hydration, thereby smoothing facial wrinkles and folds. They are also excellent products for lip sculpting. There has been an increased interest in recent years largely due to the introduction of safer fillers onto the market and because of the popularity of Botulinum toxin (see BOTULINUM TOXIN section). Dermal fillers and botox often act as complimentary treatment modalities, with botox tending to be most effective in the upper 1/3rd of the face and dermal fillers often preferred for the cheeks and lower face.

There are now many dermal fillers available and broadly they can de divided into 2 groups:

1. Semi-permanent fillers
These fillers tend to be formed from hyaluronic acid gels. They are the most popular type of dermal filler and include products like Restylane (Q-Med) and Juvederm (Allergan).
2. Permanent fillers
These non-hyaluronic acid based fillers are used less often, but may be preferred by some practitioners for cosmetic or medical use. Examples include Radiesse (made of calcium hydroxyapatite) and Sculptra (based on poly-L-lactic acid).

Restylane

Although new products are regularly entering the market I prefer to use the Restylane range of injectable fillers (www.restylane.co.uk). These fillers have been used extensively since 1996 and therefore have excellent safety data. Restylane injectable gel has in fact been used in more than 10 million treatments worldwide and is the most studied wrinkle filler. Restylane fillers are based on a sterile clear hyaluronic acid gel which is a non-animal product (patented NASHA technology), this means that no skin test required.

Restylane sterile hyaluronic acid gel

Restylane sterile hyaluronic acid gel

These products can be used to add volume and fullness to the skin to correct moderate to severe facial lines, folds and wrinkles. Recent advances now mean that most of the Restylane range is available with an "in-built" anaesthetic, making the injection procedure significantly more comfortable. The new "Pix-L" cannula system has also reduced the number of injections required and allows for a smoother introduction of the gel particles at the correct tissue depth.

Tissue tailored concept

Restylane is manufactured in different grades so that the most appropriate product can be used depending on the area being treated. Finer gels are used for superficial facial lines and thicker fillers eg Perlane, for deeper wrinkles and folds. Common areas to use dermal fillers include the lines from the nose to the corner of the mouth (nasolabial folds) and the area that extends downward from the corners of the mouth to the jawline (marionette lines). Restylane can also be effective for treating dark lines below the eyes (tear troughs), improving lip fullness and definition, as well reducing lip stick lines between the upper lip and nose.

A 42yr old lady with lines around the angle of the mouth

A 42yr old lady with lines around the angle of the mouth

Same patient immediately after restylane filler

Same patient immediately after restylane filler

Marionette lines can give the false appearance of being sad

Marionette lines can give the false appearance of being sad

Same patient immediately after restylane filler to lift the corner of the mouth

Same patient immediately after restylane filler to lift the corner of the mouth

How long does treatment last?

Restylane products are biocompatible with the human body and are eventually broken down naturally. The beneficial effect does vary from one individual to another but generally improved volume in the nasolabial fold area tends to last around 9 months. Lip enhancement may wear off quicker and often needs to be topped up after 6 months.

Relatively thin upper lip in a 36yr old lady

Relatively thin upper lip in a 36yr old lady

Same patient immediately after filler to enhance lips (using a local anaesthetic dental block)

Same patient immediately after filler to enhance lips (using a local anaesthetic dental block)