Dermal Fillers

Performed by a skincare professional, dermal fillers are one of the most widely used treatments when it comes to restoring smoothness and facial volume. When injected, they fill in space and absorb water to create a smoother, fuller appearance in the face or to enhance the contours of the face. Dermal fillers are most commonly used to fill nasolabial folds, marionette lines, the jawline, cheeks, lips, and the under eye area.

But injectable dermal fillers are not for everyone and may not be indicated for people with certain conditions (such as bleeding disorders or certain allergies). If your health care provider confirms that dermal fillers are an option for you, know that all products have benefits and risks. The FDA advises you to work with a licensed health care provider and to understand all of the risks and benefits before receiving treatment.

What it is

A syringe needle injects a gel-like substance into the skin at various depths. A series of injections evenly disperse the filler. The filler substance fills up the area, resulting in improvements such as smoother forehead lines and "crows feet".​

What They Can Do

  • Glabellar lines (vertical frown lines between the eyebrows, which resemble an “11”)

  • Crow’s feet at the corner of the eyes

  • Horizontal forehead lines

​What they can not do

 

  • For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach.

  • Nonsurgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results but may help delay the time when consideration of a facelift becomes appropriate.

  • It is important to remember that dermal fillers are temporary treatments for facial aging and that ongoing treatments will be needed for long-term results.

Types of Dermal Fillers

 

  • Calcium Hydroxylapatite - Injectable calcium hydroxylapatite (CaHA) filler, Radiesse, is a biocompatible, dermal filler that is FDA approved to improve the appearance of moderate to severe facial wrinkles and folds, such as the nasolabial folds. It can also be used to improve the signs of facial fat loss associated with the HIV virus.

  • Hyaluronic Acid - Hyaluronic acid is a common ingredient in skin-care products. Hyaluronic acid is used as a dermal filler in cosmetic surgery. It is typically injected using either a classic sharp hypodermic needle or a micro-cannula. Complications include the severing of nerves and microvessels, pain, and bruising. In some cases, hyaluronic acid fillers result in a granulomatous foreign body reaction.

  • Polyalkylimide - Polyalkylimide is a polymer which belongs to the family of acryl derivatives. Its polymeric structure does not contain free monomers. It is also the active ingredient in a permanent dermal filler called Bio-Alcamid which is a three percent polyalkylimide suspension in water used medically to treat soft tissue deficits, plastic, and surgical procedures.

 

  • Polylactic acid - Injectable poly-L-lactic acid is a biodegradable compound that has been widely used for the last 30 years throughout Europe and the USA in a wide range of medical devices. It is a soft tissue filler most commonly used to restore the volume of depressed areas of the midface or temporal fossa by stimulating neocollagenesis, increasing dermal thickness, and enhancing volume.

  • Polymethyl-methacrylate microspheres (PMMA) - Polymethylmethacrylate (PMMA) is nonbiodegradable, relatively nontoxic and chemically inert dermal filler used under the brand of ArteFill (a.k.a. ArteColl). Due to the presence of bovine collagen, it requires an allergy test. The results of PMMA injections are permanent.

Cost


The following is a list of the average cost of several popular types of dermal fillers, according to 2018 statistics from the American Society of Plastic Surgeons and are priced as a per syringe cost. Most patients need multiple syringes to achieve desired results.

 

  • Calcium hydroxylapatite (e.g., Radiesse): $691

  • Fat grafting: $2,126

  • Hyaluronic acid (e.g., (Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane, Belotero): $682

  • Platelet-Rich Plasma (PRP): $683

  • Polylactic acid (e.g., Sculptra): $915

  • Polymethyl-methacrylate microspheres (e.g., Artefill): $889

Potential Complications of Dermal Fillers

  • Acne-like skin eruptions

  • Asymmetry

  • Bruising, bleeding from the injection site, swelling

  • Damage to the skin that results in a wound and possible scarring

  • Infection at the injection site

  • Lumps

  • Palpability of the filler under the surface of the skin

  • Skin rash with itching

  • Skin redness

  • Under- or over-correction of wrinkles

  • Blindness

  • Skin necrosis (ulceration or loss of skin from disruption of blood flow)

Common Side Effects Include

  • Bruising

  • Redness

  • Swelling

  • Pain

  • Tenderness

  • Itching, rash

  • Difficulty in performing activities (only observed when injected into the back of the hand)
     

Less Common Side Effects Include

 

  • Raised bumps on or under the skin (nodules or granulomas) that may need to be surgically removed

  •  Infection

  • Open or draining wounds

  • A sore at the injection site

  • Allergic reaction

  • Necrosis (tissue death)

The Following Rare Side Effects Have Also Been Reported to the FDA:

  • Severe allergic reaction (anaphylactic shock) that requires immediate emergency medical assistance

  • Migration/ movement of filler material from the site of injection

  • Leakage or rupture of the filler material at the injection site or through the skin (which may result from tissue reaction or infection)

  • The formation of permanent hard nodules in the face or hand

  • Vision abnormalities, including blindness

  • Stroke

  • Injury to the blood supply

  • Damage to the skin or the lips

Recovery Expectations

  • An "overfilled" appearance to treated areas

  • Swelling or bruising ranging from mild to severe

  • Temporary numbness or redness

  • Palpable lumps or hard areas at the injection sites

  • Hypersensitivity reaction that can seem like an allergic reaction with hives and swelling

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