Dermal Fillers

Dermal Fillers

Aging, as well as certain diseases, make us lose facial tissue (fat, collagen, muscle and bone). The skin also changes due to reduction in collagen and elastic fibers. This makes the skin thinner, lax and more transparent, making the blood vessels under the skin more visible (this is, in part, due to the loss of fat under the skin). Gravity also plays a role in aging, lowering the cheeks, changing the lower jaw line.

Fillers can correct the effects of aging by adding volume (correcting fat, muscle and bone loss that normally occurs with aging) and “plumping” the area.

With fillers we can change some facial features and avoid surgery. Small chins can be augmented, cheeks and cheek bones can be augmented, facial imperfections can be improved, dorsal aspect of the hands can look fuller (veins less visible). Lip enhancement is another area where fillers can make a significant improvement.

It is important to understand that not all the fillers can be used in all areas, and selecting the appropriate filler is very important.

Biodegradable vs. Non-Biodegradable Fillers
Fillers classified as biodegradable are absorbed by the body and tend to have a shorter duration of effect. Fillers classified as non-biodegradable have components that do not degrade. These fillers may yield excellent longer-lasting results, but they tend to be less forgiving and are associated with an increased incidence of granuloma formation and/or extrusion.

Mode of Action
Some dermal fillers operate in a more passive manner, occupying space until the injected material biodegrades. These products are known as tissue replacement fillers or “volumizers;” they have limited action and must be repeatedly injected to yield continuing results. Other dermal fillers, known as “stimulators,” induce an inflammatory reaction with the goal of stimulating collagen production. Neo-collagenesis is believed to yield both longer-lasting treatment results and possibly other benefits to the dermis.

Types of Fillers
1. Hyaluronic Acid (HA): HA is a naturally occurring polysaccharide found in the extracellular matrix in many human tissues. Approximately 50% of the total HA in the human body is found in the skin. These fillers do not produce allergic reaction. The following fillers belong to this group: Juvederm Ultra, Juvederm Ultra Plus, Belotero Balance, Restylane and Perlane.

2. Stimulatory Fillers:These fillers are based on calcium hydroxylapatite, a naturally occurring mineral component of human bone and teeth. The dermal filler is composed of CaHA microspheres (30%) suspended in an aqueous carboxymethylcellulose gel carrier (70%). This dermal filler injection provides immediate correction, but it is believed to generate longer-lasting results by providing scaffolding for collagen growth. Following injection, the gel carrier is absorbed, and new collagen occurs around the slowly biodegrading CaHA microspheres. The patient’s own collagen production thus contributes to the prolonged effects. Some fillers in this group are Radiesse and Sculptra.

3. Permanent Filler Natural: Fat Transfer