Tips to Achieve Successful Outcome for Dermal Fillers

Dermal Fillers: Tips to Achieve Successful Outcomes

Fillers have become a common aesthetic treatment for several cosmetic problems. Several types of fillers are available from different sources and of different longevities. It is important that the treating physician be aware of the different techniques of administration and their possible side effects. This article reviews the available literature on the subject.

This article reviews the available literature on the subject.

Dermal fillers have revolutionized the field of cosmetic dermatology. With the ageing of baby boomers, dermal fillers have become a sought-after rejuvenation procedure as they offer a youthful, three-dimensional look with minimal downtime.

Dermal fillers are gaining popularity because of the increased attention by the media and the availability of a wide array of filler materials available at prices more affordable than before. The use of fillers for soft tissue augmentation with the synergistic use of botulinum toxin and a variety of complementary procedures has become the mantra for rejuvenation.

Dermal fillers are gaining popularity because of the increased attention by the media and the availability of a wide array of filler materials available at prices more affordable than before. The use of fillers for soft tissue augmentation with the synergistic use of botulinum toxin and a variety of complementary procedures has become the mantra for rejuvenation.

Presently, the fillers available in India vary in the source, longevity, site of deposition, and cost. The focus of this article is to analyse the fillers available in the market and to provide practical tips that would enable the dermatologist to derive optimal results for the patient.

 

CLASSIFICATION OF FILLERS

Fillers can be classified either on the basis of longevity in tissues or based on their source.

Based on longevity

Fillers are classified as temporary, semi-permanent, or permanent. Temporary fillers stay in the tissue for less than a year, semi-permanent fillers for up to 1–2 years, whereas permanent fillers are substances that remain in the tissue more than two years. However, there is some confusion in the classification of a semi-permanent and permanent status of some fillers, with some sources classifying any filler that lasts more than one year as permanent.

Based on the origin

Fillers may be classified depending on their source as:

  1. Human
  2. Animal
  3. Synthetic

Knowing the source of the filler is important as it helps the dermatologist to take decisions about the need for pre skin testing and to know the patient’s preference. Many patients may not wish to use animal products for religious or personal reasons.

Temporary fillers

Temporary fillers are also referred to as nonpermanent fillers. Their stay in the tissue is for less than 12 months and hence, they have the advantage of spontaneously disappearing if the patient is not satisfied with the results. Similarly, an adverse event with such fillers is also a temporary one, as seen in the majority of the cases. However, rare permanent side effects have been reported even with temporary fillers.

Some of the common temporary fillers available in India are described here:

Bovine collagen-based products

  • Zyderm 1
  • Zyderm 2
  • Zyplast

Human tissue-derived collagen

  • Cosmoderm
  • Cosmoplast

Synthetic fillers: Hyaluronic acid-based fillers

A wide range of hyaluronic acid products is available with varying hyaluronic acid concentrations and cross-linking structure and hence, also in their indications

temporary fillers -Table | Ohana CosmeticsSemi-permanent fillers

Semi-permanent fillers undergo slow degradation with time over a period of 1–2 years. Side effects with semi-permanent fillers are more common and longer lasting than temporary fillers.

Semi-permanent fillers - Table | Ohana CosmeticsPermanent fillers

Permanent fillers are fillers that remain for longer than two years in the tissue. Side effects with permanent fillers tend to be more permanent, and complication is the main issue with any permanent filler.

Permanent fillers - table | Ohana CosmeticsINDICATIONS OF DERMAL FILLERS

Fillers are mainly used in the rejuvenation of facial areas. However, dermal fillers may also be used in nonfacial areas and for cutaneous defects.

Facial areas

  • Wrinkles and folds
  • Lip Augmentation
  • Depressed scars – postsurgical, traumatic, post acne, chickenpox, and other diseases
  • Enhancement of facial contour
  • Periocular melanoses and sunken eyes
  • Dermatological diseases – angular cheilitis, dermal atrophy, AIDS lipodystrophy
  • Earring ptosis, atrophic earlobes
  • Nasal depressions

Nonfacial areas

  • Neck
  • Décolleté    }        Rejuvenation
  • Hands
  • Corns and calluses – to reduce contact points, pain, and risk of ulcer formation

CONTRAINDICATIONS

Complications of fillers are generally rare; they include

Absolute

  • Hypersensitivity to products
  • Unrealistic expectations

Relative

  • Keloidal tendency
  • Patients with autoimmune disease

PATIENT EDUCATION AND ASSESSMENT

Patients should be counselled about the nature of the filler, what to expect, longevity, any possible side effects, and the cost. An assessment of both the physical and psychological states of the patient is necessary for a successful outcome.

Written informed consent ensures compliance with regulatory and legal requirements as well as the management of the patient’s expectations. Pre- and post- photographs are important to critically analyse the results of the treatment and also, to prepare for medico-legal situations.

PROCEDURE OF FILLER INJECTION

The aesthetic benefit for the patient with temporary fillers can be attributed to 90% technique and 10% substance, whereas it is usually 99% technique with permanent fillers.

Preparation and anaesthesia

The area of injection and also the surrounding skin should be cleaned properly with antiseptics. Anaesthesia is important for the technical benefit and the patient’s comfort. Anaesthesia can be ensured by:

  • Application of ice
  • Topical EMLA cream application
  • Regional nerve blocks – infraorbital, mental, maxillary, submucosal – as applicable, depending on the area
  • Distraction Techniques such as massage, application of vibration
  • Talking in a soothing and comforting manner – Talkesthesia

Injection technique

The choice of the injection technique depends on the indication, its location, the filler substance, the size of the needle, and the experience of the injector. The techniques include:

  1. Linear threading technique
  2. Serial puncture
  3. Fanning
  4. Cross-hatching
  5. Depot
  6. Fern
  7. Cone

The first four techniques are used commonly, whereas the last three are only used in special situations. It is important to place the filler in the right place and the bevel orientation is not a significant issue at any site.

Postinjection management

Patients should be asked to avoid extreme cold or heat for 48 hours. Massaging of the treated area and strenuous physical activity should be avoided for six hours. Patients are asked to sleep with their heads elevated for one night; skin care routine may be followed by 24 hours.

Measures to achieve successful outcomes

A comprehensive treatment plan should be devised to suit the needs of each patient. Choosing the right filler for the right indication is vital. Where essential, combinations of fillers with botulinum toxin should be used to optimize the results.

In such cases, it is advisable to inject the botulinum toxin first, wait for a week to see the improvement, and then, inject the filler to achieve best results.

 

Source: Courtesy of www.ncbi.nlm.nih.gov