DERMAL FILLERS

The concept of dermal fillers has been around for a long time, since surgeons started using mineral oil and paraffin as a soft tissue filler. Unfortunately, there were many unwelcome side effects as result of these treatments. Collagen fillers were invented in the 1980s, but aren’t really used any more due to their short lifespan, and the risk of allergy. Hyaluronic acid dermal fillers have been around since the 90s, and are still used today. Restylane was launched in 1996 as the first non-animal hyaluronic acid dermal filler, and has been in use since then, although there have continued to be many innovations in new types of hyaluronic acid fillers, and the way in which they are used today is constantly evolving.

Hyaluronic acid dermal fillers are the most widely used; however, there are many other types of product available:
Polymethylmethacrylate (PMMA) is a non-absorbable sphere which stimulates skin to produce more collagen. Artefill is a suspension of PMMA in bovine collagen. At TLC, we do not use any permanent fillers such as this one, due to safety concerns.

• Collagen fillers are derived from porcine, bovine or human donors. At TLC, we do not use collagen dermal fillers, due to the need for patch testing and longevity issues.
• Poly-l-lactic acid (PLLA) is an absorbable polymer which stimulates collagen production. Sculptra is the only product to contain PLLA. At TLC we occasionally use Sculptra for large areas of facial volume loss. It does not require patch testing. For the best results, several treatment sessions are usually necessary.

Calcium hydroxylapatite is suspended in a gel carrier in Radiesse, a synthetic compound similar to the hard tissues of the body. No patch testing is required.

We generally always use a hyaluronic acid filler due to safety considerations. Hyaluronic acid fillers are dissolvable, which means that in the highly unusual event that there’s a problem, they can be dissolved with ease. The most commonly used products include Juvéderm, Teosyal, Belotero, Profhilo, Radiesse and Sculptra. Different fillers have different properties, so we select the right one for your treatment.

Dermal fillers are classified as a medical device, not as a medicine, meaning regulation around their use and production is much laxer. We only use dermal fillers produced by reputable pharmaceutical companies such as Allergan and Merz – which guarantees they’re produced under strict quality controls.

Dermal fillers have several modes of action:

• Revolumising areas of the face which have lost volume as part of the ageing process. As we get older, the bone of the skull shrinks and the fat compartments in the face also shrink which means that the skin can appear loose and saggy due to the lack of support.
• Improving the skin quality because dermal fillers act as biostimulators for collagen which makes the skin appear more luminous and healthier.

Some types of dermal filler hold water in the skin meaning it appears more hydrated and smoother.

There are many uses, the most obvious being to correct any deformity of the face or body post-surgery, after an accident, or as a congenital defect. They are also used in orthopaedics to improve symptoms of osteoarthritis, in ophthalmology, plastic surgery and gynaecology as ‘space fillers’.

Hyaluronic acid is produced by a bacterium, usually Streptococci or Bacillus which is then processed and sterilized. Cross-links are placed between the chains, making a flexible lattice work structure.

The first non-animal based hyaluronic acid product, Restylane was introduced in 2003. Since then, all fillers produced by the major companies, such as Juvéderm, Belotero, Teosyal all contain non-animal hyaluronic acid. These products, however, will at some point have been tested on animals, as is required by government regulations prior to sale in certain countries.

Sure! At TLC we see many men who enjoy the benefits of dermal filler injections, either for skin textural improvement or for facial recontouring – such as increasing the width of the jaw or the cheekbones.

We use them first to replace any volume lost in the face with age. We all lose volume in the form of fat and bone loss, which we can replace with dermal fillers. Hyaluronic acid is now also used as an injectable moisturiser, which hydrates the skin from the inside, as hyaluronic acid holds water within the skin, and also makes the skin produce more collagen in response.

This procedure can be preventative, because it can stop a line from properly forming and becoming engrained into the skin. Also, because of the collagen growth that fillers can stimulate, it can help to prevent future sagging; it can be particularly helpful in the eye area for this.

Unfortunately, no cream can provide the volume replacement provided by dermal fillers. Using topical skincare is part of the whole package, but it won’t give you either volume or the level of internal hydration that can be achieved via injectable moisturiser treatments. Using a cream will improve the canvas of the skin – but to improve the structure, we need to use a volumising agent such as dermal fillers.

Pretty much any area can be treated using dermal fillers. From improving the skin quality and texture, to hollowness above and below the eyes, to lip enhancement – the list goes on and on… As part of our commitment to always advise you of the best options, there are some areas we prefer not to treat as they are better treated surgically.

Hyaluronic acid fillers are also used in the breast and buttocks in some countries. At TLC, we also use hyaluronic acid for vaginal rejuvenation to plump the outer labia or to hydrate inside the vagina. Hands, neck and décolletage are also popular.

Dermal fillers are a really versatile treatment and can be used in many different situations. They do have their limitations though, and if a more drastic change is required, or the amount of change necessary is not possible, then surgery may be advised as an alternative. We often prefer to advise surgical rhinoplasty rather than a non-surgical nose job, due to the limitations of this particular technique. In the case of a patient requiring surgery, non-surgical techniques can be employed later to keep the skin looking at its optimum best, and to maintain and enhance surgical results.

It’s important that any dermal filler treatment is performed after a consultation to make sure it’s right for you. A picture will be taken of you in 3D to see any areas of asymmetry, and then we’ll take pictures of you moving your face (such as in a frown, raising your brows, smiling, pouting, turning the corners of the mouth down to see how your muscles work…) and we’ll check to see where you might have lost volume in the face, as no two people are the same. We’ll discuss what you’re looking to achieve the outcome you are after. Sometimes, we mark up the skin as a guide to where the injections should be placed, like a surgeon would, prior to a surgical procedure. This is because, when you’re laying back on our treatment chair, your skin will move position a little. We sometimes use an automatic injector device, which administers a smoother flow of product, thus making the procedure more accurate, and also reducing any pain. After the treatment, there can sometimes be some small red marks on the skin, but these should fade after about an hour.

It’s helpful if you don’t wear any makeup when you come in for the procedure in order to reduce the risk of infection – but don’t worry, we can take it off for you. If you’re prone to bruising, you may want to take some arnica or bromelain before and after treatment. If you have an important event coming up, you should schedule your treatment carefully, so you have an appropriate amount of time between the procedure and your event. In the case of those who suffer from cold sores, please inform your doctor, as you may need to take an anti-viral tablet prior to lip injections.

If you are prone to bruising, you may wish to use arnica or bromelain to help reduce any bruising. For areas such as the crow’s feet and neck, where there may be a large number of small veins, we use a small device to help us visualise these veins through the skin more easily. Most people will experience either no bruising (or a very small amount), which can easily be covered with makeup.

Usually no check-up is necessary with dermal fillers, although for the best results you would have regular appointments in order to maintain your results.

No treatment is completely pain-free; however, we always do all we can to minimise discomfort. This might involve the use of extremely fine needles, which are specially selected for the specific treatment performed, or the use of a cannula where appropriate to do so, which allows a wider area to be treated from one insertion point. We also sometimes use an automated injector pen, ice and/or topical anaesthetic where appropriate, and occasionally we inject local aesthetic. It’s important to remember that the way the tissues are handled also has a bearing on how painful the procedure is, and also how much post-procedure swelling there will be. There are lots of procedural tips and tricks we use, which come with experience, so you can rest assured that you are in safe hands at TLC.

Sometimes yes, although in general it’s not necessary, due to the very fine needles we use, and the skilful techniques we employ. We do know, however, that some people have a specific desire to have topical anaesthesia – so we do have it available, as is an injection of local anaesthetic if appropriate and required.

Most dermal fillers contain local aesthetic to make the procedure more comfortable. This typically wears off after a couple of hours. Dermal fillers do not make the face numb after this time period. In exceptional circumstances, if they’re creating compression on a nerve, there can be an altered sensation for a few days post-procedure – but this is extremely uncommon.

You can wear sterile surgical makeup following your procedure; we have this at the clinic. Please don’t put your regular makeup on until the day after the procedure, to minimise the risk of infection.

You’ll have a good idea of how the finished treatment is going to look immediately after the procedure. However, for the best results, please wait three to four weeks until all remaining swelling has dissipated.

Whenever you have a procedure, there will be a degree of swelling afterwards, due to the body’s reaction to the treatment. The amount of swelling will depend on the area treated. Lips, for example, tend to swell more than the rest of the face. Sometimes, when the under-eye is treated, this can also become puffy for a while. The swelling is normally mild and resolves over a one to two week period, although it will depend on our individual response to a particular treatment.

It depends on what you’re comfortable with as a person. In the case of most injections there will be a little redness post-procedure which can easily be disguised, even though it will feel a little swollen. Some people are able to tolerate this well. Many people do return straight to work after dermal fillers; however, there will be a small amount of swelling in the post-procedure period which means that sometimes patients are more comfortable having a little more time to recuperate afterwards. This is not strictly necessary though, and many patients go back to work, out to dinner or out with friends straight after.

This treatment is not approved for use during pregnancy or whilst breastfeeding.

This is a tricky question, as it depends on what you’re trying to achieve with your look, and what your starting point is. As a rule of thumb, most hyaluronic acid dermal fillers will last anywhere from 6-18 months, but as they wear off slowly, you can have additional treatment on an ongoing basis during this time period. If you want more treatment, you can have this at any point after the original treatment has been done, as long as there is no swelling remaining in the area to be treated. The filler will wear off in some areas more quickly than others; for example, you’ll typically see it doesn’t last as long in the lips as it does in the nose. Non-hyaluronic acid dermal fillers (such as those made from calcium hydroxyapatite, like Radiesse) will last for longer – up to 18 months – while polylactic acid (Sculptra) lasts for up to three years, and polycaprolactone (Ellanse) up to four years.

It’s important to remember that there is some collagen production at the site of filler placement, so the face does not revert to the pre-existing state for some time after treatment – say around three to five years although this is not a hard and fast rule.

Over time, you’ll see the skin slowly returning to its pre-treatment state. However, this can take some time to occur, due to the collagen stimulation that takes place after a dermal filler treatment; effects can be visible even when all the filler is gone.

If hyaluronic acid dermal fillers need to be removed for any reason, it is possible to do this with an enzyme called hyaluronidase. This breaks down the filler in a fairly short space of time. Other products such as Radiesse, Ellanse and Sculptra are not removable.

This is a common misconception. As they stimulate collagen formation, you will not normally get a ‘baggy’ look after having dermal fillers. The exception to this would be if an area has been over-filled and is very tight. This should never occur however, as it is a simple case of over-treatment. Should the filler then be dissolved in an area that’s been over-treated, an appearance of loose skin can sometimes be seen – but that won’t ever happen at TLC, as we never over-fill.

This depends on the rate of facial ageing and whether a treatment is being performed for beautification or restoration. Some people develop fine lines and wrinkles early in life, and if the lines are beginning to be ingrained into the tissue then it is appropriate to commence treatment. For younger patients it can be appropriate to treat areas such as the cheeks or lips for enhancement, or to balance a skeletal discrepancy. The absolute minimum age for treatment is 18 and, in most cases, we prefer patients to be over the age of 25.

Of course! Modern techniques for non-surgical work mean that you will pass people in the street all the time who have had subtle, imperceptible work. The trick is to check where a person has lost volume due to ageing of the bone or fat, and then replace that volume with dermal fillers – no more, no less than this. Combining these techniques with other non-surgical methods means we deliver great, natural, subtle results for all our patients.

Absolutely not! This is caused by incorrect administration of dermal filler too superficially in the cheek area above the muscle. This results in the filler moving upwards when the person smiles, and creates the pillow-face look. As long as the dermal filler is placed in appropriate quantities in the right areas under the muscles, you won’t have this issue.

It’s up to you! Lip enhancement can be scary for many people who are concerned about it looking unnatural or obvious. At TLC, you have total control of how much volume you want to add. If you want to simply hydrate the skin in the lip rather than changing the size, then we have a solution for that too. Immediately after the procedure, and for around 5-7 days afterwards, there will be some swelling – so make sure you plan this around your social life. If you’re after a slightly juicier enhancement, you can always start small and go for more at a later stage. This is the approach we recommend.

Yes! Dermal fillers placed in the correct plane do not alter the way the face moves in a negative fashion – and at TLC we love keeping you looking natural.

While complications are rare, they can and do happen. This can range from a bruise or swelling that lasts a little longer than anticipated, to asymmetry in the face, to more serious issues like allergy, infection, vessel occlusion and retinal artery occlusion. Thankfully, these more serious complications are extremely rare.

We do not use any permanent fillers such as Aquamid at TLC, due to safety concerns. With a permanent filler, there is no way to dissolve it if there’s an issue – such as infection or allergy – and as techniques and fashions change, what was once ‘of-the-moment’ can quickly become dated and undesirable. Permanent filler cannot be removed easily, even surgically, as it will tend to spread through the tissue and there is not a single entity to remove. Often there will be small bits of it spread through the tissue. Permanent implants placed by a surgeon are a different matter and can be removed at a later stage if desired, as they are one solid unit. Modern permanent implants are often 3D printed for the individual, and tend to look very good; they are, however, rather more expensive.

In most cases yes, due to concerns of infection. If a hyaluronic acid is injected in an area which contains a permanent filler, in some circumstances this can lead to the reactivation of a subclinical infection, even if the additional hyaluronic acid is delivered under perfectly sterile conditions. The same risk applies with a permanent implant, although this is less likely as it will have been initially placed under sterile conditions. As a permanent filler cannot be removed, these infections can be very difficult to treat and end up with significant morbidity. Therefore, we do not inject over permanent implants or fillers at TLC due to patient safety concerns.

This depends on the indication. A fat transfer can be a great way to restore lost volume from the face; however, it does necessitate a second procedure to harvest the fat. Fat transfer is also a little more unpredictable, and some of the fat breaks down after the procedure – which means it can be a little harder to be accurate. This is less important if you’re restoring large volumes of tissue though. Fat transfer is not suitable for fine procedures, such as lip augmentation.

Generally speaking, these two treatments deliver different yet complementary outcomes. Dermal fillers are used when there is volume loss in the face, or when augmenting a particular feature – for example, a lip augmentation, as lips cannot be made larger using wrinkle relaxation. There are times when volume loss may not be obvious – such as when treating the forehead lines; sometimes there will be loss of fat and bone in this region, which means that for the best result it should also be filled as using wrinkle relaxation. Each individual is assessed on a case-by-case basis. It is also appropriate to use dermal fillers when performing skin improvement although, as an exception, wrinkle relaxation is used as part of a mesotherapy treatment to reduce sebum production. Dermal fillers have many applications, and we will talk you through all the options during your appointment.

Please note that you are paying for the treatment only and no guarantee is made of any outcome. Refunds cannot be given under any circumstances, as the product has been used and the service has been delivered.

Find directions on Google here

Book a consultation here