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Skin & Ageing

Dermal Fillers

Dermal Fillers

Dermal fillers are the second most commonly requested non-surgical procedure in the world; the most common being Botox®. Dermal fillers act by replacing volume in the skin, target wrinkles and folds, and can re-contour and re-volumise the face. They also improve skin laxity.

What Are Dermal Fillers

In previous years, collagen fillers were used. These were longer lasting, but are derived from cows, and because of this, allergic reactions can occur. Poly L lactic acid fillers are also available, but they do not produce an instant result and so are less popular. The Worlds number one fillers are hyaluronic acid (HA) fillers. These are polysaccharide fillers composed of repeating disaccharide units of D-glucuronic acid and N-acetylglucosmaine. HA is found in all our bodies, especially our skin. HA fillers are very elastic and are used on a daily basis in the NHS for a variety of treatments such as joint pains and eye problems. Because HA is in all our bodies naturally, no skin test is required prior to treatment. HA fillers are progressively absorbed by the skin and turned into water and CO2 and when they are injected into the skin they temporarily increase collagen production, adding to the skin-firming effect.

How Are Dermal Fillers Made

HA is obtained by bacterial fermentation. A few HA cells are inoculated into a growth medium and incubated. When the required number of bacteria are obtained, cells are then transferred to fermentation equipment and fermentation begins. Once complete, cells are killed and filtered off. HA is precipitated of out of the fluid by the addition of ethanol. The precipitate is dissolved and filtered and the fluid is precipitated again with ethanol. The resulting precipitate is HA which is then dried and stabilised to achieve a long-lasting dermal filler product.

Different Brands Of Dermal Fillers

Like Botox®, there are many different brands of HA for example, Belotero, Juvaderm, Perlane and Restylane to name a few. They are clear viscous substances of varying consistencies. The thinner products are used for fine lines, the more viscous for deeper lines and areas requiring volume replacement.

Assessment For Dermal Fillers

When assessing a client for HA fillers, the depth of wrinkles should be determined. For fine lines the injection should be superficial, and a fine grade product used. The depth and angle of injection is also dependent on the depth of the wrinkle, for example a higher angle is required for deeper lines, a smaller angle for fine lines. In addition, there are various injection techniques for various wrinkles-linear threading, serial puncture and fanning. All techniques require post-injection massage to ensure even distribution of the product. Prior to any treatment an assessment is made during the first appointment.

Where Are Dermal Fillers Used

The most common areas injected with HA fillers are the lips, the nasolabial folds (the lines between the nose and mouth) and the marionette lines (the lines which run vertically down from the corners of the mouth). The cheeks and glabellar (between the eyebrows) can also be injected, as can the backs of the hands and the Decolletage (the skin on the upper part of the chest, exposed by low necklines.)

Is Dermal Filler Treatment Painful

Many HA filler brands contain local anaesthetic to reduce the pain associated with injection. In addition, topical local anaesthetic can be applied to the area to be injected 20-30 minutes prior to injection to maximise comfort for the client.

How Long Do Dermal Fillers Last

The effects of HA fillers last between 6 and 9 months. They are a popular alternative to surgery and are often used with Botox® to optimise results.

Dermal Fillers are available in Inverness

Author Info

Dr Lynn Kelly

Doctor Lynn Kelly graduated from Aberdeen Medical School in 1999 and qualified as a GP in 2004. She is currently working as a GP in an Inverness practice which she joined in 2006.